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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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“The degeneration and dysfunction include nuclei-mediating autonomic functions such as the dorsal vagal nucleus, nucleus ambiguus, and other medullary centers, which exert differential control on the sympathetic preganglionic neurons via descending pathways.(2) Parasympathetic and sympathetic functions may be impaired.”
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Allain, H., Bentué‐Ferrer, D., & Akwa, Y. (2007) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2007.10.003 · Cited by 52
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“However, non-motor symptoms such as autonomic, sensory, psychic and cognitive dysfunctions figure prominently in a variety of extrapyramidal disorders ( Chaudhuri et al. 2006; Friedrich et al. 2008; Poewe 2008; Schmidt et al. 2008a, b). Despite being socially disabling, these symptoms have as yet received rather littl…”
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BackgroundCognitive Training in Parkinson’s Disease
Walton, C. C., Naismith, S. L., Lampit, A., Mowszowski, L., & Lewis, S. J. G. (2016) · Neurorehabilitation and neural repair · doi:10.1177/1545968316680489 · Cited by 51
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“In most cases, the nonmotor symptoms precede the classical motor features by years (Chaudhuri et al., 2006).”
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“Insomnia represents persistent difficulty in initiating or maintaining sleep, the causes of which in PD are varied and may relate to physical discomfort, nocturia, or restless leg movements.(2) Sleep maintenance insomnia appears to be more common in PD than initial insomnia,(4) but the neurobiology underlying these di…”
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BackgroundBeta amyloid deposition and cognitive decline in Parkinson’s disease: a study of the PPMI cohort
Mihaescu, A. S., Valli, M., Uribe, C., Díez‐Cirarda, M., Masellis, M., Graff‐Guerrero, A., & Strafella, A. P. (2022) · Molecular Brain · doi:10.1186/s13041-022-00964-1 · Cited by 53
“Introduction Parkinson’s disease (PD) is the second most common neurodegenerative disorder, presenting with progressively deteriorating motor and cognitive symptoms [1, 2].”
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“A group of nonmotor PD-related symptoms has been increasingly recognized [36], suggesting that other neuronal cell types may also be aff ected.”
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“The classic treatment L-3,4-dihydroxyphenylalanine (levodopa) has little effect on most non-motor symptoms (Chaudhuri et al., 2006), and chronic administration is associated with a risk of depression and anxiety (Damãsio et al., 1971; Marsh and Markham, 1973; Choi et al., 2000; Nègre-Pagès et al.,…”
BackgroundSexual Dysfunctions in Parkinson's Disease: An Underrated Problem in a Much Discussed Disorder
Bhattacharyya, K., & Rosa‐Grilo, M. (2017) · International review of neurobiology · doi:10.1016/bs.irn.2017.05.019 · Cited by 49
Validation of the Italian version of the Non Motor Symptoms Scale for Parkinson's disease
Cova, I., Battista, M. E. D., Vanacore, N., Papi, C. P., Alampi, G., Rubino, A., Valente, M., Meco, G., Contri, P., Pucchio, A. D., et al. (2016) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2016.10.020 · Cited by 49
Differences in odor identification among clinical subtypes of Parkinson’s disease
Iijima, M., Kobayakawa, T., Saito, S., Osawa, M., Tsutsumi, Y., Hashimoto, S., & Uchiyama, S. (2010) · European Journal of Neurology · doi:10.1111/j.1468-1331.2010.03167.x · Cited by 49
“The smell identification ability in Japanese patients with idiopathic PD is impaired based on the odor stick identification test for Japanese (OSIT-J) [2,3] as well as previous reports [1,4,5].”
BackgroundMethodTreating Parkinson’s disease by astrocyte reprogramming: Progress and challenges
Wei, Z. D., & Shetty, A. K. (2021) · Science Advances · doi:10.1126/sciadv.abg3198 · Cited by 50
“The Braak stages suggest that the nonmotor symptoms occur in the preclinical stages 1 and 2 when the disease is mostly restricted to the olfactory bulb and lower brainstem (11).”
BackgroundFunctional Brain Dysconnectivity in Parkinson's Disease: A 5‐Year Longitudinal Study
Yassine, S., Gschwandtner, U., Auffret, M., Achard, S., Vérin, M., Fuhr, P., & Hassan, M. (2022) · Movement Disorders · doi:10.1002/mds.29026 · Cited by 49
“2-4 Pathologically, the most prevalent hypotheses suggest that the degeneration of dopaminergic neurons in the nigrostriatal system associated with Lewy body inclusions are the leading features in most forms of PD at early stages.”
