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[(Stages)-335.1(of)-336.6(the)-334.6(Disease,)-335.5(and)-331.9(Adverse)-336.7(Neuropsychiatric)]TJ 0 -1.2203 TD [(and)-338.2(Autonomic)-332.9(Effects)-333.7(of)-336.6(These)-334.4(Medications)]TJ T* [(at)-335.3(Later)-333.4(Stages)-335.1(of)-336.6(Disease)-331.9(May)-332.9(Limit)-337.5(Their)-336.1(Dosing)]TJ /F5 1 Tf 9.843 0 0 9.843 69.7323 199.0488 Tm [(Dopaminergic)-335.8(medications)-339.6(should)-334.8(be)-331.7(continued)-335(through-)]TJ -1.0137 -1.1174 TD [(out)-372.1(the)-367.5(course)-371.6(of)-370.8(PD,)-369.2(given)-369.7(the)-373.2(signicant)-370.5(motoric)-373.2(benet)]TJ 0 -1.1116 TD [(derived)-419.1(from)-414.5(these)-410.9(medications.)-417.9(Approximat)-8.8(ely)-413.5(ve)-413.2(years)]TJ T* [(after)-393.8(diagnosis)-391.1(of)-388.1(PD,)-386.5(most)-385.7(patients)-391.5(will)-391.6(begin)-386.9(to)-388.2(develop)]TJ T* [()50.8(moto)-6.8(r)-363.9(uctuations,)44.4()-369.7(characterized)-374(by)-365.1(motor)-369.7(deterioration)]TJ 0 -1.1174 TD [(\(also)-237(called)-235()45(off-time)49.9(\))-232.5(up)-232.6(to)-238.5(several)-235.7(hours)-235.7(before)-233.5(their)-237.3(next)]TJ 0 -1.1116 TD [(dose)-253(of)-249.8(medication.)-250(Initially,)-251.3(these)-249.7(motor)-254.5(uctuations)-250.6(can)-247.5(be)]TJ T* [(ameliorated)-317.9(with)-305(medication)-315.6(changes)-310.5(such)-310.6(as)-308.4(increased)-308.2(fre-)]TJ 0 -1.1174 TD [(quency)-325.7(of)-318.9(dosing,)-326.8(the)-321.4(initiation)-324(of)-319(long-acting)-325.8(formulations)]TJ 0 -1.1116 TD [(of)-509(levodopa,)-515.8(the)-505.7(addition)-511.5(of)-509(dopamine)-513.6(extenders,)-512.1(and/or)]TJ T* [(adding)-347.7(dopamine)-346.6(agonists)-349.7(\(Table)-344.3(2\).)]TJ 7.3823 0 0 6.5614 208.0062 93.8268 Tm (19)Tj 9.843 0 0 9.843 218.7779 89.4614 Tm [(Within)-343.3(a)-347.8(few)-345.1(years,)]TJ -16.156 -1.1174 TD .0187 Tc [(h)-5.4(o).3(wever,)-370.6(do)-5.4(paminergic)-375.2(therap)-5.4(y)-368.3(m)-.9(ight)-374.2(unpre)-6.6(d).3(ictably)-374.1(a)-.8(nd)]TJ 0 -1.1116 TD 0 Tc [(suddenly)-269.1(stop)-269.3(working)-267.9(\(called)-270.6()50.8(sudden)-267.8(off-time)45.2(\))-267.1(or)-267.1(a)-267.2(dose)]TJ T* [(may)-408.9(fail)-403.2(to)-405.5(produce)-407.4(any)-401.9(benets)-407.2(at)-406.7(all)-402.1(\(called)-408.8()50.8(dose)-409.6(fail-)]TJ 25.5097 67.9242 TD [(ures)51.2(\).)]TJ 7.3823 0 0 6.5614 339.0235 729.5242 Tm (20)Tj 9.843 0 0 9.843 350.6456 725.1588 Tm [(Oral)-432.8(dosing)-432.8(of)-428.4(dopaminergic)-432.9(medications)-437.5(in)-428.5(the)]TJ -4.0433 -1.1174 TD [(setting)-193.4(of)-198(neurodegeneration)-203.3(often)-191.1(leads)-197.8(to)-198.2(irregular)-196.7(swaying,)]TJ 0 -1.1116 TD [(rocking,)-214(and)-217.6(writhing)-211.6(movements)-222(that)-213.2(are)-218.7(called)-217.7(dyskinesias,)]TJ T* [(which)-353.3(may)-351.3(be)-354.7(more)-358.1(debilitating)-356.1(than)-351.3(the)-355.9(underlying)-352.2(motor)]TJ T* [(symptoms)-281.7(caused)-280.6(by)-284.4(PD.)]TJ 7.3823 0 0 6.5614 411.307 685.7006 Tm (21)Tj 9.843 0 0 9.843 320.8251 670.3369 Tm .0127 Tc [(S)6(i)0(mplifying)-218.8(medications)-224.4(i)5.7(n)-224.5(advan)5.8(ced)-224.5(PD)-219.7(to)-224.5(focus)-224.4(mostl)5.7(y)]TJ -1.0137 -1.1116 TD [(on)-265(levodo)5.7(pa)-271.9(is)-264.8(preferable)-271.9(t)5.6(o)-270.7(r)0(edu)5.7(c)-1.2(e)-271.9(m)4.5(edicatio)5.7(n)-270.7(burden)-270.7(a)-1.2(n)5.7(d)]TJ T* [(ameliorate)-266(p)5.8(rominent)-265(n)5.8(europsychiatric)-266(a)-1.1(nd)-264.9(aut)5.7(onomic)-266(side)]TJ 0 -1.1174 TD [(effects)-368.2(from)-363.9(dopami)5.8(nergic)-369.6(t)5.8(herapy.)]TJ 7.3823 0 0 6.5614 457.2849 641.877 Tm .0222 Tc (22)Tj 9.843 0 0 9.843 468.5668 637.455 Tm .0129 Tc [(Dop)6(amine)-363.7(agonists,)]TJ -16.0235 -1.1116 TD .0124 Tc [(amantadine,)-400(a)-1.4(nd)-397.6(trihexyphenidyl)-403.5(typically)-403.4(have)-398.8(to)-403.4(be)-404.6(ta-)]TJ T* .0127 Tc [(per)5.9(e)-1.1(d)-374.3(off)-374.3(as)-374.1(the)-375.5(d).1(isease)-375.5(progresses,)-376.6(given)-374.3(t)-.1(h)5.8(a)-1.1(t)-374.4(p).1(sychosis,)]TJ 0 -1.1174 TD [(inattention,)-324.9(and)-328.3(d)5.7(elirium)-323.8(can)-322.6(result)-322.7(from)-323.8(conti)5.6(nued)-322.6(u)0(se)-323.7(of)]TJ 0 -1.1116 TD .013 Tc [(the)5(s).6(e)-427(medic)5(ations)-425.6(at)-420.2(the)-427(a)-.8(dva)5(nced)-425.8(stage)5(s)-425.6(of)-425.8(the)-421.2(d).4(isease.)]TJ T* [(Th)6.2(ese)-478.7(p).5(syc)5.1(h).5(iatric)-473(symptom)5(s)-477.4(can)-471.8(even)-471.8(occur)-471.8(a)-.7(t)-471.9(early)-477.6(t)6.1(o)]TJ T* [(mo)6.1(derate)-380.9(stages)-379.6(of)-379.7(PD)-380.6(in)-385.5(t)6(hose)-380.9(o).4(lder)-379.7(than)-379.7(70)-379.7(years.)]TJ 7.3823 0 0 6.5614 530.192 576.1132 Tm .0222 Tc (23)Tj 9.843 0 0 9.843 541.5873 571.7479 Tm .0126 Tc (In)Tj -23.442 -1.1174 TD .0128 Tc [(add)5.9(ition,)-359.2(medication-)6(induced)-356.9(sedat)5.8(i).1(on)-356.9(and)-356.9(orthostatic)-358.1(hy)5.9(-)]TJ 0 -1.1116 TD [(potension)-287.9(can)-282.1(limit)-288(the)-283.3(u).1(se)-289.1(of)-287.9(levo)5.8(dopa)-289.1(at)-288(all)-288(s).3(tages)-287.7(o).1(f)-282.1(P).3(D)]TJ T* [(but)-357.1(may)-356.9(b).2(e)-358.1(m)-1(ore)-358.1(promin)5.9(ent)-357.1(a)-1(t)-357(l).1(ater)-356.9(stages)-356.7(and)-356.9(s).4(houl)5.8(d)-362.7(b)5.9(e)]TJ 0 -1.1174 TD .0123 Tc [(carefully)-282.5(monitored.)]TJ 1.0137 -1.1116 TD 0 Tc [(Finally,)-317.8(abrupt)-318.9(cessation)-324.3(or)-319(withholding)-324.5(of)-319(dopaminergic)]TJ -1.0137 -1.1116 TD [(medications)-368.4(is)-365(contraindicated)-374.2(in)-365.2(PD)-365.8(in)-365.2(almost)-371.9(all)-367.6(circum-)]TJ 0 -1.1174 TD [(stances.)-216(In)-209.5(particular,)-214.1(people)-216.4(can)-213(experience)-212.8(severe)-217.2(disability)]TJ 0 -1.1116 TD [(due)-759(to)-762.6(motor)-761.4(and)-759(nonmotor)-758.9(symptoms)-765.5(in)-756.8(the)-764.9()50.8(off-)]TJ T* [(medication)46.2()-191.1(state,)-195.6(and)-194.5(there)-192.2(is)-192.2(a)-192.3(very)-195.6(rare)-191(risk)-194.4(of)-192.2(a)-192.3(potentially)]TJ 0 -1.1174 TD [(fatal)-284.5(condition)-287.9(called)-286.8(parkinsonism/hyperpyrexia)-286.9(syndrome.)]TJ 0 -1.1116 TD [(In)-405.3(the)-402(case)-410.9(of)-405.3(dopamine)-409.9(agonists,)-404.9(there)-405.3(can)-408.8(be)-406.5(signicant)]TJ T* [(withdrawal)-539.6(when)-536.3(dopamine)-536.6(agonists)-534(are)-535.5(not)-533.3(tapered)-541.2(off)]TJ T* [(slowly,)-679.1(called)-684.2(dopamine)-686.4(agonist)-682.8(withdrawal)-683.6(syndrome,)]TJ 0 -1.1174 TD [(which)-359(is)-353.5(associated)-361.1(with)-356.9(severe)-355.5(agitation,)-361.8(psychosis)-356.2(and/or)]TJ 0 -1.1116 TD [(depression,)-511.8(and)-511.3(worsening)-507.2(of)-509(motor)-513.7(symptoms)-506.4(that)-512.7(may)]TJ T* [(persist)-279.4(for)-285.5(months)-278.5(to)-278.8(years.)]TJ 7.3823 0 0 6.5614 419.0739 400.7621 Tm (24)Tj /F4 1 Tf 8.9663 0 0 8.9663 310.8472 368.9007 Tm [(Tip)-331(4:)-335.3(Surgical)-335.6(Therapies)-336(\(Deep)-335.6(Brain)]TJ 0 -1.2203 TD [(Stimulation,)-335(Thalamotomy,)-336.3(and)-331.9(Levodopa)]TJ 0 -1.2266 TD [(Intestinal)-336.6(Infusion)-333.4(Therapy\))-336.5(May)-332.9(Be)-336(Used)]TJ 0 -1.2203 TD [(to)-330.2(Control)-335.9(Motor)-338.2(Symptoms)]TJ /F5 1 Tf 9.843 0 0 9.843 320.8251 319.5779 Tm [(Deep)-549(brain)-548.2(stimulation)-556.4(\(DBS\))-548.6(is)-549.3(the)-551.8(most)-547(commonly)]TJ -1.0137 -1.1116 TD [(performed)-238(PD)-239.1(surgery)-239(today.)-240.6(A)-238.1(neurostimulator)-245(is)-238.3(surgically)]TJ T* [(implanted)-474.6(in)-468.9(the)-471.1(patients)-473.2(chest)-468.5(wall)-473.2(with)-472.1(electrodes)-476.5(im-)]TJ 0 -1.1174 TD [(planted)-448(in)-451.6(specic)-448.7(deep)-450.2(brain)-450.3(nuclei.)-450.4(DBS)-448.5(alleviates)-453.7(dis-)]TJ 0 -1.1116 TD [(abling)-215.4(motor)-220(symptoms)-218.4(\(tremor,)-220.9(rigidity,)-214.3(slowness,)-221.2(dystonia,)]TJ T* [(dyskinesia,)-293.1(and)-292.4(on/off)-294.7(uctuations\))-292(that)-293.8(persist)-296.7(despite)-292.3(opti-)]TJ 0 -1.1174 TD [(mized)-372(medical)-369.8(mana)-8(gement.)]TJ 7.3823 0 0 6.5614 426.7274 258.1795 Tm (25,26)Tj 9.843 0 0 9.843 446.9668 253.8141 Tm [(It)-370.9(typically)-375.6(does)]TJ /F9 1 Tf 7.0787 0 TD (not)Tj /F5 1 Tf 1.653 0 TD (help)Tj -22.5608 -1.1116 TD [(axial)-411.3(symptoms)-408.4(\(such)-409.6(as)-406.3(balance,)-413.3(speech,)-410.8(and)-407.6(swallowing)]TJ T* [(impairment\))-316.7(or)-319(nonmotor)-315.4(symptoms)-316.3(\(such)-317.5(as)-314.2(cognitive,)-321.3(be-)]TJ 0 -1.1174 TD [(havioral,)-331.6(and)-332.8(autonomic)-330.5(impairment\).)-331.7(Furthermore,)-335.8(DBS)-333.3(is)]TJ 0 -1.1116 TD [(contraindicated)-408.7(in)-405.5(patients)-403(with)-403(dementia)-411.2(or)-399.6(unstable)-408.6(psy-)]TJ T* [(chiatric)-341(problems,)-337.1(as)-337.2(it)-336.5(can)-333.9(make)-336.3(these)-341.8(issues)-335.6(worse.)-339.1(Risks)]TJ 0 -1.1174 TD [(of)-422.6(DBS)-419.7(include)-425(intraoperative)-429.5(stroke,)-420(postoperative)-426.9(infec-)]TJ 0 -1.1116 TD [(tion,)-428.6(battery)-430.7(depletion,)-430.8(other)-433(hardware)-433.6(complications,)-431.7(and)]TJ T* [(stimulation-induced)-233.6(side)-235.9(effects)-229.9(\(such)-236.8(as)-227.8(strained)-235.8(speech)-234.5(and)]TJ T* [(behavioral)-492.8(complaints\).)-491.6(It)-491.9(is)-491.7(important)-490.7(to)-486.1(note)-495.3(that)-489.6(DBS)]TJ 0 -1.1174 TD [(usually)-285.4(continues)-288.8(to)-290.3(benet)-285.4(people)-291.3(throughout)-287.7(the)-286.8(course)-290.9(of)]TJ 0 -1.1116 TD [(PD.)-259.8(Therefore,)-265.6(to)-261.5(prevent)-263.6(severe)-263.3(motor)-260.3(worsening)-265.3(\(return)-262.3(of)]TJ T* [(disabling)-305(tremor,)-306.2(dyskinesia,)-304.6(and)-304(painful)-308.6(dystonia)-303.8(and)-304(stiff-)]TJ 0 -1.1174 TD [(ness\),)-332.2(DBS)-333.3(therapy)-332.7(should)-334.8(be)-331.7(considered)-337(palliative)-337.7(therapy)]TJ 0 -1.1116 TD [(and)-240.6(continued)-242.9(\(with)-242.8(battery)-246.4(replacements,)-242.6(if)-244.2(necessary\))-245.6(even)]TJ T* [(in)-278.8(end-stage)-284(PD.)]TJ 1.0137 -1.1174 TD [(Two)-327.9(other)-335.1(surgical)-333.7(therapies)-336(are)-333.9(sometimes)-337.1(used)-333.7(to)-330.6(alle-)]TJ -1.0137 -1.1116 TD [(viate)-209.7(motor)-208.4(symptoms,)-210.3(usually)-210.5(when)-208(DBS)-212.4(is)-209.5(contraindicated.)]TJ T* [(Ablative)-352.2(brain)-358.1(surgery)-354.2(is)-353.5(an)-354.7(older)-352.3(stereotactic)-359.1(technique)-359.2(in)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 749.7069 Tm [(PARKINSONS)-340.4(DISEASE)-335.9(AND)-337.2(RELATED)-338(DISORDERS)-26997.8(1511)]TJ ET endstream endobj 61 0 obj <>stream 0 0 0 rg /GS1 gs 97.058 56.75 .28346 699.704 re f 518.116 56.75 .22681 699.704 re f 115.767 56.75 .22676 699.704 re f BT /F7 1 Tf 0 9.845 -9.845 -0 91.6157 238.8472 Tm 0 Tc 0 Tw (Table)Tj /F5 1 Tf 3.0002 0 TD (2.)Tj /F7 1 Tf 1.2496 0 TD [(Medications)-335(Prescribed)-332(for)-332.2(Parkinsons)-340.6(Disease)-335.6(Motor)-333.6(Symptoms)]TJ /F9 1 Tf -22.7463 -1.8427 TD [(Medication)-18890.3(Dose)-334(range)-20408.5(Potential)-334.4(side)-339.1(effects)]TJ /F5 1 Tf 0 -1.9003 TD [(Carbidopa/levodopa)-9796.3(1501000)]TJ /F8 1 Tf 21.9285 0 TD (+)Tj /F5 1 Tf .8868 0 TD [(mg/day)-330.9(in)-336.2(divided)-330.9(doses)-1814(Nausea,)-336(vomiting,)-335.5(confusion,)-330.2(dyskinesia,)-338.1(low)-338(blood)-333.4(pressure)]TJ -22.8154 -1.0135 TD [(Carbidopa/benserazide)-8737.2(1501000)]TJ /F8 1 Tf 21.9285 0 TD (+)Tj /F5 1 Tf .8868 0 TD [(mg/day)-330.9(in)-336.2(divided)-330.9(doses)-1814(Nausea,)-336(vomiting,)-335.5(confusion,)-330.2(dyskinesia,)-338.1(low)-338(blood)-333.4(pressure)]TJ -22.8154 -1.0077 TD [(Carbidopa/levodopa)-340.7(oral)-333.5(disintegrating)]TJ .9905 -1.0135 TD ([Parcopa])Tj 16.9359 1.0135 TD (15010000)Tj /F8 1 Tf 4.5032 0 TD (+)Tj /F5 1 Tf .8811 0 TD [(mg/day)-336.7(in)-336.2(divided)-330.9(doses)-1313(Nausea,)-336(vomiting,)-335.5(confusion,)-330.2(dyskinesia,)-338.1(low)-338(blood)-333.4(pressure)]TJ -23.3106 -2.027 TD [(Carbidopa)-334.9(levodopa)-338.7(extended)-334.1(release)-2660.6(1501000)]TJ /F8 1 Tf 21.9285 0 TD (+)Tj /F5 1 Tf .8868 0 TD [(mg/day)-330.9(in)-336.2(divided)-330.9(doses)-1814(Nausea,)-336(vomiting,)-335.5(confusion,)-330.2(dyskinesia,)-338.1(low)-338(blood)-333.4(pressure)]TJ -22.8154 -1.0077 TD [(Carbidopa/levodopa)-340.7(entacapone)-332.6([Stalevo])-932.8(1501000)]TJ /F8 1 Tf 21.9285 0 TD (+)Tj /F5 1 Tf .8868 0 TD [(mg/day)-330.9(in)-336.2(divided)-330.9(doses)-1814(Nausea,)-336(vomiting,)-335.5(confusion,)-330.2(dyskinesia,)-338.1(low)-338(blood)-333.4(pressure)]TJ -22.8154 -1.0135 TD [(Carbidopa/levodopa)-340.7(extended)-334.1(release)]TJ .9905 -1.0135 TD [(capsules)-339.5([Rytary])]TJ 16.9359 1.0135 TD [(8552340)-169.1(mg)-331.4(total)-334.9(daily)-6801.6(Nausea,)-336(vomiting,)-335.5(confusion,)-330.2(dyskinesia,)-338.1(low)-338(blood)-333.4(pressure)]TJ -17.9264 -2.027 TD [(Carbidopa/levodopa)-340.7(enteral)-333.3(solution)]TJ .9905 -1.0077 TD ([Duopa])Tj 16.9359 1.0077 TD [(Up)-336.8(to)-330.4(2000)-165.2(mg)-337.1(over)-333.4(16)-336(hours)-4600.1(Nausea,)-336(vomiting,)-335.5(confusion,)-330.2(dyskinesia,)-338.1(low)-338(blood)-333.4(pressure)]TJ -17.9264 -2.3265 TD [(Dopamine)-334.9(agonists)]TJ 1.002 -1.0135 TD [(Ropinirole)-12635.3(624)-165.2(mg/day)-336.7(divided)-336.7(in)-330.4(34)-337(doses)-2695(Low)-333.2(blood)-333.4(pressure,)-335.8(nausea,)-335.1(vomiting,)-335.5(leg)-332.6(swelling)-338.5(and)-332.4(discoloration,)-335.8(confusion,)]TJ 34.6319 -1.0077 TD [(excessive)-335.9(daytime)-339(sleepiness,)-333.3(impulse)-337.7(control)-336.7(disorders)]TJ -34.6319 -1.0135 TD [(Ropinirole)-335.1(XL)-10968.2(224)-165.2(mg)-337.1(once/day)-9311.7(Low)-333.2(blood)-333.4(pressure,)-335.8(nausea,)-335.1(vomiting,)-335.5(leg)-332.6(swelling)-338.5(and)-332.4(discoloration,)-335.8(confusion,)]TJ 34.6319 -1.0135 TD [(excessive)-335.9(daytime)-339(sleepiness,)-333.3(impulse)-337.7(control)-336.7(disorders)]TJ -34.6319 -1.0077 TD [(Pramipexole)-11855.3(1.54.5)-167.2(mg/day)-336.7(divided)-330.9(in)-336.2(34)-331.2(doses)-1698.8(Low)-333.2(blood)-333.4(pressure,)-335.8(nausea,)-335.1(vomiting,)-335.5(leg)-332.6(swelling)-338.5(and)-332.4(discoloration,)-335.8(confusion,)]TJ 34.6319 -1.0135 TD [(excessive)-335.9(daytime)-339(sleepiness,)-333.3(impulse)-337.7(control)-336.7(disorders)]TJ -34.6319 -1.0135 TD [(Pramipexole)-332.5(ER)-10242.8(1.54.5)-334.2(once)-334.5(daily)-9145.3(Low)-333.2(blood)-333.4(pressure,)-335.8(nausea,)-335.1(vomiting,)-335.5(leg)-332.6(swelling)-338.5(and)-332.4(discoloration,)-335.8(confusion,)]TJ 34.6319 -1.0135 TD [(excessive)-335.9(daytime)-339(sleepiness,)-333.3(impulse)-337.7(control)-336.7(disorders)]TJ -34.6319 -1.0077 TD [(Rotigotine)-335.2(patch)-10177.1(28)-170(mg)-331.4(once)-334.5(daily)-9197.1(Low)-333.2(blood)-333.4(pressure,)-335.8(nausea,)-335.1(vomiting,)-335.5(leg)-332.6(swelling)-338.5(and)-332.4(discoloration,)-335.8(confusion,)]TJ 34.6319 -1.0135 TD [(excessive)-335.9(daytime)-339(sleepiness,)-333.3(impulse)-337.7(control)-336.7(disorders)]TJ -34.6319 -1.0135 TD [(Apomorphine)-11364.3(26)-170(mg)-13766.1(Signicant)-334.9(nausea;)-332.9(must)-339.1(take)-334.7(antinausea)-337.2(medication)-337.6(with)-333.4(dose)]TJ -1.002 -1.313 TD [(MAOB)-335.7(inhibitors)]TJ 1.002 -1.0135 TD [(Selegiline)-12907.3(5)-168(mg/twice)-335.3(daily)-334.7(divided)-336.7(in)-330.4(12)-337(doses)-1122.9(Nausea,)-336(dry)-331.2(mouth,)-337.9(light-headedness,)-335(constipation,)-334.8(may)-339.3(worsen)-330.2(dyskinesias,)-338.9(serotonin)]TJ 34.6319 -1.0135 TD [(syndrome)-332.6(\(rare\))]TJ -34.6319 -1.0077 TD [(Rasagiline)-12689.3(1)-168(m)0(g)-331.4(once)-334.5(daily)-10199.1(Nausea,)-336(dry)-331.2(mouth,)-337.9(light-headedness,)-335(constipation,)-334.8(may)-339.3(worsen)-330.2(dyskinesias,)-338.9(serotonin)]TJ 34.6319 -1.0135 TD [(syndrome)-332.6(\(rare\))]TJ -34.6319 -1.0135 TD [(Selegiline)-336.4(HCl)-333.2(oral)-333.5(disintegrating)]TJ -.0115 -1.0135 TD (\(Zydis\))Tj 16.9359 1.0135 TD [(1.252.5)-335.2(once)-334.5(daily)-8644.3(Nausea,)-336(dry)-331.2(mouth,)-337.9(light-headedness,)-335(constipation,)-334.8(may)-339.3(worsen)-330.2(dyskinesias,)-338.9(serotonin)]TJ 17.7075 -1.0135 TD [(syndrome)-332.6(\(rare\))]TJ -35.6339 -1.313 TD [(COMT)-336(inhibitors)]TJ 1.002 -1.0135 TD [(Entacapone)-12241.3(200)-170(mg)-331.4(up)-330.2(to)-336.2(4)-335(times)-335.7(daily)-5632.6(Diarrhea,)-338.3(discolored)-334.9(urine,)-332.1(dyskinesias,)-338.9(confusion)]TJ T* [(Tolcapone)-12688.3(100)-170(mg)-331.4(3)-335(times)-335.7(daily)-8079.9(Liver)-335.7(failure)-332.1(\(rare,)-338.9(must)-333.4(have)-334.5(liver)-334.7(function)-337.7(monitoring\))]TJ -1.002 -1.3129 TD [(Other)-335.4(classes)]TJ 1.002 -1.0135 TD [(Amantadine)-12022.3(100)-170(mg)-331.4(23)-331.2(times)-335.7(daily)-7083.7(Nausea,)-336(confusion,)-335.9(leg)-332.6(discoloration,)-335.8(dry)-337(mouth,)-332.1(blurred)-336.5(vision,)-332(constipation,)-334.8(urinary)]TJ 34.6319 -1.0077 TD [(retention,)-337.6(confusion,)-330.2(hallucinations)]TJ -35.6339 -1.3187 TD (Anticholinergics)Tj 1.002 -1.0135 TD [(Trihexyphenidyl)-10240.3(12)-170(mg)-331.4(23)-331.2(times)-335.7(daily)-7083.7(Blurred)-331.8(vision,)-337.7(confusion,)-335.9(hallucinations,)-332.4(dry)-337(mouth,)-332.1(urinary)-336.5(retention,)-337.6(constipation)]TJ 0 -1.0077 TD [(Benztropine)-12022.3(0.52)-168.6(mg)-331.4(23)-337(times)-329.9(daily)-6335.1(Blurred)-331.8(vision,)-337.7(confusion,)-335.9(hallucinations,)-332.4(dry)-337(mouth,)-332.1(urinary)-336.5(retention,)-337.6(constipation)]TJ 0 8.7511 -8.7511 -0 530.1353 64.7433 Tm [(COMT,)-332.9(catechol-O-methyltransferase)-340.4(inhibitor;)-330.4(MAOB,)-332.6(monoamine)-335.6(oxidase)-334.7(B)-331.7(inhibitor.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 297.1842 34.2425 Tm (1512)Tj ET endstream endobj 65 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.843 0 0 9.843 59.7543 725.1588 Tm 0 0 0 rg 0 Tc 0 Tw [(which)-266.9(a)-261.4(brain)-266(lesion)-261.3(is)-267.1(created)-265.9(to)-261.5(relieve)-264.8(disabling)-264.7(tremor.)-265.9(It)]TJ 0 -1.1174 TD [(still)-305.3(carries)-304.8(the)-298.3(risks)-299(of)-301.7(intracranial)-306.3(surgery)-302.4(and)-304(can)-299.4(only)-298.3(be)]TJ 0 -1.1116 TD [(unilateral,)-294.9(but)-285.7(has)-286.5(the)-292.6(benets)-286.3(of)-290.2(having)-284.4(no)-290.2(implanted)-290.3(hard-)]TJ T* [(ware)-439.5(and)-436.4(no)-439.9(need)-432.9(for)-441(complicated)-438.9(postoperative)-438.4(manage-)]TJ T* [(ment.)-281.1(Duodopa)-280.5(\(AbbVie,)-279.1(North)-282.9(Chicago,)-279.6(IL\))-275.1(is)-278.6(a)-278.7(therapy)-280.8(in)]TJ 0 -1.1174 TD [(which)-485.7(levodopa)-489.3(enteral)-489.5(suspension)-484(is)-485.9(continually)-487.3(infused)]TJ 0 -1.1116 TD [(from)-345.4(an)-343.2(external)-346.6(pump)-345.5(directly)-345.6(into)-338.7(the)-344.4(jejunum)-344.4(via)-344.4(a)-347.8(per-)]TJ T* [(cutaneous)-238(endoscopic)-233.3(gastrostomy)-239(with)-230.2(a)-232.6(jejunal)-235.1(tube)-236.1(\(PEG-)]TJ 0 -1.1174 TD [(J)-375.3(tube\).)-373.1(It)-376.7(is)-370.8(most)-374.2(commonly)-375.4(used)-374(in)-376.7(patients)-374.2(who)-372.8(are)-374.2(not)]TJ 0 -1.1116 TD [(candidates)-390.1(for)-377.6(DBS,)-382.9(but)-377.8(carries)-385.4(the)-379(risk)-384.4(of)-376.5(gastrointest)-9.9(inal)]TJ T* (complications.)Tj /F4 1 Tf 8.9663 0 0 8.9663 59.7543 593.5746 Tm [(Tip)-337.3(5:)-335.3(Isolation)-335.7(Due)-329(to)-336.6(Multiple)-333.6(Factors,)-334.4(Including)]TJ 0 -1.2203 TD [(Mobility)-339.9(and)-331.9(Communication)-340.4(Difculties,)-330.3(Is)-336.7(a)-333.2(Major)]TJ T* [(Cause)-337.9(of)-330.2(Suffering)-337.6(in)-338(PD)]TJ /F5 1 Tf 9.843 0 0 9.843 69.7323 555.2502 Tm [(People)-446.6(with)-443.3(PD)-446.4(face)-445.6(many)-444.5(impediments)-443.3(that)-443.6(lead)-450.4(to)-440.1(a)]TJ -1.0137 -1.1116 TD [(diminished)-197.9(number)-193.3(and)-194.5(quality)-199.3(of)-192.2(social)-193.3(interactions,)-199(eroding)]TJ 0 -1.1174 TD [(relationships,)-267.8(and)-263.7(fostering)-264.5(feelings)-264.6(of)-261.4(alienation)-268.4(and)-257.9(loss)-263.3(of)]TJ 0 -1.1116 TD [(identity.)-238.6(Motor)-242.7(symptoms)-235.6(such)-235.8(as)-239.3(rigidity,)-237.4(bradykinesia,)-239(and)]TJ T* [(postural)-188.6(instability,)-190.1(as)-187.5(well)-191(as)-187.5(other)-185.3(nonmotor)-188.7(symptoms)-189.6(such)]TJ 0 -1.1174 TD [(as)-187.5(pain)-178.5(and)-183(autonomic)-186.5(dysfunction,)-183.8(make)-186.5(travel)-181.9(outside)-181.7(of)-180.7(the)]TJ 0 -1.1116 TD [(home)-289(challenging,)-295.9(decreasing)-292(opportunities)-292.2(to)-284.5(participate)-293.7(in)]TJ T* [(social)-354.6(activities.)]TJ 7.3823 0 0 6.5614 124.5543 482.9101 Tm (2729)Tj 9.843 0 0 9.843 146.4944 478.5447 Tm [(Neuropsychiatric)-357.4(changes)-350.8(such)-351(as)-348.7(de-)]TJ -8.8124 -1.1174 TD [(mentia,)-232.7(psychosis,)-232.9(depression,)-229.6(anxiety,)-232.6(daytime)-230.4(somnolence)-9.9(,)]TJ 0 -1.1116 TD [(and)-194.5(apathy)-193.4(decrease)-198.7(the)-194.7(frequency)-197.7(of)-192.2(opportunities)-194.3(to)-192.4(interact)]TJ T* [(with)-368.4(the)-367.5(outside)-371.8(world)-369.3(and)-367.3(can)-368.5(impair)-372.1(effective)-371.9(communi-)]TJ T* [(cation)-205(when)-196.5(these)-197.8(opportunities)-205.9(are)-195.7(present.)]TJ 7.3823 0 0 6.5614 230.5133 439.0865 Tm (30)Tj 9.843 0 0 9.843 239.811 434.7211 Tm [(In)-198(addition,)-198.1(the)]TJ -18.2928 -1.1174 TD [(extent)-481.5(of)-480.2(neuropsychiatric)-483.2(symptoms)-483.3(inuences)-485.5(caregiver)]TJ 0 -1.1116 TD [(burden)-382.1(and)-378.8(distress.)]TJ 7.3823 0 0 6.5614 140.8251 417.1464 Tm (31)Tj 9.843 0 0 9.843 151.937 412.781 Tm [(Hypophonia)-381.8(\(quiet)-376.6(speech\))-385.4(and)-378.8(bra-)]TJ -9.3653 -1.1116 TD [(dyphrenia)-409.8(\(slowness)-408.9(of)-405.3(thought\))-400.7(make)-411.1(conversations)-409.3(dif-)]TJ 0 -1.1174 TD [(cult.)