Advanced Stage Symptoms

PD Stages

Late stage PD is differentiated by the emergence of symptoms non-responsive to dopaminergic medicine. Late stage can also include the motor complications described in Mid-Stage (motor fluctuations and dyskinesia).

Dopaminergic Non-responsive Symptoms

Brain cell loss is more expansive in later stages to include more diffuse brain loss in regions outside of the basal ganglia dopaminergic circuit. Because of more diffuse degeneration, standard PD medcines do not treat these problems. Examples of dopaminergic non-responsive symptoms are:

  • Posture (1)Flexed Posture. Forward bending of the neck, shoulders, back and hips. Flexed knees and ankles. 
  • Postural Instability. Balance problem caused by difficulty keeping your center of balance upright. This is called retropulsion if there is a tendency to fall backwards. 
  •  Freezing of gait.  Difficulty beginning or initiating movements often described as a sense of feet being “glued to the floor.” This occurs in tight, narrow or cluttered spaces such as doorways or small rooms (bathroom). When taking the first steps upon standing and with turns. 
  •  Speech.  Softer or low volume, slurred. 


  • Swallowing.  Often for liquids and dry food. Cough and drooling can accompany swallowing problems. Choking and aspiration of pneumonia are associated problems. 
Non-Motor Symptoms

The following nonmotor symptoms can increase in severity in later stage PD:

  • Confusion and dementia
  • Medicine induced visual hallucinations
  • Depression and Anxiety
  • Apathy
  • Bladder control problem- frequency and urgency
  • Dizziness when standing- orthostatic hypotension

Monique L. Giroux, MDMonique L. Giroux, MD
Guest Blogger, Former Medical Director of NWPF