Advanced Parkinson disease (PD) is associated with treatment-related motor fluctuations and reduced ability to perform activities of daily living. Progression of non-motor symptoms and medication-induced adverse effects complicate focused approach to motor symptom management, frequently accelerating reduced quality of life. It is thus critical for clinicians to consider disease progression versus therapeutic contributions when balancing management decisions. Such an approach requires careful recognition of inflection points resulting from therapeutic decisions and should prompt consideration of reduced pharmacologic burden and increased reliance on non-pharmacologic strategies in advanced disease. The successful approach to advanced PD requires a multidisciplinary effort focused on improving the patient’s and family’s quality of life, sometimes requiring sacrifice of motor symptom benefit. Here, we emphasize management strategies in advanced PD, focusing on the need to balance the therapeutic approach across advancing motor symptoms, progressive non-motor features, and potential pharmacologic adverse effects.

晚期帕金森病 (PD) 与治疗相关的运动波动和日常生活活动能力降低有关。非运动症状的进展和药物引起的不良反应使运动症状管理的集中方法复杂化，经常加速生活质量的下降。因此，临床医生在平衡管理决策时考虑疾病进展与治疗贡献至关重要。这种方法需要仔细识别治疗决策导致的拐点，并应促使考虑在晚期疾病中减少药物负担和增加对非药物策略的依赖。晚期 PD 的成功方法需要多学科的努力，专注于改善患者和家人的生活质量，有时需要牺牲运动症状的益处。在这里，我们强调晚期 PD 的管理策略，重点是需要在进展的运动症状、进展的非运动特征和潜在的药理学副作用之间平衡治疗方法。