Background. Patients with advanced stage Parkinson’s disease (PD) typically present with a myriad of motor and nonmotor symptoms in addition to comorbidities and, as a consequence, polypharmacy. Objective. To analyze a series of cases of advanced PD in which a clinical or surgical emergency played a trigger role in the irreversible progression of landmarks of the course of the disease. Methods. Data were collected during a 13-month observational period of a cohort of 230 PD patients, in 751 medical appointments. We included a total of 13 (5.65% of the total number) patients with advanced PD defined by Hoehn & Yahr (H&Y) stage ≥3 who presented with various clinical and surgical complications which, with the contribution of drug interventions, led to significant worsening of patients’ overall clinical condition. Results. Hip fractures and infections were the most common complications identified. As part of this scenario, most patients presented with delirium, often requiring treatment with dopamine receptor blocking agents and/or had dopaminergic treatment withdrawn. Upon reassessment after 3 months, all patients remained bed or wheel chair bound (H&Y 5) and presented significant worsening of their UPDRS part III score of at least 10 points (mean 51.5 ± 3.3; paired t-test two-tailed compared to baseline). The mean dose of levodopa at baseline was 907.7 ± 149.8 mg (600–1200) and significantly higher (paired t-test two-tailed ) on follow-up, 1061.5 ± 175.8 mg (700–1300). Conclusion. Clinical and surgical emergencies are major determinants for a progression of PD to more advanced stages.

中文翻译：

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临床或外科紧急情况后晚期帕金森病患者的随访：实用方法

背景。晚期帕金森病 (PD) 患者除了合并症外，通常还会出现多种运动和非运动症状，因此会出现多种药物治疗。客观。分析一系列晚期 PD 病例，其中临床或外科紧急情况在疾病进程标志的不可逆进展中发挥了触发作用。方法. 数据是在 230 名 PD 患者队列的 13 个月观察期内收集的，共进行了 751 次医疗预约。我们共纳入了 13 名（占总数的 5.65%）由 Hoehn & Yahr (H&Y) ≥3 期定义的晚期 PD 患者，这些患者出现了各种临床和手术并发症，在药物干预的作用下，导致病情显着恶化患者的整体临床状况。结果. 髋部骨折和感染是最常见的并发症。作为这种情况的一部分，大多数患者出现谵妄，通常需要用多巴胺受体阻断剂治疗和/或停止多巴胺能治疗。3 个月后重新评估后，所有患者仍卧床或坐在轮椅上（H&Y 5），并且其 UPDRS 第 III 部分评分显着恶化至少 10 分（平均 51.5 ± 3.3；配对t检验双尾与基线相比）。基线时左旋多巴的平均剂量为 907.7 ± 149.8 mg (600–1200) 并且显着更高（配对t检验双尾)随访时，1061.5 ± 175.8 mg (700–1300)。结论。临床和外科紧急情况是 PD 进展到更晚期阶段的主要决定因素。