Unité James Parkinson, Hôpital Léopold Bellan, Paris
The stage of advanced Parkinson’s disease usually occurs 10 years after the diagnosis but sometimes after 30 years. It is characterized by a severe handicap with gait disorders, posture changes, speech abnormalities and deglutition perturbations. Cognitive disorders (hallucinations, delirium, delusions, dementia) did not occur in all patients. Dysautonomic disorders are usual. Treatment is difficult and may include paradoxical prescriptions such as both apomorphine pump and clozapine.