Do we need to redefine the advanced stage in Parkinson's disease?

Identifying the advanced stage in Parkinson's disease ( PD) is crucial for shifting from conventional to device-aided therapies. The criteria to define the onset of advanced PD have been based on lengthy and disabling daily off-times, troublesome dyskinesia and complex therapeutic regimes, but have also included invalidating non-dopaminergic symptoms, such as dementia, falls or dysphagia. These last problems usually appear in a much later stage of the advanced PD. The key to the definition of advanced PD should be the lack of adequate PD control of both motor and non-motor dopaminergic symptoms. The patient's judgment about the quality of their response to conventional therapy is also critical to establish the advanced stage. The early identification of this phase allows maintaining the patient's functional state whenever appropriate treatments are applied. We should keep the term advanced stage when the dopaminergic symptoms responsive to device-aided therapy are preponderant. When invalidating non-dopaminergic symptoms dominate the clinical picture, the term post-advanced stage could be more suitable.