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Non-motor symptoms of Parkinson's disease: diagnosis and management
Abstract
The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta. However, non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression. Indeed, non-motor symptoms dominate the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy. By contrast with the dopaminergic symptoms of the disease, for which treatment is available, non-motor symptoms are often poorly recognised and inadequately treated. However, attention is now being focused on the recognition and quantitation of non-motor symptoms, which will form the basis of improved treatments. Some non-motor symptoms, including depression, constipation, pain, genitourinary problems, and sleep disorders, can be improved with available treatments. Other non-motor symptoms can be more refractory and need the introduction of novel non-dopaminergic drugs. Inevitably, the development of treatments that can slow or prevent the progression of Parkinson's disease and its multicentric neurodegeneration provides the best hope of curing non-motor symptoms.
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“Indeed, non-motor symptoms dominate the clinical picture of PD”
From Distant delivery of a mindfulness-based intervention for people with Parkinson's disease: The study protocol of a randomised pilot trial (2017) · cites this paper as [2]
In the citing paper
“and contribute to severe disability, impaired quality of life, and shortened life expectancy [2].”
From Distant delivery of a mindfulness-based intervention for people with Parkinson's disease: The study protocol of a randomised pilot trial (2017) · cites this paper as [2]
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Bertrand, J., Bedetti, C., Postuma, R. B., Monchi, O., Marchand, D. G., Jubault, T., & Gagnon, J. (2012) · Movement Disorders · doi:10.1002/mds.25272 · Cited by 84
The pathophysiological basis of sensory disturbances in Parkinson's disease
Carlos Juri, C., Rodríguez-Oroz, M. C., & Obeso, J. A. (2009) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2009.08.018 · Cited by 85
Functional Anatomy of Basal Ganglia Circuits with the Cerebral Cortex and the Cerebellum
Bostan, A. C., Dum, R. P., & Strick, P. L. (2018) · Progress in neurological surgery · doi:10.1159/000480748 · Cited by 87
Parkinson's disease: From bench to bedside
Draoui, A., Hiba, O. E., Aimrane, A., Khiat, A. E., & Gamrani, H. (2020) · Revue Neurologique · doi:10.1016/j.neurol.2019.11.002 · Cited by 82
Sex Differences in Parkinson’s Disease: A Narrative Review
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Progress in neuroprotection in Parkinson’s disease
Schapira, A. H. V. (2008) · European Journal of Neurology · doi:10.1111/j.1468-1331.2008.02055.x · Cited by 82
“ities but they are not specific for PD [2].”
BackgroundSelf-citationBassani, T. B., Gradowski, R. W., Zaminelli, T., Barbiero, J. K., Santiago, R. M., Boschen, S. L., Cunha, C. D., Lima, M. M. S., Andreatini, R., & Vital, M. A. B. F. (2014) · Brain Research · doi:10.1016/j.brainres.2014.09.068 · Cited by 83
“Braak et al. (2003) challenged the traditional concept that PD begins with the death of nigral dopaminergic neurons by introducing the idea of a six-stage pathological process (Chaudhuri et al., 2006).”
Chen, J., & Chern, Y. (2010) · Handbook of experimental pharmacology · doi:10.1007/978-3-642-13443-2_10 · Cited by 85
Quality of life in Parkinson’s disease improved by apomorphine pump: the OPTIPUMP cohort study
Drapier, S., Eusébio, A., Degos, B., Vérin, M., Durif, F., Azulay, J., Viallet, F., Rouaud, T., Moreau, C., Defebvre, L., et al. (2016) · Journal of Neurology · doi:10.1007/s00415-016-8106-3 · Cited by 89
Julienne, H., Buhl, E., Leslie, D. S., & Hodge, J. J. L. (2017) · Neurobiology of Disease · doi:10.1016/j.nbd.2017.04.014 · Cited by 90
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“As another common neurodegenerative disorder, Parkinson’s disease (PD) is primarily a movement disorder, while non-motor manifestations including cognitive dysfunction have been widely recognized as well [1].”
BackgroundApathy and Impulse Control Disorders: Yin & Yang of Dopamine Dependent Behaviors
Sierra, M., Carnicella, S., Strafella, A. P., Bichon, A., Lhommée, E., Castrioto, A., Chabardès, S., Thobois, S., & Krack, P. (2015) · Journal of Parkinson s Disease · doi:10.3233/jpd-150535 · Cited by 83
“Once patients start developing motor and non-motor fluctuations, the neuropsychological symptoms appear again during the non-motor off period [16–18].”
Optical coherence tomography as a tool to evaluate retinal changes in Parkinson's disease
Mailankody, P., Battu, R., Khanna, A., Lenka, A., Yadav, R., & Pal, P. K. (2015) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2015.08.002 · Cited by 82
Mack, J. M., Schamne, M. G., Sampaio, T. B., Pértile, R. A. N., Fernandes, P. A. C. M., Markus, R. P., & Prediger, R. D. (2016) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2016/3472032 · Cited by 81
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“Similar to MPTP-treated monkeys, patients with Parkinson’s disease exhibit motor symptoms and non-motor symptoms (NMS), such as cognitive impairments (Chaudhuri et al., 2006; Chaudhuri and Schapira, 2009).”