-187.8(Furthermore,)-186(the)-188.9(reduced)-184(facial)-188.9(expression)-185.8(\(hypomimia\))]TJ 0 -1.1116 TD [(seen)-317.6(in)-313.3(PD,)-317.4(often)-317.8(called)-315.6()50.8(masked)-316.3(facies,)43.1()-312.1(can)-316.6(render)-319.9(emo-)]TJ T* [(tional)-330.7(connection)-337.3(difcult.)]TJ 7.3823 0 0 6.5614 165.9401 373.3228 Tm (32)Tj 9.843 0 0 9.843 176.5417 368.9574 Tm [(The)-334(social)-331.5(stigma)-331.6(experienced)]TJ -11.865 -1.1174 TD [(by)-313.2(those)-317.6(with)-316.6(Parkinsons)-318.1(further)-314.2(erodes)-314(social)-320(connections)]TJ 0 -1.1116 TD [(and)-355.8(creates)-357.8(a)-353.6(sense)-353(of)-353.5(outsiderness)-360.8(and)-350(devaluation,)-359.3(which)]TJ T* [(can)-374.2(lead)-369.7(to)-365.2(feelings)-374(of)-370.8(shame,)-369.4(embarrassment,)-375.9(and)-367.3(demor-)]TJ 0 -1.1174 TD [(alization,)-627.9(ultimately)-620(leading)-620.8(many)-623.1(of)-618.5(those)-617.1(affected)-624.1(to)]TJ 0 -1.1116 TD [(withdraw)-288.4(socially.)]TJ 7.3823 0 0 6.5614 133.0015 318.5007 Tm (30,33)Tj 9.843 0 0 9.843 69.7323 303.1936 Tm [(Treating)-363.9(underlying)-363.8(issues)-358.7(whenever)-364.5(possible)-361.2(is)-365(the)-355.9(rst)]TJ -1.0137 -1.1116 TD [(step;)-191(speech)-188.5(therapy)-188.7(and)-183(the)-188.9(use)-182.8(of)-186.5(speech)-188.5(amplifying)-186.6(devices)]TJ 0 -1.1174 TD [(to)-353.7(improve)-355.8(hypophonia,)-355.6(antidepressants)-360.8(and)-355.8(psychotherapy)]TJ 0 -1.1116 TD [(to)-232.7(reduce)-234.7(depression,)-235.4(and)-234.9(melatonin)-232.7(to)-232.7(improve)-234.8(sleep)-232.4(quality)]TJ T* [(and)-534.4(ameliorate)-529.9(daytime)-535.7(sleepiness)-532.6(are)-529.7(several)-535.2(examples.)]TJ 0 -1.1174 TD [(Educating)-336.2(friends)-337(and)-332.8(family)-337.5(on)-330.5(how)-338.2(to)-330.6(communicate)-342(with)]TJ 0 -1.1116 TD [(PD)-239.1(patients)-241.7(is)-238.3(valuable)-237.2(\(e.g.,)-239.4(allowing)-241.6(for)-239.4(additional)-238.5(time)-237.4(for)]TJ T* [(the)-281.1(individual)-277.6(with)-282(PD)-273.6(to)-278.8(process)-280.3(information)-279.8(and)-280.9(respond\).)]TJ 0 -1.1174 TD [(Also)-489(crucial)-495.2(are)-489.4(ongoing)-485.9(conversations)-495.7(between)-490.3(patients,)]TJ 0 -1.1116 TD [(their)-456.2(families,)-453.7(and)-453.7(their)-450.4(interdisciplinary)-454.7(medical)-456.2(team)-451.6(to)]TJ T* [(discuss)-469.2(challenges)-465(faced,)-467.4(normalize)-469.9(experiences,)-470.5(and)-459.5(dis-)]TJ 0 -1.1174 TD [(cover)-324.6(targeted)-323.6(tools)-322.4(for)-320(coping,)-322.4(adjusting,)-320(and)-321.2(retaining)-323.6(so-)]TJ 0 -1.1116 TD [(cial)-283.5(connections.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 149.726 Tm [(Tip)-337.3(6:)-335.3(Dementia)-331.1(and)-338.2(Dementia-Related)-335.3(Behavioral)]TJ 0 -1.2203 TD [(Disturbances)-339.1(Are)-336.7(Common)-330(in)-338(PD)]TJ /F5 1 Tf 9.843 0 0 9.843 69.7323 122.3433 Tm [(Mild)-276.3(cognitive)-277.6(impairment)-275.4(\()-87.5(MCI\))-277(is)-272.8(common)-275.2(in)-273(PD)-279.4(even)]TJ -1.0137 -1.1174 TD [(at)-274.2(the)-275.3(time)-277.8(of)-272.9(diagnosis)-275.9(and)-275.2(will)-276.4(progress)-274.5(to)-273(PD)-273.6(deme)-8(ntia)-270.8(in)]TJ 0 -1.1116 TD [(up)-255.6(to)-250(80%)-252(of)-255.6(aficted)-254.3(individuals.)]TJ 7.3823 0 0 6.5614 194.7401 104.7685 Tm (34)Tj 9.843 0 0 9.843 204.6047 100.4031 Tm [(Cognitive)-254.4(assessment)-257(is)]TJ -14.716 -1.1116 TD [(thus)-505.4(imperative)-499.9(in)-503.4(this)-499.8(population)-502.1(to)-497.7(guide)-502.1(goals-of-care)]TJ 0 -1.1174 TD [(discussions,)-292.7(treatment)-285.7(decisions,)-292(and)-286.7(anticipate)-292.6(the)-286.8(needs)-284.1(of)]TJ 0 -1.1116 TD [(both)-442.3(patients)-443.3(and)-442.2(caregivers.)-445.2(Cognitive)-444.5(screening)-445.3(may)-437.7(be)]TJ T* [(reliably)-443.5(performed)-439.6(with)-431.8(several)-443.1(brief)-438.7(global)-434.3(screening)-439.5(in-)]TJ 25.5097 67.9242 TD [(struments,)-557(including)-552.9(the)-557.5(Montreal)-553.7(Cognitive)-559.7(Assessment)]TJ 0 -1.1174 TD [(\()-81.7(MoCA\).)]TJ 7.3823 0 0 6.5614 347.981 718.5825 Tm (35)Tj 9.843 0 0 9.843 358.129 714.1605 Tm [(The)-287.9(prevalence)-287.6(of)-284.4(progressive)-290.6(cognitive)-289.1(impair-)]TJ -4.8036 -1.1116 TD [(ment)-208.5(makes)-204.7(early)-209.5(goals-of-car)-10.8(e)-203.8(discussions)-208.6(and)-211.8(advance)-208.2(care)]TJ T* [(planning)-280.9(critical)-283.5(in)-278.8(this)-280.9(population.)]TJ 7.3823 0 0 6.5614 450.6518 696.6423 Tm (36)Tj 9.843 0 0 9.843 320.8251 681.3352 Tm [(Dementia)-389(in)-388.2(PD)-394.6(is)-388(commonly)-392.7(associated)-389.9(with)-391.4(other)-392.7(be-)]TJ -1.0137 -1.1174 TD [(havioral)-524(disturbances,)-526.8(including)-524.1(psychosis)-529(\(hallucinations)]TJ 0 -1.1116 TD [(and)-304(delusions\),)-309.2(agitation,)-309.9(sundowning,)-309(and)-309.7(apathy.)-306.2(Not)-309.6(sur-)]TJ T* [(prisingly,)-359.1(dementia)-359.4(is)-359.2(a)-359.4(strong)-357.8(predictor)-363.8(and)-355.8(contributor)-365(to)]TJ 0 -1.1174 TD [(caregiver)-377.5(burden)-376.4(and)-373.1(distress)-378.2(in)-370.9(this)-373.1(population.)-378.9(Psychosis)]TJ 0 -1.1116 TD [(and)-280.9(apathy)-279.8(further)-285.4(increase)-284.1(this)-280.9(burden.)]TJ 7.3823 0 0 6.5614 468.5668 630.8786 Tm (31)Tj 9.843 0 0 9.843 320.8251 615.5715 Tm [(When)-330.4(advanced)-330.2(MCI)-333.5(or)-330.5(dementia)-330.6(is)-330.4(present,)-335.9(it)-325(is)-330.4(imper-)]TJ -1.0137 -1.1174 TD [(ative)-370.9(to)-370.9(assess)-371(safety)-371.7(concerns,)-372.6(such)-368.2(as)-371.8(driving)-370.8(ability)-372.3(and)]TJ 0 -1.1116 TD [(rearm)-240.3(possession.)-239.6(Verbal,)-243.7(physical,)-239.3(and/or)-238.3(sexual)-239.3(threats)-246.2(or)]TJ T* [(abuse)-364.7(may)-368.6(be)-360.5(directed)-369.6(at)-366.4(either)-366.3(the)-367.5(caregiver)-371.7(or)-365(patient)-361.8(so)]TJ T* [(routine)-274(screening)-272.5(should)-277.3(occur.)]TJ 7.3823 0 0 6.5614 435.3448 576.1132 Tm (37)Tj 9.843 0 0 9.843 445.4361 571.7479 Tm [(Financial)-272.8(risk)-275(may)-270.6(also)-276.2(be)]TJ -13.6735 -1.1174 TD [(placed)-183(on)-186.5(families)-185.3(through)-186.4(scams)-187.2(targeted)-191.1(at)-182(older)-185.3(adults)-186.4(with)]TJ 0 -1.1116 TD [(impaired)-248.7(cognitive)-254.5(abilities.)]TJ 7.3823 0 0 6.5614 421.5684 554.1731 Tm (38)Tj 9.843 0 0 9.843 431.3763 549.8077 Tm [(The)-253.3(use)-246.2(of)-249.8(cash)-248.4(allowances)-258.5(or)]TJ -12.2451 -1.1116 TD [(low-limit)-243(credit)-245.3(cards)-243.8(may)-247.6(minimize)-244.4(risks)-241.4(while)-243.9(maintaining)]TJ 0 -1.1174 TD [(the)-413.5(patients)-415.6(sense)-416.4(of)-411.1(independence.)-420(Wandering)-417.8(behaviors)]TJ 0 -1.1116 TD [(may)-334(place)-337.4(patients)-333.9(at)-337.6(risk)-332.6(for)-331.5(adverse)-339.3(outcomes)-334.9(and)-332.8(neces-)]TJ T* [(sitate)-279.8(full-time)-283.5(supervision)-283.8(or)-284.4(institutional)-281.1(placement.)]TJ 7.3823 0 0 6.5614 524.296 510.3495 Tm (39)Tj 9.843 0 0 9.843 320.8251 494.9857 Tm [(Before)-303.6(beginning)-299.3(treatment,)-306.4(determine)-308.6(whether)-304.8(there)-301.7(is)-301.6(a)]TJ -1.0137 -1.1116 TD [(secondary)-422.1(cause)-429.3(for)-417.9(the)-425(behavioral)-423.7(disturbance)-9.9(,)-418.1(such)-425.8(as)-417.9(a)]TJ T* [(medical)-248.8(condition)-247.6(\(e.g.,)-245.1(urinary)-245.1(tract)-250(infection)-248.7(or)-244.1(medication)]TJ 0 -1.1174 TD [(side)-310.8(effect\).)]TJ 7.3823 0 0 6.5614 358.0723 466.5258 Tm (40)Tj 9.843 0 0 9.843 368.5605 462.1038 Tm [(Agitation)-312(and)-309.7(irritability)-314.7(may)-316.7(result)-313.1(from)-310.8(un-)]TJ -5.8634 -1.1116 TD [(recognized)-355.6(or)-336.2(un)20.8(tr)20.7(ea)18.5(te)19.6(d)-346.7(d)0(e)19.7(p)0(r)20.9(e)0(s)19.9(s)0(i)20.9(o)0(n)20.8(,)-343.3(an)13.9(xi)20.7(et)19.5(y,)-332.8(bo)20.8(re)19.7(do)20.8(m,)-334.1(sl)20.9(ee)18.5(p)]TJ T* [(di)20.7(so)21(rd)20.9(er)14(s,)-171.4(or)-180.7(pa)19.7(in)20.7(.)]TJ 7.3823 0 0 6.5614 379.2755 444.5857 Tm -.0162 Tc (41)Tj 9.843 0 0 9.843 388.403 440.2204 Tm 0 Tc [(Tr)19.7(ea)18.5(tm)19.5(en)19.7(t)-185.5(o)0(f)-180.7(s)0(y)21(m)0(p)19.6(t)0(o)20.7(m)0(s)-176(s)0(h)21(o)0(u)15.1(l)0(d)-175.1(b)0(e)19.7(g)0(i)20.7(n)-185.4(wi)19.8(th)]TJ -7.8793 -1.1116 TD [(no)20.8(np)20.8(ha)19.7(rm)19.6(ac)18.5(ol)20.7(og)15.1(ic)19.5(al)-205.1(ap)19.7(pr)20.9(oa)19.7(ch)19.7(es)-204.8(wh)20(en)19.7(ev)13.9(er)-204.9(po)20.8(ss)21.2(ib)20.7(le)19.5(,)-216.5(i)0(n)20.7(c)0(l)19.5(u)0(d)20.8(i)0(n)20.7(g)]TJ 0 -1.1174 TD [(ca)18.5(re)19.7(gi)20.7(ve)19.7(r)-219.9(e)0(d)19.7(u)0(c)19.7(a)0(t)13.8(i)0(o)20.7(n)0(,)-206.1(e)0(n)19.7(v)0(i)14.9(r)0(o)20.9(n)0(m)19.6(e)0(n)19.7(t)0(a)19.6(l)-220.1(mo)19.6(di)20.7(c)19.8(at)19.5(io)20.7(ns)-215.1(\(e.g.,)-227.8(bright)]TJ 0 -1.1116 TD [(lights)-219.9(during)-219.8(the)-217.7(day)-217.6(and)-223.3(removal)-218.7(of)-221(unsafe)-221.8(stimuli\),)-221.1(daytime)]TJ T* [(activities,)-237.3(and)-229.1(exercise.)]TJ 7.3823 0 0 6.5614 402.7463 400.7621 Tm [(42,)-9.4(43)]TJ 9.843 0 0 9.843 421.6818 396.3968 Tm [(Pain)-235.9(may)-230.3(be)-233.8(difcult)-234.8(to)-232.7(assess)-238.5(in)]TJ -11.2602 -1.1174 TD [(patients)-558.5(with)-552.7(severe)-562.8(cognitive)-554(or)-560.9(language)-553.8(disturbances;)]TJ 0 -1.1116 TD [(screening)-347.4(tools)-339.6(such)-345.2(as)-343(the)-344.4(PAINAD)-344(exist)-346.6(to)-342.2(evaluate)-347.8(pain)]TJ T* [(based)-278.3(on)-278.7(other)-283.2(behaviors)-282.9(\(e.g.,)-279.7(moaning,)-284.4(grimacing\).)]TJ 7.3823 0 0 6.5614 521.1211 367.8802 Tm (44)Tj 9.843 0 0 9.843 531.2692 363.5149 Tm (Data)Tj -22.3937 -1.1174 TD [(further)-348.7(suggest)-342.7(that)-345.6(an)-348.9(empiric)-345.6(trial)-346.8(of)-347.7(acetaminophen)-349.9(may)]TJ 0 -1.1116 TD [(improve)-223.3(not)-222.3(only)-217.6(untreated)-226.7(pain)-224.6(but)-216.5(also)-224.4(resulting)-224.3(behavioral)]TJ T* (disturbances.)Tj 7.3823 0 0 6.5614 362.6078 334.9983 Tm (45)Tj 9.843 0 0 9.843 373.1526 330.633 Tm [(Melatonin)-324.6(at)-320.3(bedtime)-328.3(may)-322.5(reduce)-321.1(nighttime)]TJ -6.3299 -1.1116 TD [(delirium)-207.4(and)-206.1(improve)-211.8(sleep)-209.4(quality)-210.9(without)-204.8(the)-211.9(increased)-210.3(risk)]TJ 0 -1.1174 TD [(of)-422.6(falls)-421.4(or)-422.6(morning)-423.7(sedation)-425.9(seen)-427(with)-420.2(benzodiazepines.)]TJ 7.3823 0 0 6.5614 542.551 313.0582 Tm (46)Tj 9.843 0 0 9.843 310.8472 297.7511 Tm [(Pharmacological)-588.2(agents)-584.8(to)-584.1(treat)-584(dementia-related)-590.7(behav-)]TJ 0 -1.1116 TD [(ioral)-317.9(disturbances)-327.6(may)-316.7(also)-322.3(include)-321.3(antidepressants,)-323.9(cholin-)]TJ 0 -1.1174 TD [(esterase)-404.8(inhibitors,)-400.6(and)-401.9(specic)-402.6(antipsychotics)-404.9(\(quetiapine,)]TJ 0 -1.1116 TD [(pimavanserin,)-441.9(and)-442.2(clozapine\).)]TJ 7.3823 0 0 6.5614 433.0771 269.2346 Tm (41)Tj 9.843 0 0 9.843 444.8125 264.8692 Tm [(Valproic)-438.5(acid)-444.6(and)-436.4(benzo-)]TJ -13.6102 -1.1116 TD [(diazepines)-321(can)-322.4(be)-320.1(cautiously)-318.8(considered,)-323.1(but)-320.2(carry)-318.8(a)-319(risk)-321.1(of)]TJ 0 -1.1174 TD [(a)-520.6(paradoxical)-523.9(worsening)-524.5(of)-520.5(parkinsonism,)-525.7(dementia,)-524.1(and)]TJ 0 -1.1116 TD (agitation.)Tj 7.3823 0 0 6.5614 347.981 236.3527 Tm (41,47)Tj /F4 1 Tf 8.9663 0 0 8.9663 310.8472 204.4913 Tm [(Tips)-335.4(7:)-329(Some)-337(Commonly)-338(Used)-333.5(Medications)]TJ 0 -1.2203 TD [(in)-331.6(the)-334.7(PC)-335.8(Setting)-331.2(Should)-340.2(NOT)-334(be)-332.5(Used)]TJ T* [(in)-331.6(People)-337.7(with)-330.5(PD)]TJ /F5 1 Tf 9.843 0 0 9.843 320.8251 166.1669 Tm .0127 Tc [(S)6(e)-1.1(veral)-357.2(c)-1.1(lasses)-356.8(o).1(f)-357(drugs)-356.8(frequent)5.7(ly)-357(used)-357(in)-357(PC)-358.1(settin)5.8(g).1(s)]TJ -1.0137 -1.1116 TD [(\(including)-218.8(h)5.8(o).1(spice)-219.9(c)4.7(omfort)-213.2(kits\))-218.8(a)-1.1(re)-214.2(relativ)5.8(ely)-218.8(o).1(r)-213(a)-1.1(bsolutel)5.7(y)]TJ 0 -1.1174 TD .013 Tc [(con)6.1(t).3(raindicat)6(ed)-356.7(in)-356.7(the)-352.1(P).5(D)-357.6(popula)5(tion.)-353.3(Antiemet)6(ic)-357.9(and)-356.7(a)5(n-)]TJ 0 -1.1116 TD .0127 Tc [(tipsy)5.8(chotic)-433.1(dopami)5.7(ne)-438.8(receptor)-431.9(blocking)-431.9(agents)-431.7(\(DRBAs\))]TJ T* .0131 Tc [(are)-329(o)6.2(f)-327.8(c)-.7(hief)-327.8(conce)5.1(r).5(n)-327.8(b).5(ecause)-329(th)6.2(ey)-327.8(block)-327.8(t).4(he)-329(D)5.4(2)-327.8(dopamin)6.2(e)]TJ 0 -1.1174 TD .0124 Tc [(receptor)-357.3(with)-357.3(high)-357.3(afn)5.5(ity.)-359.7(A)-1.1(nti)5.4(emetic)-358.5(DRBAs)-357.1(\()-.2(e.g.,)-359.7(m)-1.4(e-)]TJ 0 -1.1116 TD .0126 Tc [(toclopramide,)-659(promethazine,)-653.2(a)-1.2(nd)-656.6(prochlo)5.7(rperazine\))-656.6(a)-1.2(r)5.8(e)]TJ T* .013 Tc [(con)6.1(t).3(raindicat)6(ed.)