Objective: 1. To assess whether sialorrhoea severity at referral correlates with advanced Parkinson’s 

2. Evaluate survival outcomes following clinic attendance

3. Explore the potential role of sialorrhoea as an indicator for transition into palliative phase

Background: Sialorrhoea is a common and distressing non-motor symptom in Parkinson’s, significantly affecting quality of life and carer burden. Sialorrhoea often serves as a marker for the advanced phase of disease. Whilst botulinum toxin A (BoNT-A) is an effective targeted treatment, late referrals to specialist services may result in missed opportunities for earlier intervention.

Method: A five-year retrospective review (2019–2024) was undertaken of all patients referred to the Cardiff and Vale Sialorrhea Service (S. Wales, UK). Demographics, Hoehn and Yahr (H&Y) staging, Drooling Severity and Frequency Scale (DSFS), and Visual Analogue Scale (VAS) scores were collected across 180 clinic encounters from 78 patients. Survival outcomes were compared between groups stratified by disease severity (H&Y ≥3 and DSFS >6) at referral to clinic.

Results: On review, out of 78 patients, 44 were alive and 34 deceased. Patients with H&Y ≥3 and DSFS >6 (n=32) demonstrated disproportionately higher mortality (20 deceased vs 12 alive). Within this subgroup, mean survival following first clinic attendance was 14 months. The mean number of BoNT-A treatment cycles was 3.46 per patient. Despite stable VAS scores (mean 55 pre- and post-injection), maintenance of perceived quality of life amidst advancing disease may reflect meaningful therapeutic stabilization.

Conclusion: Attendance at a specialist sialorrhea clinic frequently coincides with late-stage PD trajectory, often within the final year of life. These findings support sialorrhea presentation as a potential marker of the palliative phase, consistent with recognized indicators including progressive dysphagia, recurrent infections, and complex medication regimens. Earlier identification and referral may enable timely discussion of symptom management and advance care planning alongside targeted drooling control.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/sialorrhoea-as-an-indicator-of-palliative-phase-in-advanced-parkinsons/