Diagnosis and Treatment of Parkinson Disease: A Review
Abstract
Importance: Parkinson disease is the most common form of parkinsonism, a group of neurological disorders with Parkinson disease-like movement problems such as rigidity, slowness, and tremor. More than 6 million individuals worldwide have Parkinson disease. Observations: Diagnosis of Parkinson disease is based on history and examination. History can include prodromal features (eg, rapid eye movement sleep behavior disorder, hyposmia, constipation), characteristic movement difficulty (eg, tremor, stiffness, slowness), and psychological or cognitive problems (eg, cognitive decline, depression, anxiety). Examination typically demonstrates bradykinesia with tremor, rigidity, or both. Dopamine transporter single-photon emission computed tomography can improve the accuracy of diagnosis when the presence of parkinsonism is uncertain. Parkinson disease has multiple disease variants with different prognoses. Individuals with a diffuse malignant subtype (9%-16% of individuals with Parkinson disease) have prominent early motor and nonmotor symptoms, poor response to medication, and faster disease progression. Individuals with mild motor-predominant Parkinson disease (49%-53% of individuals with Parkinson disease) have mild symptoms, a good response to dopaminergic medications (eg, carbidopa-levodopa, dopamine agonists), and slower disease progression. Other individuals have an intermediate subtype. For all patients with Parkinson disease, treatment is symptomatic, focused on improvement in motor (eg, tremor, rigidity, bradykinesia) and nonmotor (eg, constipation, cognition, mood, sleep) signs and symptoms. No disease-modifying pharmacologic treatments are available. Dopamine-based therapies typically help initial motor symptoms. Nonmotor symptoms require nondopaminergic approaches (eg, selective serotonin reuptake inhibitors for psychiatric symptoms, cholinesterase inhibitors for cognition). Rehabilitative therapy and exercise complement pharmacologic treatments. Individuals experiencing complications, such as worsening symptoms and functional impairment when a medication dose wears off ("off periods"), medication-resistant tremor, and dyskinesias, benefit from advanced treatments such as therapy with levodopa-carbidopa enteral suspension or deep brain stimulation. Palliative care is part of Parkinson disease management. Conclusions and Relevance: Parkinson disease is a heterogeneous disease with rapidly and slowly progressive forms. Treatment involves pharmacologic approaches (typically with levodopa preparations prescribed with or without other medications) and nonpharmacologic approaches (such as exercise and physical, occupational, and speech therapies). Approaches such as deep brain stimulation and treatment with levodopa-carbidopa enteral suspension can help individuals with medication-resistant tremor, worsening symptoms when the medication wears off, and dyskinesias.
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Treatment of PD is symptomatic, and none of the available pharmacological treatments for PD can modify disease progression.
“Treatment of PD is symptomatic, with pharmacologic treatments of PD motor symptoms being dopamine-based and pharmacologic treatments of PD non-motor symptoms being based on other neurotransmitters such as serotonin and acetylcholine [79]. As with AD, none of the available pharmacological treatments for PD can modify disease progression.”
From Extracellular vesicles as nanotheranostic platforms for targeted neurological disorder interventions (2024) · cites this paper as [79]
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- Authors
- Armstrong, M. J., & Okun, M. S.
- Affiliations
- University of Florida Health (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2020-02-11
- Volume
- 323
- Issue
- 6
- Pages
- 548
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W3006012411
- Cited by
- 2,924
- References
- 5
- Citations by year
- 2026: 420 · 2025: 560 · 2024: 596 · 2023: 528 · 2022: 444 · 2021: 292 · 2020: 79
- FWCI
- 37.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- Parkinson's disease, parkinsonism, dopamine transporter SPECT, dopaminergic therapy, levodopa, levodopa/carbidopa, dopamine agonists, dyskinesia, deep brain stimulation, palliative care
- MeSH terms
- Antiparkinson Agents, Carbidopa, Combined Modality Therapy, Diagnosis, Differential, Drug Combinations, Humans, Levodopa, Parkinson Disease, Prognosis, Disease Progression, Dopamine Agonists, Deep Brain Stimulation
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