-301.5(O)5.3(ndansetron)-293.4(\(Zofran\))-299.1(is)-293.2(the)-300.3(a)-.8(nti)6(emetic)-294.5(of)]TJ 0 -1.1174 TD [(cho)6(i).2(ce)-283.1(in)-276.2(PD)-282.8(p)6(a)-.9(tients.)]TJ 1.0137 -1.1116 TD 0 Tc [(R)15.2(e)0(g)19.7(a)15(rd)20.9(in)26.5(g)-392.8(n)0(e)19.7(u)0(r)26.6(o)0(l)20.7(e)0(p)25.4(t)0(i)20.6(c)0(s)25.6(,)-395.1(al)19.6(l)-392.9(t)16.1(yp)20.8(ic)25.3(al)-383.6(\(e)19.7(.)13.9(g)0(.)24.3(,)-395.1(h)16.2(a)0(l)19.5(o)0(p)26.6(e)0(r)19.7(i)0(d)26.5(o)0(l)20.7(\))-392.7(an)25.4(d)]TJ -1.0137 -1.1116 TD [(m)15(o)0(s)21(t)-335.3(at)19.5(y)16.2(p)0(i)20.7(c)0(a)24.3(l)-341(\()16.2(e)0(.)17.3(g)16.2(.,)-323.6(ol)20.7(an)25.4(za)18.5(pi)26.5(ne)19.7(,)-337.5(z)15(ip)20.7(ra)25.5(si)20.9(do)26.6(ne)19.7(,)-337.5(r)0(i)26.5(s)0(p)21(e)0(r)25.5(i)0(d)20.7(o)0(n)26.6(e)0(,)-328.2(a)0(n)25.4(d)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 749.7069 Tm [(PARKINSONS)-340.4(DISEASE)-335.9(AND)-337.2(RELATED)-338(DISORDERS)-26997.8(1513)]TJ ET endstream endobj 69 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.843 0 0 9.843 62.022 725.1588 Tm 0 0 0 rg 0 Tc 0 Tw [(ar)19.7(i)16.1(p)0(i)20.7(p)0(r)26.6(a)0(z)18.5(o)0(l)26.5(e)0(\))-274(a)0(n)25.4(t)0(i)20.6(p)0(s)21(y)16.2(ch)19.7(o)16.2(t)0(i)20.6(c)0(s)-273.9(a)15(re)-274(si)20.9(m)15(i)0(l)20.6(a)15(rl)20.7(y)-283.3(c)0(o)25.4(n)0(t)20.7(r)0(a)25.5(i)0(n)20.7(d)0(i)26.5(c)0(a)18.5(t)0(e)25.3(d)0(.)]TJ 7.3823 0 0 6.5614 284.9385 729.5242 Tm [(48)24.7(,)19.6(4)16.2(9)]TJ 9.843 0 0 9.843 62.022 714.1605 Tm [(It)-278.8(is)-278.6(im)19.5(p)16.2(o)0(r)20.9(t)0(a)25.3(n)0(t)-278.8(t)0(o)-278.8(h)0(i)20.7(g)0(h)26.6(l)0(i)20.6(g)0(h)26.6(t)-295(t)16.1(h)0(a)19.7(t)0(,)-275.4(c)0(o)19.7(n)0(t)26.5(r)0(a)19.7(r)0(y)-278.6(t)0(o)-278.8(c)0(o)25.4(m)0(m)18.4(o)16.2(n)-294.8(m)15(ed)19.7(i)16.1(c)0(a)18.5(l)]TJ 0 -1.1116 TD [(pr)20.9(a)15(c)0(t)19.5(i)0(c)25.3(e)0(,)-287.9(e)0(v)25.4(e)0(n)-291.3(t)16.1(he)-291.3(n)16.2(e)0(w)18.8(e)15(r)-300.6(a)0(t)25.3(y)0(p)20.8(i)0(c)25.3(a)0(l)-285.7(a)0(n)19.7(t)0(i)26.3(p)0(s)21(y)0(c)25.4(h)0(o)20.8(t)0(i)26.3(c)0(s)-291.1(p)16.2(re)19.7(se)19.9(n)16.2(t)-300.7(a)-296(s)0(e)19.9(-)]TJ T* [(ri)20.7(o)16.2(u)0(s)-290(r)0(i)26.5(s)0(k)-290(f)0(o)26.6(r)-300.6(Pa)25.6(rk)20.9(in)26.5(so)21(n)20.9(s)-294.6(p)0(a)19.7(t)16.1(ie)19.6(nt)26.5(s.)-286.6(In)-290.2(fa)25.5(ct)19.5(,)-297.2(r)0(i)26.5(s)0(p)21(e)0(r)25.5(i)0(d)20.7(o)0(n)26.6(e)-301.8(ha)25.4(s)-300.4(a)0(n)]TJ T* [(af)19.7()16.3(n)0(i)20.7(t)0(y)-319.1(f)0(o)26.6(r)-335.1(th)26.5(e)-336.3(D)15.3(2-)20.9(re)25.5(ce)18.5(p)16.2(t)0(o)20.7(r)-329.4(eq)19.7(ua)25.4(l)-335.3(t)16.1(o)-335.2(t)16.1(ha)19.7(t)-329.5(o)0(f)-318.9(h)0(a)19.7(l)16.1(op)20.8(er)25.5(id)20.7(ol)26.5(.)-331.7(U)0(n)20(-)]TJ 0 -1.1174 TD [(fo)20.9(r)16.2(t)0(u)20.7(n)0(a)25.4(t)0(e)19.6(l)0(y)26.5(,)-308.7(be)25.4(ca)18.5(u)16.2(s)0(e)-296.9(o)0(f)-295.9(h)16.2(ig)20.7(h)-306.4(r)0(a)25.5(t)0(e)19.6(s)-306.2(o)16.2(f)-306.3(sl)20.9(ee)24.3(p)-306.4(d)0(y)20.8(s)0(f)26.8(u)0(n)20.8(c)0(t)25.3(i)0(o)20.7(n)0(,)-292.5(d)0(e)25.4(l)0(i)20.6(r)0(-)]TJ 0 -1.1116 TD [(iu)20.7(m)15(,)-556.4(a)15(n)0(x)20.8(i)0(e)25.3(t)0(y)20.7(,)-556.4(a)15(g)0(i)20.7(t)0(a)25.3(t)0(i)20.6(o)16.2(n,)-545.9(an)25.4(d)-554(p)0(s)21(y)0(c)25.4(h)0(o)20.8(s)0(i)26.7(s)-559.6(i)16.1(n)-554(th)20.7(os)26.8(e)-555.2(w)0(i)19.8(t)0(h)-543.7(P)16.3(D,)]TJ T* [(me)24.2(di)20.7(ca)24.3(l)-248.9(m)0(a)18.4(n)16.2(ag)19.7(em)24.2(en)19.7(t)-248.9(o)16.2(f)-248.7(t)0(h)20.7(e)0(s)19.9(e)-249.9(i)16.1(s)0(s)21.2(u)0(e)25.4(s)-254.3(i)16.1(s)-254.3(f)16.2(r)0(e)19.7(q)0(u)26.6(e)0(n)19.7(t)0(l)26.3(y)-248.8(re)19.7(qu)26.6(ir)20.7(ed)25.4(.)-251.1(I)0(n)]TJ 0 -1.1174 TD [(ge)19.7(n)16.2(e)0(r)19.7(a)15(l,)-258.1(t)16.1(h)0(e)]TJ /F9 1 Tf 4.8612 0 TD -.0185 Tc [(on)-18.5(ly)]TJ /F5 1 Tf 1.9583 0 TD 0 Tc [(r)16.2(e)0(l)19.5(a)0(t)25.3(i)0(v)20.7(e)0(l)25.3(y)-266(sa)19.9(f)16.2(e)-267.2(an)25.4(ti)20.6(ps)21(y)16.2(c)0(h)19.7(o)16.2(ti)20.6(cs)-250.8(in)-255.8(PD)-250.6(ar)19.7(e)-267.2(l)16.1(ow)20(-)]TJ -6.8195 -1.1116 TD [(do)20.8(s)16.4(e)-422.7(qu)20.8(e)15(t)0(i)20.6(a)0(p)25.4(i)0(n)20.7(e)15(,)-423.9(C)0(l)25.4(o)0(z)19.7(a)15(ri)20.7(l,)-407.8(an)19.7(d)-415.8(p)0(i)20.7(m)15(av)19.7(a)15(n)0(s)21(e)0(r)19.7(i)16.1(n.)-407.7(Gi)19.8(ve)25.4(n)-421.6(t)0(h)20.7(i)16.1(s)-421.4(i)0(n)20.7(-)]TJ T* [(fo)20.9(r)16.2(m)0(a)18.4(t)16.1(io)20.7(n,)-367.4(we)-372.9(re)19.7(c)15(o)0(m)19.6(m)15(en)19.7(d)-381.2(t)0(h)26.5(a)0(t)-372.1(h)0(o)20.8(s)0(p)26.8(i)0(c)19.6(e)-382.4(pr)26.6(og)20.8(ra)25.5(ms)-371.9(de)19.7(v)16.2(e)0(l)19.6(o)0(p)-370.8(a)]TJ 0 -1.1174 TD [(se)19.9(p)16.2(a)0(r)19.7(a)0(t)25.3(e)-226.9(PD)-210.3(co)19.7(m)15(f)0(o)20.9(r)0(t)-209.6(k)0(i)20.7(t)-225.9(t)16.1(h)0(a)19.7(t)-220.1(us)21(es)-216.3(q)16.2(u)0(e)19.7(t)16.1(ia)19.6(pi)26.5(ne)-216.5(as)-210.5(th)20.7(e)-221.1(n)0(e)19.7(u)0(r)26.6(o)0(l)20.7(e)0(p)25.4(t)0(i)20.6(c)]TJ 0 -1.1116 TD [(ag)19.7(e)15(n)0(t)-255.8(a)0(n)19.7(d)-266(on)20.8(d)16.2(a)0(n)19.7(s)0(e)25.6(t)0(r)20.7(o)0(n)-255.6(a)0(s)-256.6(t)0(h)20.7(e)-267.2(an)25.4(ti)20.6(em)24.2(et)19.6(i)16.1(c)-273(a)15(g)0(e)19.7(n)0(t)26.5(.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 62.022 566.192 Tm [(Tip)-312(8:)-303.7(People)-312.4(with)-311.5(PD)-310.5(Can)-310.1(Often)-308.2(Benet)-309.6(from)-305.9(Physical)]TJ 0 -1.2203 TD [(Therapy)-296.5(and)-300.2(Dopaminergic)-299.6(Therapy)-296.5(Even)-303.2(at)-297.4(the)-296.7(Latest)]TJ T* [(Stages)-335.1(of)-336.6(Their)-329.8(Disease)-338.3(to)-330.2(Reduce)-337.2(Pain)-334(and)-331.9(Improve)]TJ 0 -1.2266 TD [(Range)-332.8(of)-336.6(Motion)]TJ /F5 1 Tf 9.843 0 0 9.843 72 516.8691 Tm [(Physical)-310.5(activity)-316.9(is)-307.4(important)-312.2(to)-313.3(continue)-310.9(as)-314.2(a)-307.5(part)-310.9(of)-313.2(PD)]TJ -1.0137 -1.1116 TD [(care)-215.2(in)-215.4(the)-211.9(last)-218.7(few)-212.6(years)-215(of)-215.3(life.)-216.6(Even)-214.1(when)-213.8(a)-215.4(person)-214.9(with)-212.9(PD)]TJ T* [(is)-290.1(wheelchair)-299(bound)-287.7(or)-290.2(bedbound,)-289.9(active)-298.3(and)-286.7(passive)-297.8(move-)]TJ 0 -1.1174 TD [(ment)-335.2(and)-332.8(breathing)-335(exercises)-342.6(have)-335(been)-335(shown)-334.5(to)-330.6(maintain)]TJ 0 -1.1116 TD [(residual)-454.7(mobility)-454.1(and)-453.7(prevent)-453.6(complications)-457.1(such)-454.6(as)-452.4(con-)]TJ T* [(tractures,)-258.7(decubiti,)-262.6(and)-252.1(pneumonia.)]TJ 7.3823 0 0 6.5614 201.033 466.4692 Tm (19)Tj 9.843 0 0 9.843 210.9543 462.1038 Tm [(As)-256.3(hospice)-257.6(services)-259.7(do)]TJ -15.1307 -1.1174 TD [(not)-349(routinely)-351.3(offer)-352.2(these)-353.3(therapies,)-350.9(the)-355.9(benets)-349.6(of)-347.7(these)-353.3(in-)]TJ 0 -1.1116 TD [(terventions)-210.4(should)-213.9(be)-205(carefully)-215.2(considered)-210.2(when)-208(planning)-211.8(for)]TJ T* [(end-of-life)-285.3(care.)]TJ 1.0137 -1.1116 TD [(Fu)26.8(rt)20.7(he)25.4(rm)19.6(o)16.2(r)0(e)19.7(,)-314.5(p)16.2(e)0(o)19.7(p)0(l)26.5(e)-313.3(wi)19.8(th)-301.8(l)16.1(a)0(t)19.5(e)15(-s)21.1(ta)19.6(g)16.2(e)-313.3(PD)-302.4(co)19.7(n)16.2(t)0(i)20.6(n)0(u)26.6(e)-313.3(to)-301.8(ob)20.8(t)16.1(a)0(i)19.6(n)]TJ -1.0137 -1.1174 TD [(si)20.9(g)16.2(n)0(i)20.7()0(c)25.6(a)0(n)19.7(t)-358.3(m)15(o)0(t)20.7(o)16.2(r)-358.2(b)0(e)19.7(n)16.2(e)19.8(t)-358.3(f)16.2(ro)20.9(m)-359.4(l)16.1(ev)19.7(o)16.2(d)0(o)20.8(p)0(a)25.4(,)-360.5(a)15(n)0(d)-347.8(t)0(h)26.5(e)0(r)19.7(e)-359.4(a)15(r)0(e)-348.9(o)0(f)26.6(t)0(e)19.6(n)]TJ 0 -1.1116 TD [(im)25.2(pr)20.9(ov)26.6(em)18.5(e)15(n)0(t)20.7(s)-283.1(in)-273(no)20.8(n)16.2(m)0(o)19.6(t)16.1(or)-272.9(sy)21(mp)25.4(to)20.7(m)15(s)-288.9(a)15(s)-288.9(w)15.3(e)0(l)19.6(l)-283.5(\(e)25.5(.g)18.5(.)13.9(,)-285.7(i)16.1(n)0(s)21(o)0(m)25.4(n)0(i)20.7(a)]TJ T* [(an)19.7(d)-398.5(d)0(e)19.7(p)0(r)26.6(e)0(s)19.9(s)0(i)20.9(o)16.2(n\))-393.8(wi)19.8(t)16.1(h)-404.3(th)20.7(i)16.1(s)-409.8(m)15(e)0(d)19.7(i)16.1(ca)18.5(t)16.1(i)0(o)20.7(n)0(.)-390.4(I)0(n)-393.8(l)0(a)25.3(t)0(e)19.6(r)-404.2(st)26.7(ag)19.7(es)-394.8(o)16.2(f)-404.2(th)20.7(e)]TJ 0 -1.1174 TD [(di)20.7(s)16.4(e)0(a)18.5(s)0(e)25.6(,)-372(pa)19.7(t)16.1(i)0(e)19.5(n)0(t)26.5(s)-375.3(o)16.2(f)0(t)20.7(e)0(n)-360.5(n)0(e)25.4(e)0(d)-360.5(t)0(o)-359.4(r)0(e)19.7(d)16.2(uc)19.7(e)-370.9(d)0(o)20.8(p)16.2(am)18.5(i)16.1(n)0(e)19.7(r)0(g)26.6(i)0(c)-360.6(t)0(h)20.7(e)0(r)25.5(a)0(p)19.7(y)]TJ 0 -1.1116 TD [(du)20.8(e)-417(t)0(o)-411.3(l)16.1(ev)19.7(od)26.6(op)20.8(a)15(-)0(i)20.7(n)0(d)26.6(u)0(c)19.7(e)0(d)-406.5(d)0(y)20.8(s)0(k)26.8(i)0(n)20.7(e)0(s)25.6(i)0(a)19.6(s)0(,)-407.5(p)0(s)21(y)16.2(ch)19.7(o)16.2(s)0(i)20.9(s)0(,)-407.5(a)0(n)19.7(d)-415.8(de)19.7(l)16.1(i)0(r)20.7(i)0(-)]TJ T* [(um)25.4(.)]TJ 7.3823 0 0 6.5614 76.7622 356.8818 Tm -.0162 Tc (50)Tj 9.843 0 0 9.843 86.6267 352.5164 Tm 0 Tc [(Th)19.6(us)26.8(,)-268.4(w)0(e)18.8(a)15(ni)20.7(n)16.2(g)-271.8(o)16.2(f)-266(do)20.8(pa)25.4(mi)19.5(n)16.2(e)0(r)19.7(g)0(i)20.7(c)-267.2(m)15(e)0(d)19.7(i)16.1(ca)18.5(ti)26.3(on)20.8(s,)-252(if)-255.7(co)19.7(n)16.2(s)0(i)20.9(d)0(-)]TJ -2.4997 -1.1174 TD [(er)19.7(e)15(d)0(,)-286.8(s)16.4(ho)20.8(ul)26.5(d)-294.8(s)0(e)19.9(e)15(k)-294.8(t)0(o)-284.5()0(n)21(d)-289.1(a)-296(b)0(a)19.7(l)16.1(an)19.7(ce)-281(be)19.7(tw)25.6(ee)18.5(n)-294.8(b)16.2(en)19.7(e)25.6(ts)-284.4(an)19.7(d)-289.1(s)0(i)20.9(d)0(e)]TJ 0 -1.1116 TD [(ef)19.7(f)16.2(e)0(c)18.5(t)0(s)26.7(.)]TJ 7.3823 0 0 6.5614 89.9149 334.9417 Tm -.0162 Tc (19)Tj 9.843 0 0 9.843 100.6866 330.5763 Tm 0 Tc [(C)15.2(o)0(n)20.8(s)0(u)26.8(l)0(t)20.6(i)0(n)26.5(g)-358.2(wi)25.6(th)-342.1(a)-359.4(m)15(ov)20.8(em)24.2(en)19.7(t)-352.6(d)0(i)20.7(s)16.4(or)20.9(de)25.4(r)-358.2(s)0(p)26.8(e)0(c)18.5(i)0(a)25.3(l)0(i)20.6(s)0(t)-342(t)0(o)]TJ -3.9281 -1.1116 TD [(he)19.7(l)16.1(p)-271.8(g)16.2(u)0(i)20.7(d)0(e)-256.8(d)0(o)26.6(s)0(i)20.9(n)0(g)-255.6(o)0(f)-255.6(l)0(e)19.5(v)0(o)26.6(d)0(o)20.8(p)16.2(a)-273(i)0(n)-255.8(t)0(h)26.5(i)0(s)-261.3(s)16.4(et)19.5(ti)26.3(ng)-261.4(i)16.1(s)-271.6(pr)26.6(ef)19.7(er)25.5(re)19.7(d.)]TJ 1.0137 -1.1116 TD [(Oral)-375.2(dissolving)-373.9(carbidopa/l)-10.2(evodopa)-372.9(or)-376.5(rectally)-375.5(delivered)]TJ -1.0137 -1.1174 TD [(carbidopa/levodopa)-221.8(can)-213(be)-216.5(administered)-219.7(for)-216.3(PD)-216(patients)-212.9(with)]TJ 0 -1.1116 TD [(pill)-321.6(dysphagia.)]TJ 7.3823 0 0 6.5614 120.8692 291.118 Tm (51,52)Tj 9.843 0 0 9.843 140.5984 286.7527 Tm [(While)-326(continuous)-317.5(infusions)-320.8(of)-318.9(levodopa)]TJ -7.983 -1.1116 TD [(gel)-194.7(through)-192.1(a)-198.1(PEG-J)-191.5(tube)-195.8(\(called)-195.7(Duodopa\))-195.1(can)-195.7(be)-193.4(considered)]TJ 0 -1.1174 TD [(for)-400.7(people)-400.7(with)-403(PD)-400.3(who)-401.6(have)-404.1(motor)-398.5(uctuations,)-403.8(it)-399.9(is)-399.5(the)]TJ 0 -1.1116 TD [(opinion)-267.2(of)-261.4(the)-269.5(authors)-262.2(that)-265(the)-269.5(high)-263.7(risk)-263.5(of)-267.1(the)-263.8(PEG-J)-266.4(device)]TJ T* [(insertion)-431.7(\(e.g.,)-423.7(aspiration,)-431.6(intraperitoneal)-436.5(infection,)-425(wound)]TJ 0 -1.1174 TD [(infection,)-425(abdominal)-428.4(pain,)-423.8(abdominal)-422.7(distention,)-424.9(intestinal)]TJ 0 -1.1116 TD [(hemorrhage,)-410.8(pneumoperitoneum,)-413.2(ileus,)-407.6(delirium,)-406.7(agitation,)]TJ T* [(and)-309.7(nausea\))]TJ 7.3823 0 0 6.5614 109.474 214.4125 Tm (53)Tj 9.843 0 0 9.843 119.9055 210.0472 Tm [(outweighs)-311.5(the)-309.9(likely)-307.7(minimal)-311.2(benet)-308.4(an)-308.6(indi-)]TJ -5.8807 -1.1174 TD [(vidual)-319.1(with)-316.6(end-stage)-324.3(PD)-319.7(would)-317.5(have)-317.8(with)-322.3(this)-315.5(medication,)]TJ 0 -1.1116 TD [(given)-444.5(that)-449.3(most)-443.3(of)-445.7(those)-444.3(aficted)-450.1(in)-445.8(the)-448.1(end-stage)-445.3(of)-445.7(the)]TJ T* [(disease)-483.2(are)-477.9(bedbound,)-480(demented,)-477.9(and)-482.5(psychotic)-478.8(from)-477.9(the)]TJ T* [(disease)-408.4(itself.)