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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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“These symptoms have been termed NMS by Chaudhuri and others.(1) The NMS Questionnaire (NMS Quest) was developed(2) and validated(3) to screen for the presence of NMS.”
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“genitourinary problems, postural hypotension and constipation) [27].”
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BackgroundInfluentialRisk of incident depression in patients with Parkinson disease in the UK
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“From a public health perspective, it is important to understand the rate of occurrence of this complication to enable clinicians and caregivers to adequately develop strategies addressing the needs of patients with PD [12].”
BackgroundChanges in diagnosis with follow-up in an incident cohort of patients with parkinsonism
Caslake, R., Moore, J. N., Gordon, J. C., Harris, C. E., & Counsell, C. E. (2008) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2008.144501 · Cited by 71
“with a number of non-motor features, including progressive cognitive impairment, neuropsychiatric symptoms, dysautonomia and sleep disturbance.(1) Accurate diagnosis of PD is important both in”
BackgroundObstructive Sleep Apnea and Cognition in Parkinson's disease
Harmell, A. L., Neikrug, A. B., Palmer, B. W., Avanzino, J. A., Liu, L., Maglione, J. E., Natarajan, L., Corey‐Bloom, J., Loredo, J. S., & Ancoli‐Israel, S. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.01.001 · Cited by 69
“In PD, sleep disturbances have been found to impair quality of life and increase the level of disability [9].”
BackgroundTessitore, A., Marano, P., Modugno, N., Pontieri, F. E., Tambasco, N., Canesi, M., Latorre, A., Lopiano, L., Sensi, M., Quatrale, R., et al. (2018) · Journal of Neurology · doi:10.1007/s00415-018-8816-9 · Cited by 69
Mishra, A., Singh, S., Tiwari, V., Parul, P., & Shukla, S. (2018) · Neurochemistry International · doi:10.1016/j.neuint.2018.11.020 · Cited by 71
Dahlberg, L. S., Lungu, O., & Doyon, J. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00127 · Cited by 68
Dar, M. N., Akram, M. U., Yuvaraj, R., Khawaja, S. G., & Murugappan, M. (2022) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2022.105327 · Cited by 68
Radad, K., Moldzio, R., Krewenka, C., Kranner, B., & Rausch, W. (2023) · Exploration of Neuroprotective Therapy · doi:10.37349/ent.2023.00036 · Cited by 68
Redefining Non-Motor Symptoms in Parkinson’s Disease
Peña-Zelayeta, L., Delgado-Minjares, K. M., Villegas-Rojas, M. M., León‐Arcia, K., Santiago-Balmaseda, A., Andrade-Guerrero, J., Pérez-Segura, I., Ortega‐Robles, E., Soto-Rojas, L. O., & Arias-Carrión, Ó. (2025) · Journal of Personalized Medicine · doi:10.3390/jpm15050172 · Cited by 80
Inpatient Management of Parkinson Disease
Oguh, O., & Videnović, A. (2011) · The Neurohospitalist · doi:10.1177/1941874411427734 · Cited by 68
“Despite its frequent occurrence, nonmotor manifestations are frequently underreported by patients and underdiagnosed by physicians.(54,55) Most common nonmotor manifestations of PD are mood disturbances (depression and anxiety), impaired sleep–wake cycle, autonomic dysfunction (orthostatic hypotension, urinary and sex…”
BackgroundCrosiers, D., Theuns, J., Cras, P. P., & Broeckhoven, C. V. (2011) · Journal of Chemical Neuroanatomy · doi:10.1016/j.jchemneu.2011.07.003 · Cited by 70
“In addition to the motor disturbances PD is characterized by numerous non-motor symptoms (NMS), e.g. cognitive impairment, autonomic dysregulation, sleep problems and neuropsychiatric symptoms (Chaudhuri et al., 2006).”
BackgroundJang, W., Park, J., Shin, K. J., Kim, J., Kim, J. S., Youn, J., Cho, J. W., Oh, E., Ahn, J. Y., Oh, K., et al. (2013) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2013.11.015 · Cited by 68
“In addition to motor function, non-motor symptoms (NMS) are an important aspect of Parkinson's disease (PD), and they are commonly found in PD patients [1].”
BackgroundBloem, B. R., & Stocchi, F. (2011) · European Journal of Neurology · doi:10.1111/j.1468-1331.2011.03532.x · Cited by 68
Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage?
Batla, A., Phé, V., Min, L. D., & Panicker, J. N. (2016) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.12374 · Cited by 68
Development of stem cell-based therapy for Parkinson’s disease
Han, F., Baremberg, D., Gao, J., Duan, J., Lu, X., Zhang, N., & Chen, Q. (2015) · Translational Neurodegeneration · doi:10.1186/s40035-015-0039-8 · Cited by 70
“The reliable identification of non-motor symptoms is important as many non-motor symptoms, including depression, cognitive dysfuction, pain, and sleep disorders, precede the motor dysfunctions; not only is management of these symptoms important for quality of life, but early diagnosis of PD could also be key for effec…”
BackgroundMutated ATP10B increases Parkinson’s disease risk by compromising lysosomal glucosylceramide export
Martin, S., Smolders, S., den Haute, C. V., Heeman, B., van Veen, S., Crosiers, D., Beletchi, I., Verstraeten, A., Gossye, H., Gelders, G., et al. (2020) · Acta Neuropathologica · doi:10.1007/s00401-020-02145-7 · Cited by 67
Song, W., Guo, X., Chen, K., Chen, X., Cao, B., Wei, Q., Huang, R., Zhao, B., Wu, Y., & Shang, H. (2013) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2013.10.005 · Cited by 67
“NMS are often underrecognized and poorly managed in clinical practice [4].”
BackgroundPredicting Parkinson's disease – why, when, and how?
Postuma, R. B., & Montplaisir, J. Y. (2009) · Parkinsonism & Related Disorders · doi:10.1016/s1353-8020(09)70793-x · Cited by 67
“Autonomic dysfunction is experienced by 40–70% of PD patients [12].”
BackgroundInfluentialMglur4-Positive Allosteric Modulation as Potential Treatment for Parkinson’s Disease
Hopkins, C. R., Lindsley, C. W., & Niswender, C. M. (2009) · Future Medicinal Chemistry · doi:10.4155/fmc.09.38 · Cited by 67
Nonmotor Symptoms in Genetic Parkinson Disease
Kasten, M., Kertelge, L., Brüggemann, N., van der Vegt, J., Schmidt, A., Tadić, V., Buhmann, C., Steinlechner, S., Behrens, M. I., Ramı́rez, A., et al. (2010) · Archives of Neurology · doi:10.1001/archneurol.67.6.670 · Cited by 67
Caudal, D., Alvarsson, A., Björklund, A., & Svenningsson, P. (2015) · Experimental Neurology · doi:10.1016/j.expneurol.2015.09.002 · Cited by 73
“Anhedonia, defined as a “markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day”, is considered as one of the core symptoms of depression in PD (Chaudhuri et al., 2006, Aarsland et al., 2011).”
A Review of Scales to Evaluate Sleep Disturbances in Movement Disorders
Kurtis, M. M., Balestrino, R., Rodríguez‐Blázquez, C., Forjaz, M. J., & Martínez‐Martín, P. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00369 · Cited by 67
Alpha-synuclein deregulates the expression of COL4A2 and impairs ER-Golgi function
Paiva, I., Jain, G., Lázaro, D. F., Gotovac, K., Hentrich, T., Kerimoglu, C., Pinho, R., Szegő, É. M., Burkhardt, S., Capece, V., et al. (2018) · Neurobiology of Disease · doi:10.1016/j.nbd.2018.08.001 · Cited by 68
Stacy, M. (2010) · Journal of Neural Transmission · doi:10.1007/s00702-010-0424-5 · Cited by 66
“Given that none of these questionnaires specifically assesses symptoms of wearing-off, new tools are required to detect both the motor and non-motor symptoms of wearing-off (Reichmann et al. 2005; Chaudhuri et al. 2006a, b). The development and validation of wearing-off questionnaires that can assist physicians in ide…”
BackgroundLi, X., Redus, L., Chen, C., Martinez, P. A., Strong, R., Li, S., & O’Connor, J. C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071341 · Cited by 67
“motor symptoms associated with PD that can appear years, sometimes decades, before the onset of the motor phenotype [1,2,3].”
BackgroundBerg, J., Roch, M., Altschüler, J., Winter, C., Schwerk, A. M. K., Kurtz, A., & Steiner, B. (2014) · Stem Cell Reviews and Reports · doi:10.1007/s12015-014-9551-y · Cited by 66
“PD however, is more than just a motor disease – non-motor symptoms, such as cognitive decline or depression also significantly contribute to disability [5, 6].”
BackgroundSuzuki, K., Okada, K., Wakuda, T., Shinmura, C., Kameno, Y., Iwata, K., Takahashi, T., Suda, S., Matsuzaki, H., Iwata, Y., et al. (2010) · PLoS ONE · doi:10.1371/journal.pone.0009260 · Cited by 68
Aguirre-Mardones, C., Iranzo, Á., Vilas, D., Serradell, M., Gaig, C., Santamaría, J., & TOLOSA, E. S. (2015) · Journal of Neurology · doi:10.1007/s00415-015-7742-3 · Cited by 65
“This indicates that the neurodegenerative process in PD extends beyond the substantia nigra and dopaminergic deficit [5–9].”
Contributions of the Basal Ganglia to Temporal Processing: Evidence from Parkinson’s Disease
Jones, C. R. G., & Jahanshahi, M. (2013) · Timing & Time Perception · doi:10.1163/22134468-00002009 · Cited by 66
Rizzo, S. J. S., & Crawley, J. N. (2017) · Annual Review of Animal Biosciences · doi:10.1146/annurev-animal-022516-022754 · Cited by 67
Zhan, Z., Lin, L., Yu, E., Xin, J., Lin, L., Lin, H., Ye, Q., Chen, X., & Pan, X. (2018) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.12838 · Cited by 66
Molecular landscape of long noncoding RNAs in brain disorders
Yang, S., Lim, K., Kim, S.-H., & Joo, J. (2020) · Molecular Psychiatry · doi:10.1038/s41380-020-00947-5 · Cited by 66
Respiratory disorders of Parkinson’s disease
Aquino, Y. C., Cabral, L. M., Miranda, N. C., Naccarato, M. C., Falquetto, B., Moreira, T. S., & Takakura, A. C. T. (2021) · Journal of Neurophysiology · doi:10.1152/jn.00363.2021 · Cited by 69
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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