BackgroundResultMotor and Perceptual Timing in Parkinson’s Disease
Jones, C. R. G., & Jahanshahi, M. (2014) · Advances in experimental medicine and biology · doi:10.1007/978-1-4939-1782-2_14 · Cited by 82
“[72]).”
APOE , MAPT , and COMT and Parkinson’s Disease Susceptibility and Cognitive Symptom Progression
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Cerebral control of swallowing: An update on neurobehavioral evidence
Cheng, I., Takahashi, K., Miller, A. J., & Hamdy, S. (2022) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2022.120434 · Cited by 83
The Relationship between Thermoregulation and REM Sleep Behaviour Disorder in Parkinson’s Disease
Zhong, G., Bolitho, S., Grunstein, R. R., Naismith, S. L., & Lewis, S. J. G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0072661 · Cited by 86
“Traditionally Parkinson’s disease (PD) has been characterised by its constellation of motor symptoms, but non-motor symptoms such as disturbances of sleep, circadian rhythm and thermoregulation have been increasingly recognised[1,2,3,4,5,6].”
BackgroundEffect of Exercise on Motor and Nonmotor Symptoms of Parkinson’s Disease
Dashtipour, K., Johnson, E., Kani, C., Kani, K., Hadi, E., Ghamsary, M. G., Pezeshkian, S., & Chen, J. J. (2015) · Parkinson s Disease · doi:10.1155/2015/586378 · Cited by 87
Novel investigational adenosine A2Areceptor antagonists for Parkinson's disease
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Loss of dopamine disrupts circadian rhythms in a mouse model of Parkinson's disease
Fifel, K., & Cooper, H. M. (2014) · Neurobiology of Disease · doi:10.1016/j.nbd.2014.08.024 · Cited by 80
“Certain of these non-motor symptoms precede the emergence of cardinal motor symptoms of the disease and inevitably deteriorate over time (Chaudhuri et al., 2006; Maetzler et al., 2009).”
BackgroundFan, D., Liu, L., Wu, Z., & Cao, M. (2018) · Current Neuropharmacology · doi:10.2174/1570159x16666180419141613 · Cited by 80
High-Resolution Motor State Detection in Parkinson’s Disease Using Convolutional Neural Networks
Pfister, F., Um, T. T., Pichler, D., Goschenhofer, J., Abedinpour, K., Lang, M., Endo, S., Ceballos-Baumann, A., Hirche, S., Bischl, B., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-61789-3 · Cited by 83
Rektorová, I., Srovnalová, H., Kubíková, R., & Prášek, J. (2008) · Movement Disorders · doi:10.1002/mds.22158 · Cited by 80
“The radiotracer uptake in the caudate nucleus is rather spared in mild- to-moderate PD. Finally, our results also accord with studies reporting positive effects of dopaminergic treatment on depres- sive symptoms of PD (e.g., Refs.”
BackgroundInfluentialGrow, D. A., McCarrey, J. R., & Navara, C. S. (2016) · Stem Cell Research · doi:10.1016/j.scr.2016.08.013 · Cited by 89
Long Non-Coding RNAs in Multifactorial Diseases: Another Layer of Complexity
Cipolla, G. A., de Oliveira, J. C., Salviano‐Silva, A., Lobo‐Alves, S. C., Lemos, D. S., Oliveira, L., Jucoski, T. S., Mathias, C., Pedroso, G. A., Zambalde, É. P., et al. (2018) · Non-Coding RNA · doi:10.3390/ncrna4020013 · Cited by 81
Metadata
- Authors
- Chaudhuri, K. R., Healy, D. G., & Schapira, A. H.
- Affiliations
- Guy's and St Thomas' NHS Foundation Trust (GB)
- The Royal Free Hospital (GB)
- ORCID
- Schapira, Anthony HV
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2006-03
- Volume
- 5
- Issue
- 3
- Pages
- 235-245
- ISSN
- 1474-4422 (ISSN-L)
- OpenAlex
- W1982535961
- Cited by
- 2,807
- References
- 140
- Citations by year
- 2026: 184 · 2025: 170 · 2024: 143 · 2023: 159 · 2022: 168 · 2021: 165 · 2020: 197 · 2019: 168 · 2018: 161 · 2017: 174 · 2016: 152 · 2015: 156 · 2014: 130 · 2013: 130 · 2012: 129
- FWCI
- 9.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- Parkinson's disease, non-motor symptoms, depression, constipation, pain, genitourinary dysfunction, sleep disorders, substantia nigra pars compacta, neurodegeneration, quality of life, disability
- MeSH terms
- Autonomic Nervous System Diseases, Humans, Pain, Parkinson Disease, Psychotic Disorders, Sleep Wake Disorders, Disease Progression, Pain Management
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