-403(Of)-400.5(note,)-406.5(a)-399.7(PEG)-402.6(tube)-408.9(used)-402.8(for)-400.7(nutrition)-402.1(will)]TJ 0 -1.1174 TD [(require)-252(placement)-252.2(of)-244.1(an)-251(FDA-approved)-247.5(jejunal)-252.3(extension)-248.5(for)]TJ 0 -1.1116 TD [(concurrent)-285.3(Duodopa)-280.5(delivery.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 62.022 116.8441 Tm [(Tip)-337.3(9:)-329(PD)-335.8(Contributes)-339.9(to)-330.2(Mortality,)-335.1(and)-338.2(There)]TJ 0 -1.2203 TD [(Are)-336.7(Certain)-333.5(Signs)-333.3(and)-338.2(Symptoms)-330.4(That)-334(Predict)]TJ 0 -1.2266 TD [(the)-334.7(Terminal)-337.9(Phase)-333(of)-330.2(This)-335.4(Disease)]TJ /F5 1 Tf 9.843 0 0 9.843 72 78.463 Tm [(W)13.9(h)0(e)19.7(n)-473.4(in)20.7(di)26.5(vi)20.7(du)26.6(al)19.5(s)-473.2(w)0(i)19.8(t)0(h)-463.1(P)0(D)-469.4(a)15(sk)-468.5(a)15(b)0(o)20.8(u)0(t)-463.1(t)0(h)20.7(e)15(ir)-468.8(p)16.2(r)0(o)20.9(g)0(n)26.6(o)0(s)21(i)0(s)20.9(,)-475.7(a)]TJ -1.0137 -1.1116 TD [(co)19.7(m)15(m)0(o)25.4(n)-496.4(re)25.5(sp)21(on)26.6(se)-481.2(fr)20.9(om)-481.5(ne)25.4(ur)20.9(ol)26.5(og)20.8(is)26.7(ts)-480.2(ca)18.5(n)-490.7(o)0(f)20.9(f)16.2(er)-487.1(f)16.2(a)0(l)19.6(s)0(e)-481.2(h)0(o)26.6(p)0(e)19.7(:)]TJ T* [()62.3()0(D)20(o)16.2(n)20.9(t)-329.5(w)0(o)20(r)16.2(ry)20.9(,)-331.7(y)0(o)26.6(u)0()20.9(l)0(l)-319.2(d)0(i)26.5(e)-336.3(w)15.3(i)0(t)20.6(h)-329.4(Pa)25.6(rk)20.9(in)20.7(s)16.4(o)0(n)20.8()0(s)-318.8(a)0(n)25.4(d)-335.2(n)16.2(o)0(t)-319.1(f)0(r)20.9(o)0(m)-320.2(i)0(t)26.3(.)0()70.4()]TJ 25.504 67.9242 TD [(Un)20(fo)26.6(rt)20.7(un)20.8(a)15(t)0(e)19.6(l)16.1(y,)-511.4(th)20.7(e)-520.6(m)0(a)24.2(j)0(o)20.7(r)0(i)26.5(t)0(y)-509.2(o)0(f)-514.8(t)16(ho)20.8(se)-510(wi)25.6(th)-509.2(PD)-515.5(\()16.2(7)0(1)20.8(%)0(\))-510.1(w)0(i)25.6(l)0(l)]TJ 0 -1.1174 TD [(ac)18.5(tu)26.5(al)19.5(ly)-445.8(d)16.2(i)0(e)-447(f)0(r)26.7(o)0(m)-446.9(c)0(o)25.4(m)0(p)19.6(l)0(i)26.3(c)0(a)18.5(t)16(io)20.7(ns)-445.5(o)16.2(f)-456.1(th)20.7(ei)25.3(r)-456.1(n)0(e)19.7(u)0(r)26.6(o)0(d)20.8(e)0(g)25.4(e)0(n)19.7(e)15(ra)19.7(ti)26.3(ve)]TJ 0 -1.1116 TD [(di)20.7(se)19.9(a)15(s)0(e)19.9(.)]TJ 7.3823 0 0 6.5614 343.1054 707.5841 Tm -.0162 Tc [(54,)-16.2(5)11.9(5)]TJ 9.843 0 0 9.843 363.4015 703.2188 Tm 0 Tc [(Ch)19.8(a)15(l)0(l)20.6(e)15(ng)20.8(es)-406.3(wi)19.8(th)-405.5(pr)20.9(o)16.2(g)0(n)20.8(o)0(s)26.8(t)0(i)20.6(c)0(a)24.3(t)0(i)20.6(o)0(n)-405.4(i)0(n)-405.5(P)0(D)-411.9(i)0(n)26.5(c)0(l)19.5(u)16.2(de)]TJ -5.1146 -1.1116 TD [(li)20.6(mi)25.2(te)19.5(d)-208.4(e)0(x)19.7(i)0(s)26.7(t)0(i)20.6(n)0(g)-198(r)0(e)19.7(s)0(e)25.6(a)0(r)19.7(c)0(h)-199.2(o)0(n)-203.8(t)16.1(hi)20.7(s)-214(t)16(op)20.8(ic)-199.3(an)19.7(d)-208.4(t)0(h)20.7(e)-209.6(va)19.7(r)16.2(i)0(a)19.6(b)0(i)26.5(l)0(i)20.6(t)0(y)-198.2(o)0(f)-203.8(t)16.1(he)]TJ T* [(du)20.8(ra)25.5(ti)20.6(on)-411.1(a)15(n)0(d)-411.1(p)0(r)26.6(o)0(g)20.8(r)0(e)25.5(s)0(s)21.2(i)0(o)20.7(n)-415.8(of)-411.1(di)20.7(s)16.4(e)0(a)18.5(s)0(e)25.6(.)-423.9(W)13.9(h)0(i)20.7(l)0(e)-406.7(t)0(h)20.7(e)0(r)25.5(e)-422.7(is)-411.1(li)26.3(mi)19.5(t)16.1(e)0(d)]TJ 0 -1.1174 TD [(in)20.7(fo)20.9(r)16.2(m)0(a)18.4(t)16.1(io)20.7(n)-202.7(o)16.2(n)-202.7(p)0(r)20.9(e)15(di)20.7(ct)25.3(in)20.7(g)-202.7(t)0(h)26.5(e)-203.8(te)25.3(rm)19.6(in)26.5(al)-193.6(st)20.9(a)15(g)0(e)19.7(s)-202.5(o)16.2(f)-202.7(PD)20.1(,)-199.3(s)0(o)21(m)15(e)-203.8(d)0(a)25.4(t)0(a)]TJ 0 -1.1116 TD [(ca)18.5(n)-266(g)0(u)20.8(i)16.1(de)-262.5(i)16.1(n)0(f)20.9(o)0(r)26.6(m)0(a)18.4(t)16.1(io)20.7(n)-266(w)0(e)-257.7(s)0(h)21(a)0(r)25.5(e)-273(w)15.3(i)0(t)20.6(h)-266(pa)19.7(ti)26.3(en)19.7(t)16.1(s)-271.6(an)25.4(d)-271.8(f)0(a)25.5(m)0(i)19.5(l)16.1(ie)19.5(s.)]TJ 1.0137 -1.1116 TD [(The)-299.4(Hoehn)-301.3(and)-292.4(Yahr)-300.2(\(H&Y\))-302.2(scale)-296.9(is)-295.9(the)-298.3(only)-298.3(disease)-298.9(se-)]TJ -1.0137 -1.1174 TD [(verity)-313.3(staging)-308.4(system)-314(for)-308.5(PD;)-309.4(it)-307.7(includes)-310.7(stages)-313.9(1)-306.4(through)-307.3(5)]TJ 0 -1.1116 TD [(\(Tabl)-8(e)-307.5(3\).)-310.9(The)-310.9(chances)-311.7(of)-307.4(dying)-310.9(from)-310.8(a)-313.3(PD-related)-309.2(cause)-314.1(is)]TJ T* [(78%)-309.6(for)-302.7(those)-306.1(who)-309.4(survive)-308.3(long)-304(enough)-307.3(\(812)-305(years)-307.1(on)-307.5(av-)]TJ 0 -1.1174 TD [(erage)-9(\))-392.7(t)0(o)-394(reach)-400.6(H&Y)-397.9(stage)-399.4(3)-392.8(\(characterized)-403.9(by)-399.6(signicant)]TJ 0 -1.1116 TD [(imbalance)-465.3(with)-454.8(falls,)-453.6(but)-458.5(ambulating)-458.5(without)-458.2(an)-452.6(assistive)]TJ T* [(devic)-8(e\).)-300.5(Common)-303.9(underlying)-306.2(causes)-309.2(of)-301.7(death)-307.5(in)-301.8(these)-307.3(cases)]TJ T* [(include)-459.6(sepsis,)-454.2(respiratory)-457.9(failure,)-457.2(wasting)-453.3(syndrome,)-457.9(and)]TJ 0 -1.1174 TD (choking.)Tj 7.3823 0 0 6.5614 347.3574 565.1148 Tm (5,54,56,57)Tj 9.843 0 0 9.843 381.9967 560.7495 Tm [(There)-331.5(has)-332.6(been)-329.3(only)-327.1(one)-332.8(study)-328(that)-328.4(evalu-)]TJ -7.0038 -1.1116 TD [(ated)-196.9(predictors)-197.7(of)-192.2(mortality)-197.1(in)-192.4(PD)-193(within)-197.9(612)-188.7(months.)]TJ 7.3823 0 0 6.5614 525.373 554.1731 Tm (56)Tj 9.843 0 0 9.843 534.6707 549.8077 Tm (This)Tj -22.5147 -1.1116 TD [(study)-397.1(indicated)-399.7(that)-397.5(a)-399.7(body)-396.1(mass)-398.1(index)]TJ /F8 1 Tf 16.8126 0 TD (<)Tj /F5 1 Tf .5529 0 TD [(18.5,)-396.1(accelerated)]TJ -17.3655 -1.1174 TD [(weight)-515.8(loss,)-514.4(and)-517.1(a)-514.9(signicant)-514.5(reduction)-519.3(in)-509.2(dopaminergic)]TJ 0 -1.1116 TD [(medications)-489.3(due)-476.8(to)-480.4(neuropsychiatric)-483.2(side)-483.6(effects,)-481(all)-482.8(pre-)]TJ T* [(dicted)-498.8(a)-486.1(6)0(-)-491.7(t)0(o)-491.9(12-month)-494(life)-489.6(expectancy.)-498.5(In)-491.7(the)-488.4(authors)]TJ 0 -1.1174 TD [(clinical)-312.3(experience,)-314.1(weight)-308.4(loss)-309.4(\(with)-306.1(or)-307.4(without)-308.5(loss)-309.4(of)-301.7(ap-)]TJ 0 -1.1116 TD [(petite\),)-451.6(dysphagia)-444.2(for)-446.7(liquids)-445.6(and)-448(aspiration,)-448.9(recurrent)-445.4(in-)]TJ T* [(fections,)-573.3(and)-568.9(accelerating)-573.5(loss)-568.6(of)-566.6(function)-568.9(and)-563.2(mobility)]TJ 0 -1.1174 TD [(should)-340.6(encourage)-342.8(consideration)-346.3(of)-342(hospice.)-341.7(The)-339.7(most)-339.6(com-)]TJ 0 -1.1116 TD [(mon)-344.4(causes)-343.8(of)-347.8(terminal)-341(hospital)-344.2(admissions)-347.2(include)-344.4(aspira-)]TJ T* [(tion)-281.1(pneumonia,)-287.8(sepsis,)-281.5(failure)-280.9(to)-284.5(thrive,)-282.1(and)-280.9(falls.)]TJ 7.3823 0 0 6.5614 512.844 444.5857 Tm [(5,54)-8.6(,56,57)]TJ /F4 1 Tf 8.9663 0 0 8.9663 313.0582 407.5652 Tm [(Tip)-337.3(10:)-333.4(End-Stage)-335.7(PD)-335.8(Is)-330.4(Characterized)]TJ 0 -1.2266 TD [(by)-338.9(Psychosis,)-335.5(Dementia,)-334.6(and)-331.9(an)-332.5(Inability)]TJ 0 -1.2203 TD [(to)-336.6(Ambulate)-338.6(Independently)]TJ /F5 1 Tf 9.843 0 0 9.843 323.0361 369.1841 Tm .0187 Tc [(H&Y)-386.4(s).5(ta)4.9(ge)-386.7(5)-385.6(i).2(s)-379.6(c)-.8(onsidered)-379.8(end-stage)-386.7(P).5(D)-380.7(a)-.8(nd)-385.6(is)-379.6(char-)]TJ -1.0137 -1.1116 TD .0185 Tc [(acterized)-345.5(by)-345.5(dementia,)-347.8(p).1(sychosis,)-342(a)-1(nd)-345.5(wheelchair-bound/)]TJ 0 -1.1174 TD .0187 Tc [(bedbound)-472(status)-466(\(unless)-471.8(a)-.8(ided\).)-468.5(The)-473.1(t)6(ypical)-472.1(life)-467.4(e)-.8(xpec-)]TJ 0 -1.1116 TD [(tancy)-322.3(f).3(or)-316.5(a)-323.5(p).2(erson)-316.6(w)-.6(ith)-322.3(PD)-317.4(ranges)-322.1(from)-317.8(1).2(2)-322.3(t).1(o)-316.6(2).2(0)-322.3(y).2(ears,)]TJ 7.3823 0 0 6.5614 544.592 340.6676 Tm .0299 Tc (58)Tj 9.843 0 0 9.843 313.0582 325.3605 Tm .0187 Tc [(and)-391.3(t).2(his)-391.1().5(nal)-385.7(s).5(tage)-392.5(of)-391.3(PD)-386.4(\(H&Y)-392.2(stage)-386.7(5).3(\))-391.3(t).2(ypicall)6(y)-391.3(lasts)]TJ 0 -1.1174 TD [(about)-224.4(2)-224.3(y).3(ears.)]TJ 7.3823 0 0 6.5614 369.8078 318.7842 Tm .0222 Tc (59)Tj 9.843 0 0 9.843 379.729 314.3621 Tm .0186 Tc [(Severe)-225.6(dysphagia)-225.6(a)-.9(nd)-224.4(bedrid)6(den)-224.4(s).4(tatus)-224.2(a)-.9(re)]TJ -6.7734 -1.1116 TD .0183 Tc [(the)-398.7().1(nal)-397.6(c)-1.2(ommon)-397.5(p)-.1(athways)-397.3(f)0(or)-397.5(many)-397.5(neurodegenerative)]TJ ET 313.058 255.798 239.131 .22673 re f 313.058 68.882 239.131 .28348 re f 313.058 227.168 239.131 .22676 re f BT /F7 1 Tf 9.845 0 0 9.845 336.9259 271.4456 Tm 0 Tc (Table)Tj /F5 1 Tf 3.0002 0 TD (3.)Tj /F7 1 Tf 1.2496 0 TD [(Hoehn)-336.2(and)-332(Yahr)-334(Staging)-335.8(System)]TJ -1.8197 -1.0135 TD [(of)-337(Parkinsons)-334.8(Disease)-335.6(Severity)]TJ /F9 1 Tf -4.8545 -1.8427 TD (H&Y)Tj 0 -1.0135 TD [(stage)-9029.8(Clinical)-333.3(description)]TJ /F5 1 Tf 0 -1.8946 TD [(Stage)-335.5(1)-3012.7(Unilateral)-337.4(mild)-333.7(motor)-334.5(symptoms)-332.6(\(tremor,)]TJ 7.0657 -1.0135 TD [(rigidity,)-334.5(bradykinesia\).)-336.6(Independent)-337.1(am-)]TJ 0 -1.0077 TD (bulation.)Tj -7.0657 -1.0135 TD [(Stage)-335.5(2)-3012.7(Bilateral)-302.1(mild)-293.4(motor)-300(symptoms.)-295.6(Independent)]TJ 7.0657 -1.0135 TD (ambulation.)Tj -7.0657 -1.0135 TD [(Stage)-335.5(3)-3012.7(Bilateral)-330.8(mild)-322.2(to)-324.6(moderate)-329.5(motor)-323(symptoms.)]TJ 7.0657 -1.0077 TD [(Postural)-337.3(instability)-335.4(present.)-335.1(Independent)]TJ 0 -1.0135 TD (ambulation.)Tj -7.0657 -1.0135 TD [(Stage)-335.5(4)-3012.7(Severe)-337.5(bilateral)-335.6(motor)-334.5(symptoms.)-335.9(Severe)]TJ 7.0657 -1.0135 TD [(disability.)-337.6(Needs)-336.2(an)-331.4(assistive)-339.5(device)]TJ 0 -1.0077 TD [(to)-336.2(walk)-334.4(and)-332.4(stand.)]TJ -7.0657 -1.0135 TD [(Stage)-335.5(5)-3012.7(Severe)-337.5(bilateral)-335.6(motor)-334.5(symptoms.)-335.9(Severe)]TJ 7.0657 -1.0135 TD [(disability.)-257(Wheelchair)-253.2(bound)-252.6(or)-249.6(bedridden.)]TJ T* [(Can)-333.4(only)-338.1(ambulate)-335.4(with)-333.4(another)-337.7(person)]TJ 0 -1.0077 TD (assisting.)Tj 8.7511 0 0 8.7511 321.0519 57.0898 Tm [(H&Y,)-331.7(Hoehn)-334.5(and)-334.6(Yahr.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 62.022 749.6502 Tm (1514)Tj 48.4398 0 TD [(KATZ)-333.1(ET)-338.7(AL.)]TJ ET endstream endobj 73 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.843 0 0 9.843 59.7543 725.1588 Tm 0 0 0 rg .0185 Tc 0 Tw [(diseases,)-221.1(i)0(ncluding)-218.7(PD.)-226.8(A)5(rticial)-224.6(hydration/nutrition)-224.5(i)0(s)-218.5(not)]TJ 0 -1.1174 TD .0187 Tc [(recommended)-368.3(f).4(or)-368.3(these)-369.5(i).2(ndividuals)-368.1(since)-369.5(i).2(t)-368.4(h)6.1(as)-368.1(not)-368.4(been)]TJ 0 -1.1116 TD .0185 Tc [(shown)-328.2(t)0(o)-328.2(p).1(rolong)-328.2(life)-329.3(o).1(r)-328.1(i)0(mprove/maintain)-328.2(quality)-328.2(of)-328.1(life)]TJ T* [(for)-644.8(t).1(hose)-646(w)-.6(ith)-644.9(en)6(d-s)-5.3(t)5.9(age)-646(n).2(eurodegenerative)-646(d).2(isease.)]TJ 7.3823 0 0 6.5614 291.2881 696.6423 Tm .0299 Tc (60)Tj 9.843 0 0 9.843 59.7543 681.3352 Tm .0186 Tc [(Notably,)-353.4(as)-350.9(with)-351.1(other)-356.8(a)-.9(spects)-356.7(of)-351.1(PD,)-353.4(t).1(here)-352.3(is)-350.9(signicant)]TJ 0 -1.1174 TD [(variability)-362.7(in)-357(end-stage)-358.1(d).1(isease)-363.9(r).2(anging)-357(from)-364(a)-1(mbulatory)]TJ 0 -1.1116 TD [(persons)-264.6(dyi)5.8(ng)-264.8(of)-259(complications)-264.6(of)-259(dement)5.8(ia)-266(to)-259.1(others)-258.9(with)]TJ T* [(a)-323.6(s).3(oun)5.9(d)-322.4(m)4.7(ind)-322.4(d).1(y)5.9(i)0(ng)-322.4(of)-316.6(complications)-316.5(of)-322.4(p)5.9(hysical)-316.8(debility)]TJ 0 -1.1174 TD .0183 Tc [(and)-322.6(dysphagia.)]TJ 1.0137 -1.1116 TD 0 Tc [(In)-365(ad)19.7(di)20.7(ti)14.8(on)-359.3(to)-365.2(ma)18.4(na)19.7(ge)19.7(me)18.4(nt)-365.2(of)-365(mo)19.6(to)20.7(r)-375.4(s)0(y)21(m)0(p)13.9(t)0(o)20.7(m)0(s)19.8(,)-372.1(it)-365.3(is)-365(im)19.5(-)]TJ -1.0137 -1.1116 TD [(po)15.1(rt)20.7(an)19.7(t)-300.7(t)0(o)-290.3(c)0(o)19.7(n)0(t)20.7(i)0(n)15(u)0(e)-291.3(t)0(o)-290.3(m)0(o)19.6(n)0(i)20.7(t)0(o)20.7(r)-300.6(an)13.9(d)-300.6(t)0(r)20.7(e)0(a)18.5(t)-300.7(no)20.8(nm)19.6(ot)20.7(or)-295.9(sy)21(mp)19.6(to)20.7(ms)]TJ 0 -1.1174 TD [(th)15(at)-331.8(ca)18.5(n)-346.7(a)0(r)19.7(i)0(s)15.1(e)-342.1(in)-336.4(th)20.7(e)-347.8(l)0(a)19.6(s)0(t)-336.2(f)0(e)19.7(w)-347.5(ye)19.7(ar)19.7(s)-346.5(o)0(f)-336.2(l)0(i)20.6(f)0(e)-337.4(f)0(o)20.9(r)-346.6(so)21(me)18.4(on)20.8(e)-347.8(w)0(i)19.8(t)0(h)]TJ 0 -1.1116 TD [(PD)14.4(,)]TJ 7.3823 0 0 6.5614 74.4378 597.9967 Tm (61)Tj 9.843 0 0 9.843 85.6063 593.6313 Tm [(su)15.3(ch)-383.5(as)-383.3(ey)13.9(el)19.5(id)-382.5(op)20.8(en)19.7(in)15(g)-392.8(a)0(p)19.7(r)0(a)19.7(x)0(i)20.7(a)-399.7(\(d)20.9(if)20.7(c)19.8(ul)14.9(ty)-382.5(ra)19.7(is)20.9(in)15(g)-392.8(t)0(h)20.7(e)]TJ -2.6264 -1.1116 TD [(ey)13.9(el)19.5(id)20.7(s,)-396(wh)20(ic)13.8(h)-404.3(c)0(a)18.5(n)-410(co)19.7(nt)20.7(ri)20.7(bu)20.8(te)-400.9(to)-399.7(so)21(ci)19.5(al)-400.9(is)20.9(ol)20.7(at)19.5(io)15(n\))20.9(.)-406.6(S)0(h)21(o)0(u)20.8(l)0(d)-399.7(a)]TJ T* [(pe)13.9(rs)21.1(on)-261.4(wi)19.8(th)-255.8(en)13.9(d-)20.9(st)20.9(ag)19.7(e)-273(P)0(D)-256.3(e)0(n)13.9(r)0(o)20.9(l)0(l)-261.6(i)0(n)-255.8(h)0(o)20.8(s)0(p)15.3(i)0(c)19.6(e)-267.2(se)14.1(rv)20.9(ic)19.6(es)19.9(,)-268.4(c)0(a)18.5(r)0(b)15.1(i)0(d)20.7(o)0(-)]TJ 0 -1.1174 TD [(pa)13.9(/l)20.6(ev)19.7(od)20.8(op)20.8(a)-428.5(a)0(n)13.9(d)-427.3(ot)20.7(he)19.7(r)-427.3(s)0(y)15.3(m)0(p)19.6(t)0(o)20.7(m)0(-)19.6(t)0(a)19.6(r)0(g)20.9(e)0(t)13.8(e)0(d)-418.1(m)0(e)18.4(d)0(i)20.7(c)0(a)18.5(t)0(i)20.6(o)0(n)15.1(s)-427.1(\(e)19.7(.g)18.5(.)13.9(,)]TJ 0 -1.1116 TD [(ch)13.9(ol)20.7(in)20.7(es)19.9(te)19.6(ra)19.7(se)-331.5(in)20.7(hi)20.7(bi)20.7(to)20.7(rs)15.3(\))-335.1(s)0(h)21(o)0(u)20.8(l)0(d)-324.9(b)0(e)-325.9(c)0(o)19.7(n)0(t)20.7(i)0(n)20.7(u)0(e)13.9(d)-335.2(fo)20.9(r)-335.1(a)0(s)-325.7(l)0(o)20.7(n)0(g)-324.7(a)0(s)]TJ T* [(to)15(le)19.6(ra)19.7(te)19.6(d.)-286.8(An)20(ot)20.7(he)13.9(r)-294.8(c)0(o)19.7(n)0(s)21(i)0(d)20.7(e)0(r)14(a)0(t)19.5(i)0(o)20.7(n)-294.8(is)-290.1(th)20.7(at)-285.7(ps)15.3(yc)19.7(ho)20.8(lo)20.7(gi)20.7(ca)18.5(l)-300.7(b)0(u)20.8(r)0(d)20.9(e)0(n)]TJ 0 -1.1174 TD [(an)13.9(d)-461.9(d)0(e)19.7(p)0(r)15.1(e)0(s)19.9(s)0(i)20.9(o)0(n)-457.2(a)0(m)18.5(o)0(n)20.8(g)-467.6(ca)18.5(re)19.7(gi)20.7(ve)19.7(rs)-457(be)19.7(co)19.7(me)-459.6(mo)19.6(re)-452.6(pr)15.1(om)19.6(in)20.7(en)19.7(t)]TJ 0 -1.1116 TD [(wi)14.1(th)-336.4(la)19.6(te)19.5(-s)15.3(ta)19.6(ge)-337.4(PD)-342.7(as)-337.2(we)18.8(ll)20.6(;)-352.6(p)0(r)20.9(o)0(v)20.8(i)0(d)20.7(e)0(r)19.7(s)-352.2(sh)21(ou)20.8(ld)-342.1(ch)19.7(ec)18.5(k)-346.7(o)0(n)-342(c)0(a)18.5(r)0(e)19.7(-)]TJ T* [(gi)14.9(ve)19.7(rs)21.1()-381.2(w)0(e)18.8(l)0(l)20.6(-)0(b)20.9(e)0(i)19.5(n)0(g)-370.8(r)0(o)20.9(u)0(t)20.7(i)0(n)20.7(e)0(l)13.8(y)-375.5(an)19.7(d)-381.2(d)0(i)20.7(s)0(c)19.9(u)0(s)21(s)-381(su)21(pp)20.8(or)15.1(ti)20.6(ve)-366.2(se)14.1(rv)20.9(ic)19.6(es)]TJ 0 -1.1174 TD [(su)15.3(ch)-256.8(as)-262.4(so)15.3(ci)19.5(al)-256.9(wo)14.2(rk)20.9(,)-268.4(s)0(p)21(i)0(r)15(i)0(t)20.6(u)0(a)19.7(l)-271.9(ca)18.5(re)19.7(,)-268.4(a)0(n)19.7(d)-271.8(re)19.7(sp)15.3(it)20.6(e)-267.2(a)0(s)-262.4(i)0(n)20.7(d)0(i)14.9(c)0(a)18.5(t)0(e)19.6(d)0(.)]TJ 7.3823 0 0 6.5614 290.3243 499.4077 Tm -.0162 Tc (62)Tj 9.843 0 0 9.843 69.7323 484.0439 Tm 0 Tc [(Cu)19.8(r)16.2(r)0(e)19.7(n)0(t)26.5(l)0(y)20.7(,)-239.6(th)20.7(er)25.5(e)-244.2(i)0(s)-232.5(a)-244.2(si)20.9(g)16.2(n)0(i)20.7()0(c)25.6(a)0(n)19.7(t)-243.1(u)16.2(n)0(d)20.8(e)0(r)25.5(u)0(s)21(e)-244.2(of)-232.6(P)16.3(C)-244(an)19.7(d)-243(h)16.2(os)21(pi)26.5(ce)]TJ -1.0137 -1.1116 TD [(in)-324.9(th)26.5(e)-336.3(t)0(e)19.6(r)16.2(mi)19.5(na)25.4(l)-335.3(s)0(t)20.9(a)15(ge)-325.9(of)-319(PD)20.1(.)-331.7(L)0(e)18.5(s)16.4(s)-335(t)0(h)20.7(a)0(n)-320.1(5)0(%)-325.8(o)0(f)-319(t)0(h)20.7(o)0(s)26.8(e)-336.3(wi)19.8(t)16.1(h)-335.2(PD)]TJ 0 -1.1174 TD [(re)19.7(ce)24.3(iv)20.7(e)-169.3(h)16.2(os)21(pi)20.7(c)15(e)-169.3(at)-159(th)26.5(e)-169.3(e)0(n)19.7(d)-168.1(of)-157.7(l)16.1(i)0(f)20.7(e)-169.3(\(a)19.7(l)16.1(t)0(h)20.7(o)0(u)26.6(g)0(h)-157.7(u)0(s)21(e)-169.3(m)15(a)0(y)-158.9(b)0(e)-158.9(h)16.2(ig)20.7(he)25.4(r)-168.1(i)0(n)]TJ 0 -1.1116 TD [(nu)20.8(rs)21.1(i)16.1(n)0(g)-347.8(h)16.2(om)19.6(e)-353.6(r)0(e)19.7(s)0(i)26.7(d)0(e)19.7(n)0(t)26.5(s)0(\))21.1(,)]TJ 7.3823 0 0 6.5614 156.6992 455.5274 Tm (63)Tj 9.843 0 0 9.843 167.5275 451.1621 Tm [(a)15(n)0(d)-347.8(t)16.1(he)-348.9(m)15(a)0(j)19.5(o)0(r)26.6(i)0(t)20.6(y)-358.2(d)16.2(i)0(e)-349.1(i)16.1(n)-358.2(t)0(h)20.7(e)-353.6(ac)18.5(u)16.2(t)0(e)]TJ -10.9492 -1.1116 TD [(in)20.7(pa)25.4(ti)20.6(en)25.4(t)-323.8(h)0(o)26.6(s)0(p)21(i)0(t)20.6(a)15(l)-323.8(s)0(e)25.6(t)0(t)20.6(i)0(n)26.5(g)0(.)]TJ 7.3823 0 0 6.5614 158.1732 444.5857 Tm -.0173 Tc [(55,6)-17.3(4)]TJ 9.843 0 0 9.843 177.5054 440.2204 Tm .3074 Tc [(A)-11.3(p)307.4(a)327.1(r)323.6(t)-16.4(o)307.4(ft)307.4(h)328.1(i)307.4(sm)307.4(a)325.8(y)-10.5(b)307.4(e)-7(d)323.6(u)307.4(e)-7(t)323.5(o)-16.2(a)]TJ -11.9629 -1.1116 TD 0 Tc [(la)19.6(ck)-268.3(of)-267.1(tr)26.5(ai)19.5(ni)26.5(ng)-267.1(in)-267.3(se)19.9(ri)26.5(ou)20.8(s)-277.4(i)0(l)20.6(l)16.1(ne)19.7(ss)-266.8(co)19.7(m)15(m)0(u)25.4(n)0(i)20.7(c)0(a)24.3(t)0(i)20.6(o)0(n)-267.1(a)0(m)24.2(o)0(n)20.8(g)-277.6(ne)25.4(u-)]TJ 0 -1.1174 TD [(ro)20.9(lo)26.5(gi)20.7(st)20.9(s)16.4(.)-326(O)15.3(n)0(e)-314.4(s)0(t)26.7(u)0(d)20.8(y)-323.6(t)16.1(h)0(a)19.7(t)-323.8(e)15(x)0(a)19.7(m)15(in)20.7(ed)-308.6(pa)19.7(ti)26.3(en)19.7(t)16.1(s)-323.4(wi)19.8(th)-307.6(Pa)19.8(rk)26.6(in)20.7(so)26.8(n)20.9(s)]TJ 0 -1.1116 TD [(wh)20(o)-392.8(d)16.2(ie)19.6(d)-392.8(i)0(n)-376.7(t)0(h)20.7(e)-393.9(i)16.1(n)0(p)20.8(a)0(t)25.3(i)0(e)19.6(n)0(t)-376.7(h)0(o)20.8(s)0(p)21(i)16.1(ta)19.6(l)-392.9(s)16.4(et)19.5(ti)26.3(ng)-382.3(sh)21(o)16.2(w)0(e)18.8(d)-392.8(t)16.1(h)0(a)19.7(t)-392.9(9)16.2(7)0(%)]TJ T* [(la)19.6(ck)25.4(ed)-297.1(a)-307.5(d)16.2(oc)19.7(um)25.4(en)19.7(t)16.1(e)0(d)-297.1(g)0(o)26.6(a)0(l)19.5(s)0(-)21.1(o)16.2(f-)20.9(ca)24.3(re)-297.1(di)26.5(sc)19.9(us)26.8(si)20.9(on)-295.9(o)16.2(r)-306.3(ad)19.7(va)25.4(nc)19.7(e)-301.8(d)0(i)20.7(-)]TJ 0 -1.1174 TD [(re)19.7(ct)25.3(iv)20.7(e.)]TJ 7.3823 0 0 6.5614 88.2708 389.7637 Tm -.0162 Tc (64)Tj 9.843 0 0 9.843 98.5889 385.3983 Tm 0 Tc [(Pa)19.8(ti)26.3(en)19.7(ts)-295.9(wh)20(o)-312.1(d)0(o)-295.9(c)0(o)19.7(m)15(pl)20.7(et)25.3(e)-313.3(a)0(n)-302.9(a)15(dv)20.8(an)25.4(ce)-304(di)26.5(re)19.7(ct)25.3(iv)20.7(e)-313.3(a)15(re)]TJ -3.9454 -1.1116 TD [(mu)19.6(c)15(h)-220(mo)25.4(re)-210.7(li)26.3(ke)19.7(ly)-203.9(to)-209.7(d)16.2(i)0(e)-210.8(a)0(t)-205.1(h)0(o)20.8(m)15(e.)]TJ 7.3823 0 0 6.5614 186.4629 378.8219 Tm -.0162 Tc (65)Tj 9.843 0 0 9.843 195.9307 374.4566 Tm 0 Tc [(A)15.3(n)0(o)20.8(t)0(h)26.5(e)0(r)-210.7(r)0(e)25.5(a)0(s)19.9(o)0(n)-203.8(f)0(o)20.9(r)-214.2(th)20.7(e)-221.1(l)16.1(ow)]TJ -13.8348 -1.1116 TD [(ra)19.7(te)-193.6(of)-198(h)16.2(o)0(s)21(p)0(i)26.5(c)0(e)-200.4(u)16.2(se)-199(at)-193.6(th)20.7(e)-203.8(e)0(n)19.7(d)-202.7(of)-198(li)26.3(fe)-199.2(fo)26.6(r)-208.4(t)0(h)26.5(o)0(s)21(e)-209.6(w)15.3(i)0(t)20.6(h)-202.7(PD)-198.7(co)25.4(ul)20.7(d)-202.7(b)0(e)]TJ 0 -1.1174 TD [(th)20.7(e)-330.6(l)0(a)19.5(c)15(k)-335.2(o)16.2(f)-335.1(c)15(le)19.5(ar)-320.1(ho)26.6(sp)21(ic)19.6(e)-330.6(e)15(li)20.6(gi)20.7(b)16.2(i)0(l)20.6(i)0(t)26.3(y)-335.2(g)16.2(u)0(i)20.7(d)0(e)25.4(l)0(i)20.6(n)0(e)25.4(s)-335(f)16.2(o)0(r)-324.7(P)16.3(D.)-322.2(Ad)25.7(di)20.7(-)]TJ 0 -1.1116 TD [(ti)20.6(on)26.6(al)-233.9(re)25.5(se)19.9(ar)19.7(c)15(h)-243(on)-232.6(p)16.2(r)0(e)19.7(d)0(i)26.5(c)0(t)19.5(o)0(r)26.6(s)-242.8(of)-232.6(a)-244.2(s)0(i)20.9(x)16.2(-m)19.6(o)16.2(n)0(t)20.7(h)-243(li)26.3(fe)-233.7(ex)25.4(pe)19.7(ct)25.3(an)19.7(c)15(y)-243(in)]TJ T* [(PD)-262.1(i)16.1(s)-271.6(n)16.2(e)0(e)18.5(d)0(e)25.4(d)-271.8(t)16.1(o)-271.8(op)26.6(ti)20.6(m)15(i)0(z)19.6(e)-267.2(ti)20.6(m)15(i)0(n)20.7(g)-266(of)-255.6(ho)20.8(sp)26.8(ic)19.6(e)-267.2(r)0(e)19.7(f)16.2(er)19.7(ra)25.5(ls)20.9(.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 308.6928 Tm (Conclusion)Tj /F5 1 Tf 9.843 0 0 9.843 69.7323 292.2519 Tm [(Th)25.4(e)-342.1(i)16.1(nt)20.7(ro)26.6(du)20.8(ct)25.3(io)20.7(n)-335.2(o)0(f)-324.7(P)0(C)-325.6(t)0(o)-324.9(t)0(h)26.5(e)-342.1(t)16.1(r)0(e)19.7(a)0(t)25.3(m)0(e)18.4(n)16.2(t)-341(o)16.2(f)-340.9(t)16.1(ho)20.8(se)-325.7(wi)25.6(th)-324.9(PD)]TJ -1.0137 -1.1116 TD [(re)19.7(pr)26.6(es)19.9(en)25.4(ts)-336.2(a)-353.6(p)16.2(ar)19.7(ad)25.4(ig)20.7(m)-347.9(s)0(h)26.8(i)0(f)20.7(t)-346.8(in)-336.4(th)20.7(e)-347.8(c)15(ar)19.7(e)-347.8(o)0(f)-336.2(p)0(a)25.4(t)0(i)20.6(e)0(n)25.4(t)0(s)-336.2(w)0(i)19.8(t)0(h)-336.4(n)0(e)25.4(u)0(-)]TJ T* [(ro)20.9(de)25.4(ge)19.7(ne)25.4(ra)19.7(ti)26.3(ve)-268.3(di)20.7(se)19.9(a)15(s)0(e)19.9(s)0(.)]TJ 7.3823 0 0 6.5614 153.4677 274.7338 Tm -.0162 Tc (66)Tj 9.843 0 0 9.843 163.5023 270.3684 Tm 0 Tc [(Th)25.4(e)-284.5(t)0(o)26.5(p)-283.3(10)-267.1(ti)20.6(p)16.2(s)-283.1(in)-267.3(th)20.7(i)16.1(s)-283.1(ar)25.5(ti)20.6(cl)25.3(e)-284.5(s)0(u)26.8(m)0(-)]TJ -10.5403 -1.1174 TD [(ma)18.4(r)16.2(i)0(z)19.6(e)-215.4(c)15(o)0(r)20.9(e)-215.4(i)16.1(n)0(f)20.9(o)0(r)26.6(m)0(a)18.4(t)16.1(io)20.7(n)-214.2(a)15(nd)-203.8(pe)25.4(ar)19.7(ls)-198(fr)20.9(om)-199.3(a)-215.4(g)0(r)20.9(o)16.2(up)-203.8(o)16.2(f)-214.2(mo)19.6(v)16.2(e)0(m)18.5(e)15(nt)]TJ 0 -1.1116 TD [(di)20.7(so)26.8(rd)20.9(er)-366.2(ne)25.4(ur)20.9(ol)26.5(og)20.8(is)26.7(ts)-365(an)19.7(d)-375.5(P)0(C)-365.9(c)0(l)25.3(i)0(n)20.7(i)0(c)25.3(i)0(a)19.6(n)16.2(s)-381(w)15.3(ho)-365.1(ar)19.7(e)-376.6(e)0(n)25.4(g)0(a)19.7(g)16.2(ed)-366.2(in)]TJ T* [(re)19.7(se)25.6(ar)19.7(ch)-210.7(an)19.7(d)-220(c)0(l)19.5(i)0(n)26.5(i)0(c)19.5(a)0(l)-210.8(w)0(o)20(r)16.2(k)-225.7(a)0(t)-210.8(t)0(h)20.7(e)-226.9(i)16.1(n)0(t)20.7(e)0(r)25.5(s)0(e)19.9(c)0(t)25.3(i)0(o)20.7(n)-225.7(o)16.2(f)-225.7(ne)25.4(ur)20.9(ol)20.7(o)16.2(g)0(y)-215.3(a)15(nd)]TJ 0 -1.1174 TD [(PC)20(.)-228.1(L)0(a)18.5(c)15(k)-231.5(o)0(f)-215.3(t)0(r)20.7(a)0(i)25.3(n)0(i)20.7(n)0(g)-215.3(a)0(n)19.7(d)-231.5(e)15(x)0(p)20.8(o)0(s)26.8(u)0(r)20.9(e)-232.6(t)16.1(o)-231.5(PC)-221.9(i)16.1(n)-231.5(ne)19.7(u)16.2(r)0(o)20.9(l)0(o)26.5(g)0(y)-221.1(t)0(r)26.5(a)0(i)19.6(n)0(i)26.5(n)0(g)]TJ 0 -1.1116 TD [(ca)18.5(n)-479.2(l)0(e)19.6(a)15(d)-484.9(t)0(o)-468.9(m)0(i)19.5(s)0(u)26.8(n)0(d)20.8(e)15(rs)21.1(ta)19.5(n)16.2(d)0(i)20.7(n)0(g)26.6(s)-484.7(ab)25.4(ou)20.8(t)-479.3(P)0(C)-475.4(i)0(n)-468.9(t)0(h)20.7(e)-480.3(ne)19.7(u)16.2(r)0(o)20.9(l)0(o)26.5(g)0(y)]TJ T* [(co)19.7(m)15(m)0(u)19.6(n)16.2(it)20.6(y)-358.2(a)15(nd)-347.8(m)15(e)0(a)18.5(n)-352.4(th)20.7(at)-343.3(PC)-348.6(c)15(l)0(i)20.6(n)0(i)20.7(c)15(ia)19.6(n)16.2(s)-358(sh)21(ou)26.6(ld)-347.9(a)15(c)0(t)19.5(i)0(v)26.5(e)0(l)19.5(y)-358.2(e)15(n)0(-)]TJ 0 -1.1174 TD [(ga)19.7(ge)-256.8(th)26.5(ei)19.6(r)-266(n)0(e)19.7(u)16.2(ro)20.9(lo)26.5(gy)-261.4(c)15(o)0(l)20.7(l)0(e)25.3(a)0(g)19.7(u)16.2(es)-262.4(t)16.1(o)-271.8(fo)26.6(st)20.9(er)-256.8(co)25.4(ll)20.6(ab)25.4(or)20.9(at)25.3(io)20.7(n.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 171.7228 Tm [(Author)-338.7(Disclosure)-336.7(Statement)]TJ /F5 1 Tf 9.843 0 0 9.843 69.7323 155.2818 Tm [(No)-279.5(competing)-284.4(nancial)-283.1(interests)-288.7(exist.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 135.326 Tm (References)Tj /F5 1 Tf 9.2951 0 0 9.2951 64.4031 119.2819 Tm [(1.)-500.4(Walker)-417.9(RW,)-418.1(Hand)-415(A,)-416.5(Jones)-411.8(C,)-413.6(et)-418.7(al.:)-412.2(The)-415.2(prevalence)-420.7(of)]TJ 1.2503 -1.1223 TD [(Parkinsons)-346.5(disease)-346.7(in)-341.3(a)-339.8(rural)-344.5(area)-344.9(of)-344.2(North-East)-347.2(England.)]TJ 0 -1.1284 TD [(Parkinsonism)-337.2(Relat)-336(Disord)-338.8(2010;16:572575.)]TJ -1.2503 -1.1223 TD [(2.)-500.4(Bostantjopoulou)-416.6(S,)-417.9(Katsarou)-420.7(Z,)-410.8(Karakasis)-424.1(C,)-413.6(et)-412.6(al.:)-418.3(Eva-)]TJ 1.2503 -1.1284 TD [(luation)-302.4(of)-301.5(non-motor)-303.8(symptoms)-302.9(in)-304.7(Parkinsons)-303.8(disease:)-303.6(An)]TJ 0 -1.1223 TD [(underestimated)-341.4(necessity.)-334.3(Hippokratia)-341.5(2013;17:214219.)]TJ 25.7632 70.806 TD [(3.)-500.4(Shulman)-519.5(LM,)-513.8(Taback)-521.6(RL,)-519.4(Rabinstein)-518.3(AA,)-521.9(Weiner)-521.6(WJ:)]TJ 1.2503 -1.1223 TD [(Non-recognition)-899.5(of)-899.2(depression)-906.4(and)-895.1(other)-903.3(non-motor)]TJ 0 -1.1284 TD [(symptoms)-729.9(in)-725.5(Parkinsons)-730.7(disease.)-731.1(Parkinsonism)-733.6(Relat)]TJ 0 -1.1223 TD [(Disord)-332.7(2002;8:193197.)]TJ -1.2503 -1.1283 TD [(4.)-500.4(M)12.8(u)0(r)21.8(p)0(h)24.1(y)-335.6(S)15.3(L)0(,)-325.4(X)0(u)-325.1(J)12.9(,)-335.5(K)0(o)22.5(c)0(h)19.9(a)14(ne)19.9(k)-335.6(K)0(D)21(,)-335.5(e)14(t)-335(al)20.5(.:)-322.9(De)18.3(a)14(t)12.6(hs)18.9(:)-335(F)15.3(i)12.6(n)0(a)19.9(l)-335(da)19.9(t)12.6(a)]TJ 1.2503 -1.1223 TD -.0241 Tc [(f)-8.3(o)-24.1(r)-282.9(2)-24.1(01)-24.1(5.)-292.5(I)-8.3(n)-24.1(:)]TJ /F9 1 Tf 5.2331 0 TD 0 Tc [(Na)19.3(t)12.6(i)12.6(o)0(n)24.1(a)0(l)-255.9(V)0(i)22.8(t)12.6(al)-255.9(St)24.7(at)18.6(i)12.6(s)12.9(t)12.6(i)12.6(c)0(s)-259.8(R)16.3(ep)19.9(or)25(t)12.6(s)0(,)-255.5(V)0(o)22.2(l)12.6(.)-268.4(6)0(6)-256.5(N)13.4(o.)-256.4(6.)]TJ /F5 1 Tf -5.2331 -1.1284 TD -.0134 Tc [(H)-13.4(y)9.1(atts)-13.4(v)5.5(ille,)-281.8(M)-13.4(D:)-281.3(N)-13.4(a)11(tio)-13.4(n)10.7(a)-13.4(l)-273.5(C)0(e)-13.4(n)6.5(ter)-284.2(f)-13.4(o)8.4(r)-278.1(H)-13.4(e)4.9(alt)-13.4(h)-275.4(Sta)-13.4(t)7.1(isti)-13.4(c)7.1(s)-.5(,)-281.8(2)-13.4(0)10.7(1)-13.4(8)10.7(.)]TJ -1.2503 -1.1223 TD 0 Tc [(5.)-500.4(Pennington)-440.5(S,)-442.3(Snell)-439.7(K,)-440.9(Lee)-443.8(M,)-438.6(Walker)-442.3(R:)-443.6(The)-439.6(cause)-445.5(of)]TJ 1.2503 -1.1284 TD [(death)-258.6(in)-262(idiopathic)-263.7(Parkinsons)-261.1(disease.)-261.4(Parkinsonism)-264(Relat)]TJ 0 -1.1223 TD [(Disord)-332.7(2010;16:434437.)]TJ -1.2503 -1.1284 TD [(6.)-500.4(Lyons)-569(KE,)-571.1(Pahwa)-574.7(R:)-565.6(The)-573.8(impact)-574.9(and)-565.8(management)-578(of)]TJ 1.2503 -1.1223 TD [(nonmotor)-368.4(symptoms)-376.1(of)-368.6(Parkinsons)-376.9(disease.)-371.2(Am)-373.5(J)-371.3(Manag)]TJ 0 -1.1284 TD [(Care)-333.3(2011;17)-335.9(Suppl)-332.4(12:S308S314.)]TJ -1.2503 -1.1284 TD [(7.)-500.4(Miyasaki)-391.1(JM:)-394.7(Palliative)-392.3(care)-393.7(in)-390.1(Parkinsons)-395.3(disease.)-395.6(Curr)]TJ 1.2503 -1.1223 TD [(Neurol)-331.7(Neurosci)-341.4(Rep)-332.7(2013;13:367.)]TJ -1.2503 -1.1284 TD [(8.)-500.4(Kluger)-350(BM,)-346(Fox)-344.9(S,)-350.8(Timmons)-348.2(S,)-350.8(et)-345.5(al.:)-351.2(Palliative)-349.6(care)-351(and)]TJ 1.2503 -1.1223 TD [(Parkinsons)-407.4(disease:)-413.4(Meeting)-410.1(summary)-408.3(and)-407.2(recommenda-)]TJ 0 -1.1284 TD [(tions)-242.7(for)-249(clinical)-249.4(research.)-253.6(Parkinsonism)-245.7(Relat)-250.6(Disord)-247.3(2017;)]TJ 0 -1.1223 TD (37:1926.)Tj -1.2503 -1.1284 TD [(9.)-500.4(Barone)-388.4(P,)-393.5(Antonini)-391.4(A,)-386(Colosimo)-393.8(C,)-389.3(et)-388.2(al.:)-393.9(The)-390.8(PRIAMO)]TJ 1.2503 -1.1223 TD [(study:)-486.8(A)-489.7(multicenter)-495.7(assessment)-491.4(of)-490.5(nonmotor)-490.4(symptoms)]TJ 0 -1.1284 TD [(and)-370.6(their)-372.1(impact)-367.6(on)-372.3(quality)-369.5(of)-374.7(life)-371.9(in)-365.7(Parkinsons)-376.9(disease.)]TJ 0 -1.1223 TD [(Mov)-329.1(Disord)-338.8(2009;24:16411649.)]TJ -1.7505 -1.1284 TD [(10.)-500.5(Chaudhuri)-725.7(KR,)-726.4(Healy)-729.9(DG,)-723.2(Schapira)-725.9(AH:)-728.8(Non-motor)]TJ 1.7505 -1.1223 TD [(symptoms)-370(of)-368.6(Parkinsons)-377(disease:)-376.8(Diagnosis)-370.1(and)-370.6(manage-)]TJ 0 -1.1284 TD [(ment.)-333.2(Lancet)-338.1(Neurol)-331.7(2006;5:235245.)]TJ -1.7505 -1.1223 TD [(11.)-500.5(Schapira)-262.4(AH,)-265.8(Chaudhuri)-262.1(KR,)-269(Jenner)-260.8(P:)-264.9(Non-motor)-262.7(features)]TJ 1.7505 -1.1284 TD [(of)-332(Parkinson)-332.5(disease.)-340.7(Nat)-335(Rev)-332.7(Neurosci)-335.3(2017;18:435.)]TJ -1.7505 -1.1223 TD [(12.)-500.5(Miyasaki)-305.7(JM,)-303.7(Long)-301.3(J,)-304.3(Mancini)-306.4(D,)-300.7(et)-302.8(al.:)-302.4(Palliative)-306.9(care)-308.3(for)]TJ 1.7505 -1.1284 TD [(advanced)-255.9(Parkinson)-253.2(disease:)-254.8(An)-258(interdisciplinary)-253.3(clinic)-257.6(and)]TJ 0 -1.1223 TD [(new)-280.7(scale,)-280.3(the)-278.5(ESAS-PD.)-285.5(Parkinsonism)-282.3(Relat)-281.1(Disord)-277.8(2012;)]TJ 0 -1.1284 TD [(18)-329.6(Suppl)-332.4(3:S6S9.)]TJ -1.7505 -1.1223 TD [(13.)-500.5(McKeith)-393.4(IG,)-388.5(Dickson)-389.6(DW,)-390.5(Lowe)-392.5(J,)-389.7(et)-394.3(al.:)-387.8(Diagnosis)-394.5(and)]TJ 1.7505 -1.1284 TD [(management)-242.5(of)-234.4(dementia)-244(with)-238.9(Lewy)-240(bodies:)-235(Third)-242.2(report)-240.9(of)]TJ 0 -1.1223 TD [(the)-333.4(DLB)-331.9(consortium.)-335(Neurology)-338.2(2005;65:18631872.)]TJ -1.7505 -1.1284 TD .0194 Tc [(1)19.4(4)19.4(.)-481.1(Litvan)-365(I,)-371(Agid)-371.1(Y,)-364.9(C)-3.8(a)2.9(ln)-5.1(e)-369.2(D)-.6(,)-364.9(e)-3.2(t)-370.5(a)2.9(l.)-5.1(:)-364.4(C)-3.8(linical)-364.4(research)-371.1(cri)-4.6(-)]TJ 1.7505 -1.1223 TD .0184 Tc [(teria)-345.8(f)-2.4(or)-337.8(t)-5.6(h)0(e)-339.7(d)0(i)-5.6(a)1.9(gnos)-5.3(is)-340.7(of)-343.9(progres)-5.3(sive)-345.8(supranu)-6.1(c)1.9(lear)-343.9(palsy)]TJ 0 -1.1284 TD .0186 Tc [(\(Steel)-5.4(e-Ri)-5.4(chardson-Olszew)]TJ 11.491 0 TD .019 Tc [(s)-4.7(k).6(i)-377(s)-4.7(yndrome\):)-383.1(R)1.9(eport)-377(o).6(f)-386(t)1.1(he)]TJ -11.491 -1.1223 TD .0188 Tc [(NINDS-SPSP)-423.4(int)-5.2(e)2.3(rnat)-5.2(ional)-426(w)-1.2(orkshop.)-426.5(Neuro)-5.7(l).9(ogy)-426.6(1996;)]TJ 0 -1.1284 TD .0183 Tc (47:19.)Tj -1.7505 -1.1223 TD 0 Tc [(15.)-500.5(Gilman)-273.4(S,)-271.5(Wenning)-277.4(GK,)-271.9(Low)-272.3(PA,)-273.2(et)-278.4(al.:)-271.9(Second)-274.4(consensus)]TJ 1.7505 -1.1284 TD [(statement)-547.6(on)-549.2(the)-546.9(diagnosis)-551.5(of)-545.4(multiple)-551.6(system)-545.1(atrophy.)]TJ 0 -1.1223 TD [(Neurology)-332.1(2008;71:670676.)]TJ -1.7505 -1.1284 TD [(16.)-500.5(Armstrong)-383.8(MJ,)-376.9(Litvan)-384(I,)-380.7(Lang)-384.8(AE,)-382(et)-382.1(al.:)-381.7(Criteria)-383.2(for)-383.2(the)]TJ 1.7505 -1.1223 TD [(diagnosis)-246.6(of)-246.6(corticobasal)-250.1(degeneration.)-245.5(Neurology)-246.7(2013;80:)]TJ 0 -1.1284 TD (496503.)Tj -1.7505 -1.1284 TD [(17.)-500.5(Levin)-396.6(J,)-395.8(Kurz)-399(A,)-398.2(Arzberger)-400.6(T,)-398.6(et)-394.3(al.:)-400(The)-396.9(differential)-403.3(di-)]TJ 1.7505 -1.1223 TD [(agnosis)-618.9(and)-620.7(treatment)-630.1(of)-618.6(atypical)-622(parkinsonism.)-627.1(Dtsch)]TJ 0 -1.1284 TD [(Arztebl)-335.4(Int)-331.5(2016;113:6169.)]TJ -1.7505 -1.1223 TD [(18.)-500.5(Wiblin)-302.4(L,)-301(Lee)-303.5(M,)-298.3(Burn)-300.4(D:)-300.2(Palliative)-306.9(care)-302.2(and)-303.5(its)-303.4(emerging)]TJ 1.7505 -1.1284 TD [(role)-555.5(in)-548.6(multiple)-557.7(system)-551.2(atrophy)-555.9(and)-553.6(progressive)-555.1(supra-)]TJ 0 -1.1223 TD [(nuclear)-332.5(palsy.)-339(Parkinsonism)-331.1(Relat)-336(Disord)-338.8(2017;34:714.)]TJ -1.7505 -1.1284 TD [(19.)-500.5(Varanese)-307.7(S,)-302(Birnbaum)-310.3(Z,)-301(Rossi)-308.1(R,)-303.9(Di)-306.3(Rocco)-306.7(A:)-300.2(Treatment)]TJ 1.7505 -1.1223 TD [(of)-569.8(advanced)-579.1(Parkinsons)-572.1(disease.)-578.6(Parkinsons)-569.7(Dis)-573.9(2011;)]TJ 0 -1.1284 TD (2010:480260.)Tj -1.7505 -1.1223 TD [(20.)-500.5(Cenci)-489.1(MA:)-488.6(Presynaptic)-493.1(mechanisms)-492.7(of)-490.5(l-DOPA-induced)]TJ 1.7505 -1.1284 TD [(dyskinesia:)-457.9(The)-451.8(ndings,)-460(the)-455.4(debate,)-458.2(and)-456(the)-455.4(therapeutic)]TJ 0 -1.1223 TD [(implications.)-335.4(Front)-334.7(Neurol)-331.7(2014;5:242.)]TJ -1.7505 -1.1284 TD [(21.)-500.5(B)13.4(a)14(st)19.5(i)12.6(d)0(e)-327.7(M)12.8(F)15.3(,)-341.6(M)12.8(e)14(i)12.6(s)0(s)19.8(n)0(e)26(r)-337.9(WG)24.3(,)-341.6(P)15.3(i)12.6(c)0(c)21.8(o)0(n)24.1(i)-341.1(B)13.4(,)-335.5(et)-327.2(a)14(l)0(.)18.7(:)-335(P)15.3(a)0(t)20.5(h)0(o)24.1(p)0(h)24.1(y)0(s)25(i)12.6(ol)18.6(-)]TJ 1.7505 -1.1223 TD [(og)24.1(y)-353.9(o)0(f)]TJ /F7 1 Tf 3.013 0 TD (l)Tj /F5 1 Tf .4879 0 TD [(-)15.8(d)0(o)24.1(p)0(a)19.9(-)15.8(in)18.6(du)24.1(c)14(e)0(d)-346(m)12.5(ot)24.7(or)-350.3(a)14(n)0(d)-347.9(n)0(o)24.1(n)0(-)27.9(m)0(o)18.4(t)12.6(or)-344.2(c)14(o)0(m)18.4(p)0(l)24.7(i)12.6(c)14(a)0(t)20.5(i)12.6(on)24.1(s)]TJ -3.501 -1.1284 TD [(i)12.6(n)-317.3(Pa)23.1(rk)21.8(i)12.6(n)0(s)18.9(o)0(n)24.1()15.8(s)-322.5(d)0(i)24.7(s)0(e)20.8(a)14(se)20.8(.)-323.3(P)15.3(ro)21.8(g)-323.4(N)0(e)24.4(u)0(r)21.8(o)0(b)24.1(i)12.6(ol)-310.8(20)24.1(15)24.1(;)12.6(1)0(3)24.1(2)0(:)24.7(9)0(6)24.1()0(1)24.1(6)0(8)24.1(.)]TJ -1.7505 -1.1223 TD [(22.)-500.5(C)13.4(h)0(a)26(n)0(g)-415(A)0(,)-416.5(F)15.3(ox)-415(S)15.3(H)0(:)-416(P)0(s)22.1(y)0(c)26(h)0(o)24.1(s)12.9(is)-413.6(in)-414.5(Pa)23.1(rk)21.8(i)12.6(n)0(s)25(o)0(n)24.1()0(s)-416.5(d)0(i)24.7(s)12.9(ea)21.8(s)12.9(e)0(:)-418.7(E)16.3(pi)18.6(-)]TJ 1.7505 -1.1284 TD [(de)26(m)12.5(i)12.6(ol)18.6(og)24.1(y,)-280.8(pa)19.9(t)12.6(h)0(o)24.1(p)0(h)24.1(y)0(s)25(i)12.6(ol)24.7(og)24.1(y,)-286.9(a)14(n)0(d)-286.9(m)12.5(an)19.9(a)14(g)0(e)19.9(m)12.5(e)14(n)0(t)24.7(.)-298.9(Dr)26.3(ug)24.1(s)-298.1(2)0(0)24.1(1)0(6)24.1(;)]TJ 0 -1.1223 TD -.0241 Tc [(7)-24.1(6)0(:)-11.5(1)-24.1(09)-24.1(3)-24.1(11)-24.1(18)-24.1(.)]TJ /F4 1 Tf 8.9663 0 0 8.9663 59.7543 749.7069 Tm 0 Tc [(PARKINSONS)-340.4(DISEASE)-335.9(AND)-337.2(RELATED)-338(DISORDERS)-26997.8(1515)]TJ ET endstream endobj 77 0 obj <>stream /GS1 gs BT /F5 1 Tf 9.2951 0 0 9.2951 62.022 725.1588 Tm 0 0 0 rg 0 Tc 0 Tw [(23.)-500.5(Le)24.1(wi)23.1(s)-523.8(S)0(J)22.1(,)-524.6(Ga)24.4(ng)24.1(ad)19.9(ha)26(ra)23.7(n)-524.7(S)15.3(,)-524.6(P)0(a)23.1(d)0(m)24.5(a)0(k)19.9(u)0(m)24.5(a)14(r)-527(C)13.4(P:)-514.9(P)15.3(a)0(r)23.7(k)0(i)24.7(n)0(s)18.9(o)0(n)24.1()15.8(s)]TJ 1.7505 -1.1223 TD [(di)24.7(s)12.9(e)0(a)21.8(s)0(e)-235.4(i)12.6(n)-250.2(t)12.6(he)-236.3(ol)24.7(de)26(r)-246.4(p)0(a)19.9(t)12.6(i)12.6(e)0(n)19.9(t)12.6(.)-244(C)13.4(li)19.2(n)-244.1(M)12.8(ed)19.9(i)12.6(c)14(i)12.6(n)0(e)-236.3(2)0(0)24.1(1)0(6)24.1(;)12.6(16)24.1(:3)18.6(76)24.1(3)24.1(78)24.1(.)]TJ -1.7505 -1.1284 TD .0104 Tc [(2)10.4(4)10.4(.)-490.1(Pondal)-349(M)10.4(,)-355(Marras)-348.7(C)-.6(,)-343.4(M)-1.2(iyasaki)-349(J)-1(,)-343.4(e)0(t)-349(a)0(l.:)-349(C)-.6(l)10.4(i)-7(nical)-342.9(feat)10.4(u)-7.6(r)1.8(es)]TJ 1.7505 -1.1223 TD .012 Tc [(of)-271(d)5.8(o)-.3(p)5.8(a)-4.5(m)12(i)-5.6(ne)-266.8(ag)5.8(on)5.8(ist)-268.1(w)-1.9(it)12(h)-6(d)-.3(rawal)-268.1(s).6(y)5.8(ndrom)12(e)-278.7(i).2(n)-268.7(a)-272.9(mo)5.8(vement)]TJ 0 -1.1283 TD .0111 Tc [(di)11.1(sorders)-360.2(c).7(l)11.1(i)-6.3(nic.)-354.9(J)-360.2(N)3.3(eurol)-354.4(N)-2.8(euro)4.9(surg)-361.1(Psy)4.9(c).7(hiat)11.1(r)-9.2(y)-355(20)4.9(13;)11.1(8)-6.9(4)4.9(:)]TJ 0 -1.1223 TD .0123 Tc [(13)6.1(0)6.1(135)6.1(.)]TJ -1.7505 -1.1284 TD 0 Tc [(25.)-500.5(Okun)-331.5(MS:)-325.3(Deep-brain)-336.9(stimulation)-331(for)-328.3(Parkinsons)-334.3(disease.)]TJ 1.7505 -1.1223 TD [(N)-331.1(Engl)-337.4(J)-334.7(Med)-333.3(2012;367:15291538.)]TJ -1.7505 -1.1284 TD [(26.)-500.5(Sillay)-506.4(KA,)-509.8(Larson)-508.5(PS,)-512.4(Starr)-505.9(PA:)-510.6(Deep)-510.7(brain)-506.8(stimulator)]TJ 1.7505 -1.1223 TD [(hardware-related)-342.2(infections:)-332.4(Incidence)-337(and)-334(management)-340.1(in)]TJ 0 -1.1284 TD [(a)-333.7(large)-334.1(series.)-338.7(Neurosurgery)-335(2008;62:360367.)]TJ -1.7505 -1.1223 TD [(27.)-500.5(Jankovic)-422.9(J:)-413.6(Parkinsons)-419.6(disease:)-425.6(Clinical)-420.7(features)-419.5(and)-419.4(di-)]TJ 1.7505 -1.1284 TD [(agnosis.)-332.3(J)-334.7(Neurol)-337.8(Neurosurg)-334.1(Psychiatry)-336.3(2008;79:368376.)]TJ -1.7505 -1.1284 TD [(28.)-500.5(Kadastik-Eerme)-311.2(L,)-301(Muldmaa)-300.4(M,)-304.4(Lilles)-303.2(S,)-302(et)-302.8(al.:)-302.4(Nonmotor)]TJ 1.7505 -1.1223 TD [(features)-352.4(in)-353.5(Parkinsons)-352.6(disease:)-358.5(What)-350.1(are)-352.7(the)-351.7(most)-352.4(impor-)]TJ 0 -1.1284 TD [(tant)-967.3(associated)-972.9(factors?)-968.4(Parkinsons)-966.1(Dis)-970.3(2016;2016:)]TJ 0 -1.1223 TD (4370674.)Tj -1.7505 -1.1284 TD [(29.)-500.5(Boersma)-369(I,)-368.5(Jones)-369.1(J,)-365.3(Carter)-365.8(J,)-371.4(et)-363.8(al.:)-369.5(Parkinson)-369.1(disease)-371.1(pa-)]TJ 1.7505 -1.1223 TD [(tients)-297.7(perspectives)-304.6(on)-299.1(palliative)-297.9(care)-302.2(needs:)-300.6(What)-301.3(are)-297.8(they)]TJ 0 -1.1284 TD [(telling)-332.3(us?)-339.2(Neurol)-331.7(Clin)-333.6(Pract)-337(2016;6:209219.)]TJ -1.7505 -1.1223 TD [(30.)-500.5(Balestrino)-404.7(R,)-401.4(Martinez-Martin)-406.4(P:)-405.2(Neuropsychiatric)-407(symp-)]TJ 1.7505 -1.1284 TD [(toms,)-370.8(behavioural)-375.2(disorders,)-373.8(and)-376.7(quality)-369.4(of)-374.7(life)-371.9(in)-371.8(Parkin-)]TJ 0 -1.1223 TD [(sons)-336.7(disease.)-334.6(J)-334.7(Neurol)-331.7(Sci)-336.3(2017;373:173178.)]TJ -1.7505 -1.1284 TD [(31.)-500.5(Martinez-Martin)-650.4(P,)-649.6(Rodriguez-Blazquez)-656.9(C,)-645.4(Forjaz)-648.2(MJ,)]TJ 1.7505 -1.1223 TD [(et)-382.1(al.:)-381.7(Neuropsychiatric)-382.6(symptoms)-382.2(and)-376.7(caregivers)-389.9(burden)]TJ 0 -1.1284 TD [(in)-243.7(Parkinsons)-248.9(disease.)-249.2(Parkinsonism)-251.8(Relat)-250.6(Disord)-247.3(2015;21:)]TJ 0 -1.1223 TD (629634.)Tj -1.7505 -1.1284 TD [(32.)-500.5(Chiong-Rivero)-440(H,)-434.8(Ryan)-436.5(GW,)-439.3(Flippen)-433.9(C,)-438(et)-437(al.:)-436.6(Patients)]TJ 1.7505 -1.1223 TD [(and)-425.5(caregivers)-432.6(experiences)-426(of)-429.6(the)-424.9(impact)-428.6(of)-423.5(Parkinsons)]TJ 0 -1.1284 TD [(disease)-261.4(on)-256.5(health)-258.2(status.)-258.4(Patient)-254.6(Relat)-262.8(Outcome)-254(Meas)-263.5(2011;)]TJ 0 -1.1223 TD (2011:5770.)Tj -1.7505 -1.1284 TD [(33.)-500.5(Koo)-447.3(BB,)-443(Chow)-446.1(CA,)-445.9(Shah)-440.7(DR,)-445.9(et)-449.2(al.:)-442.7(Demoralization)-447(in)]TJ 1.7505 -1.1223 TD [(Parkinson)-332.5(disease.)-340.7(Neurology)-332.1(2018;90:e1613e1617.)]TJ -1.7505 -1.1284 TD [(34.)-500.5(Hely)-347.3(MA,)-342.8(Reid)-350.5(WG,)-341.8(Adena)-346.2(MA,)-348.9(et)-345.5(al.:)-345.1(The)-342(Sydney)-349.5(mul-)]TJ 1.7505 -1.1223 TD [(ticenter)-404.7(study)-401.8(of)-399.1(Parkinsons)-401.3(disease:)-401.2(The)-403(inevitability)-402.7(of)]TJ 0 -1.1284 TD [(dementia)-335.5(at)-333.3(20)-335.7(years.)-333.9(Mov)-335.1(Disord)-332.7(2008;23:837844.)]TJ -1.7505 -1.1223 TD [(35.)-500.5(Skorvanek)-405.3(M,)-402(Goldman)-408.3(JG,)-403.6(Jahanshahi)-408.2(M,)-402(et)-400.4(al.:)-406.1(Global)]TJ 1.7505 -1.1284 TD [(scales)-364.9(for)-364.9(cognitive)-361.8(screening)-368.5(in)-365.7(Parkinsons)-364.8(disease:)-364.6(Cri-)]TJ 0 -1.1223 TD [(tique)-241.7(and)-248.6(recommendations.)-244.2(Mov)-243.7(Disord)-247.3(2018;33:208218.)]TJ -1.7505 -1.1284 TD [(36.)-500.5(Snineh)-525.8(MA,)-519.6(Camicioli)-524.1(R,)-523.4(Miyasaki)-525.2(JM:)-522.8(Decisional)-525.4(ca-)]TJ 1.7505 -1.1223 TD [(pacity)-368(for)-371(advanced)-371.7(care)-375.4(directives)-367.5(in)-371.8(Parkinsons)-370.8(disease)]TJ 0 -1.1284 TD [(with)-348.7(cognitive)-343.5(concerns.)-350.8(Parkinsonism)-343.3(Relat)-348.2(Disord)-351(2017;)]TJ 0 -1.1223 TD (39:7779.)Tj -1.7505 -1.1284 TD [(37.)-500.5(Bruno)-300.6(V,)-300.7(Mancini)-300.3(D,)-294.6(Ghoche)-303.6(R,)-297.8(et)-302.8(al.:)-296.3(High)-300.4(prevalence)-304.8(of)]TJ 1.7505 -1.1223 TD [(physical)-410.1(and)-413.3(sexual)-410.4(aggression)-412.4(to)-408.4(caregivers)-411.8(in)-408.4(advanced)]TJ 0 -1.1284 TD [(Parkinsons)-651.4(disease.)-645.7(Experience)-656.2(in)-646.2(the)-644.5(Palliative)-654.5(Care)]TJ T* [(Program.)-335.7(Parkinsonism)-337.2(Relat)-336(Disord)-332.7(2016;24:141142.)]TJ -1.7505 -1.1223 TD [(38.)-500.5(Han)-372.2(SD,)-370.8(Boyle)-375.1(PA,)-370.8(James)-372.9(BD,)-378.8(et)-369.9(al.:)-369.5(Mild)-376.8(cognitive)-374(im-)]TJ 1.7505 -1.1284 TD [(pairment)-364.1(and)-364.5(susceptibility)-365.1(to)-365.7(scams)-366.8(in)-359.6(old)-365.8(age.)-362.7(J)-365.2(Alzhei-)]TJ 0 -1.1223 TD [(mers)-335.1(Dis)-336(2016;49:845851.)]TJ -1.7505 -1.1284 TD [(39.)-500.5(Futrell)-752.8(M,)-749.7(Melillo)-752.4(KD,)-747.6(Remington)-752.8(R,)-749.1(Butcher)-754(HK:)]TJ 1.7505 -1.1223 TD [(Evidence-based)-355.2(practice)-354.6(guideline:)-355.2(Wandering.)-357.5(J)-353(Gerontol)]TJ 0 -1.1284 TD [(Nurs)-332.9(2014;40:1623.)]TJ -1.7505 -1.1223 TD [(40.)-500.5(Lau)-262.7(T,)-264.4(Russell)-263.3(S:)-258.8(A)-264(complex)-258.5(case)-268.5(of)-258.8(delirium:)-261.3(From)-261.5(theory)]TJ 1.7505 -1.1284 TD [(to)-292.5(clinical)-298.1(management.)-303.6(In:)]TJ /F9 1 Tf 11.43 0 TD [(Complex)-295.8(Clinical)-294.5(Conundrums)]TJ -11.43 -1.1223 TD [(in)-335.2(Psychiatry.)]TJ /F5 1 Tf 5.9894 0 TD [(Springer,)-335.7(2018,)-330(pp.)-335.8(1522.)]TJ -7.7399 -1.1284 TD [(41.)-500.5(Kales)-674.1(HC,)-665.4(Gitlin)-671.1(LN,)-674.7(Lyketsos)-669.7(CG:)-671(Assessment)-671.7(and)]TJ 1.7505 -1.1223 TD [(management)-303.5(of)-301.5(behavioral)-301.9(and)-303.5(psychological)-298.6(symptoms)-302.9(of)]TJ 0 -1.1284 TD [(dementia.)-335.5(BMJ)-332.9(2015;350:h369.)]TJ -1.7505 -1.1223 TD [(42.)-500.5(Gitlin)-530.8(LN,)-528.4(Kales)-527.7(HC,)-531.3(Lyketsos)-529.4(CG:)-524.7(Nonpharmacologic)]TJ 1.7505 -1.1284 TD [(management)-376.7(of)-368.6(behavioral)-375.1(symptoms)-370(in)-371.8(dementia.)-378.2(JAMA)]TJ 0 -1.1223 TD (2012;308:20202029.)Tj -1.7505 -1.1284 TD [(43.)-500.5(Seitz)-547.6(DP,)-541.6(Brisbin)-542.8(S,)-539.8(Herrmann)-546(N,)-544.6(et)-546.7(al.:)-540.3(Efcacy)-545.3(and)]TJ 1.7505 -1.1223 TD [(feasibility)-386.7(of)-380.8(nonpharmacological)-383.7(interventions)-381.5(for)-383.2(neuro-)]TJ 27.0074 70.8975 TD [(psychiatric)-489.7(symptoms)-479.8(of)-484.4(dementia)-481.8(in)-481.6(long)-481.8(term)-481.8(care:)-484.7(A)]TJ 0 -1.1223 TD [(systematic)-321.2(review.)-317.6(J)-316.4(A)0(m)-312.5(Med)-321.1(Dir)-314.8(Assoc)-315.8(2012;13:503506)]TJ 0 -1.1284 TD (e502.)Tj -1.7505 -1.1223 TD [(44.)-500.5(Warden)-369.7(V,)-367.7(Hurley)-368.2(AC,)-372.7(Volicer)-365.9(L:)-367.6(Development)-374.1(and)-364.5(psy-)]TJ 1.7505 -1.1283 TD [(chometric)-344(evaluation)-341.7(of)-338.1(the)-333.4(Pain)-342.6(Assessment)-342.4(in)-335.2(Advanced)]TJ 0 -1.1223 TD [(Dementia)-361.4(\(PAINAD\))-358.9(scale.)-353.5(J)-353(A)0(m)-355.2(Med)-357.7(Dir)-351.4(Assoc)-358.5(2003;4:)]TJ 0 -1.1284 TD (915.)Tj -1.7505 -1.1223 TD [(45.)-500.5(Chibnall)-374.4(JT,)-373.4(Tait)-371.5(RC,)-369.8(Harman)-372.6(B,)-371(Luebbert)-373.1(RA:)-372.2(Effect)-369(of)]TJ 1.7505 -1.1284 TD [(acetaminophen)-399.5(on)-396.7(behavior,)-389.5(well-being,)-396.4(and)-395(psychotropic)]TJ 0 -1.1223 TD [(medication)-396.2(use)-394.1(in)-396.2(nursing)-392.2(home)-394.7(residents)-393.4(with)-391.4(moderate-)]TJ 0 -1.1284 TD [(to-severe)-309.9(dementia.)-305(J)-304.2(A)0(m)-306.4(Geriatr)-307.3(Soc)-300.3(2005;53:19211929.)]TJ -1.7505 -1.1223 TD [(46.)-500.5(Choy)-450.6(SW,)-446.8(Yeoh)-451.6(AC,)-445.9(Lee)-449.9(ZZ,)-449.4(et)-449.2(al.:)-448.8(Melatonin)-452.5(and)-443.8(the)]TJ 1.7505 -1.1284 TD [(prevention)-340.4(and)-327.9(management)-340.1(of)-332(delirium:)-334.5(A)-337.2(scoping)-333.1(study.)]TJ T* [(Front)-334.7(Med)-333.3(2017;4:242.)]TJ -1.7505 -1.1223 TD [(47.)-500.5(Mahmoud)-540.8(F,)-539.8(Tampi)-536.5(RR:)-540.1(Valproic)-543(acid-induced)-538.2(parkin-)]TJ 1.7505 -1.1284 TD [(sonism)-370.1(in)-365.7(the)-370(elderly:)-370(A)-361.6(comprehensive)-372.9(review)-372.5(of)-362.5(the)-370(lit-)]TJ 0 -1.1223 TD [(erature.)-341(Am)-330.8(J)-334.7(Geriatr)-337.8(Pharmacother)-336.2(2011;9:405412.)]TJ -1.7505 -1.1284 TD [(48.)-500.5(Goldman)-444.9(JG,)-440.2(Holden)-445.2(S:)-441.8(Treatment)-443.5(of)-441.7(psychosis)-441.4(and)-443.8(de-)]TJ 1.7505 -1.1223 TD [(mentia)-385.9(in)-384(Parkinsons)-389.1(disease.)-383.4(Curr)-388.2(Treat)-384.8(Options)-384.8(Neurol)]TJ 0 -1.1284 TD (2014;16:281.)Tj -1.7505 -1.1223 TD [(49.)-500.5(Weintraub)-271.4(D,)-264.1(Chiang)-265.5(C,)-261.2(Kim)-263.3(HM,)-263.5(et)-266.2(al.:)-265.8(Antipsychotic)-264.9(use)]TJ 1.7505 -1.1284 TD [(and)-321.8(physical)-324.7(morbidity)-324.7(in)-323(Parkinson)-320.3(disease.)-322.4(Am)-324.7(J)-322.5(Geriatr)]TJ 0 -1.1223 TD [(Psychiatry)-336.3(2017;25:697705.)]TJ -1.7505 -1.1284 TD [(50.)-500.5(Coelho)-424(M,)-420.3(Ferreira)-419.5(JJ:)-418.9(Late-stage)-429.1(Parkinson)-417.9(disease.)-426.1(Nat)]TJ 1.7505 -1.1223 TD [(Rev)-338.8(Neurol)-331.7(2012;8:435442.)]TJ -1.7505 -1.1284 TD [(51.)-500.5(Donnelly)-463.2(RF:)-458.9(Stability)-456.9(of)-460(levodopa/carbidopa)-463.4(rectal)-459.9(sus-)]TJ 1.7505 -1.1223 TD [(pensions.)-338.6(Hosp)-330.6(Pharm)-339.1(2016;51:915921.)]TJ -1.7505 -1.1284 TD [(52.)-500.5(Jimenez-Shahed)-288.7(J:)-285.5(A)-282.3(review)-287.1(of)-277.1(current)-288(and)-279.1(novel)-284.9(levodopa)]TJ 1.7505 -1.1223 TD [(formulations)-300.3(for)-291.7(the)-296.8(treatment)-300.8(of)-289.3(Parkinsons)-297.7(disease.)-298(Ther)]TJ 0 -1.1284 TD [(Deliv)-340.8(2016;7:179191.)]TJ -1.7505 -1.1223 TD [(53.)-500.5(Olanow)-440.7(CW,)-442.5(Kieburtz)-439.3(K,)-440.9(Odin)-440.7(P,)-436.2(et)-437(al.:)-442.7(Continuous)-437.3(in-)]TJ 1.7505 -1.1284 TD [(trajejunal)-343.5(infusion)-330.8(of)-338.1(levodopa-carbidopa)-338.2(intestinal)-335.5(gel)-339.5(for)]TJ 0 -1.1223 TD [(patients)-293.6(with)-293.8(advanced)-292.4(Parkinsons)-291.6(disease:)-291.4(A)-288.4(randomised,)]TJ 0 -1.1284 TD [(controlled,)-754.7(double-blind,)-750.7(double-dummy)-751(study.)-749.5(Lancet)]TJ 0 -1.1223 TD [(Neurol)-337.8(2014;13:141149.)]TJ -1.7505 -1.1284 TD [(54.)-500.5(Fall)-488.4(PA,)-480.6(Saleh)-487.2(A,)-483.6(Fredrickson)-485.7(M,)-487.4(et)-479.7(al.:)-485.4(Survival)-485.2(time,)]TJ 1.7505 -1.1223 TD [(mortality,)-358.9(and)-358.4(cause)-360.1(of)-356.4(death)-356.2(in)-359.6(elderly)-358.3(patients)-354.6(with)-360.9(Par-)]TJ 9.2951 0 0 9.2951 329.329 338.1165 Tm [(kinsons)-263.4(disease.)-255.3(A)-257.9(9-year)-264(follow-up.)-256.5(Mov)-255.9(Disord)-259.5(2003;18:)]TJ T* (13121316.)Tj -1.7505 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