Side of Onset in Parkinson’s Disease and Alterations in Religiosity: Novel Behavioral Phenotypes
Butler, P. M., McNamara, P., & Durso, R. (2011) · Behavioural Neurology · doi:10.1155/2011/493013 · Cited by 48
Li, S., Ritz, B. R., Gong, Y., Cockburn, M., Folle, A. D., Rosario, I. D., Yu, Y., Zhang, K., Castro, E., Keener, A. M., et al. (2022) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2022.160851 · Cited by 48
“We also recognize that there are other PD-related motor and non-motor symptoms that were not investigated in our study, including dysautonomia, pain, and sleep disorders (Chaudhuri et al., 2006).”
BackgroundParkinson’s disease diagnosis using deep learning: A bibliometric analysis and literature review
Abumalloh, R. A., Nilashi, M., Samad, S., Ahmadi, H., Alghamdi, A., Alrizq, M., & AlYami, S. S. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102285 · Cited by 51
Varanese, S., Perfetti, B., Monaco, D., Thomas, A., Bonanni, L., Tiraboschi, P., & ONOFRJ, M. C. (2010) · Journal of Neurology · doi:10.1007/s00415-010-5453-3 · Cited by 48
“In recent years it has become apparent that non-motor symptoms of PD, including dementia and behavioural disorders, form an important part of this condition [7].”
BackgroundDepression in Parkinson's disease: diagnosis and treatment
Costa, F. H. D. R., de Rosso, A. L. Z., Maultasch, H., Nicaretta, D. H., & Vincent, M. B. (2012) · Arquivos de Neuro-Psiquiatria · doi:10.1590/s0004-282x2012000800011 · Cited by 48
Parkinson's disease: 10 years of progress, 1997–2007
Fahn, S. (2010) · Movement Disorders · doi:10.1002/mds.22796 · Cited by 51
When does Parkinson's disease begin? From prodromal disease to motor signs
Meissner, W. G. (2012) · Revue Neurologique · doi:10.1016/j.neurol.2012.07.004 · Cited by 51
Kitta, T., Chancellor, M. B., de Groat, W. C., Kuno, S., Nonomura, K., & Yoshimura, N. (2012) · The Journal of Urology · doi:10.1016/j.juro.2011.12.062 · Cited by 48
Markerless Analysis of Articulatory Movements in Patients With Parkinson's Disease
Bandini, A., Orlandi, S., Giovannelli, F., Felici, A., Cincotta, M., Clemente, D., Vanni, P., Zaccara, G., & Manfredi, C. (2015) · Journal of Voice · doi:10.1016/j.jvoice.2015.10.014 · Cited by 54
“Cardinal motor symptoms of PD are rest tremor, bradykinesia, and rigidity.(4,5) Other common motor signs involve the control of speech production, affecting motion and coordination of the articulatory organs (ie, tongue, lips, and jaw).”
BackgroundZeng, L., Xie, L., Shen, H., Luo, Z., Fang, P., Hou, Y., Tang, B., Wu, T., & Hu, D. (2016) · The Cerebellum · doi:10.1007/s12311-016-0781-1 · Cited by 48
“Cognitive and executive deficits are very common in PD; the gray matter alterations in the left medial and right cerebellar Crus I may be related to such deficits that are optionally present in PD [1, 16].”
BackgroundNeural mechanisms underlying cognitive inflexibility in Parkinson's disease
Lange, F., Seer, C., Loens, S., Wegner, F., Schrader, C., Dressler, D. W., Dengler, R., & Kopp, B. (2016) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2016.09.021 · Cited by 48
Impact of autonomic dysfunctions on the quality of life in Parkinson’s disease patients
Tomić, S., Rajkovaca, I., Pekić, V., Salha, T., & Mišević, S. (2016) · Acta Neurologica Belgica · doi:10.1007/s13760-016-0739-6 · Cited by 48
Advances in the development of imaging probes and aggregation inhibitors for alpha-synuclein
Xu, M., Ryan, P., Rudrawar, S., Quinn, R. J., Zhang, H., & Mellick, G. D. (2019) · Acta Pharmacologica Sinica · doi:10.1038/s41401-019-0304-y · Cited by 49
“With disease progression, nonmotor symptoms, such as depression, psychosis, falls, and sleep disturbance, also emerge [2].”
BackgroundAdvances in the Research of Risk Factors and Prodromal Biomarkers of Parkinson’s Disease
Xie, F., Gao, X., Yang, W., Chang, Z., Yang, X., Wei, X., Huang, Z., Xie, H., Yue, Z., Zhou, F., et al. (2018) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.8b00520 · Cited by 47
The initial diagnosis and management of Parkinson’s disease
Waller, S. E., Williams, L., Morales‐Briceño, H., & Fung, V. S. C. (2021) · Australian Journal of General Practice · doi:10.31128/ajgp-07-21-6087 · Cited by 47
Gerrits, N. J. H. M., van der Werf, Y. D., Verhoef, K. M. W., Veltman, D. J., Groenewegen, H. J., Berendse, H. W., & van den Heuvel, O. A. (2015) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2014.12.022 · Cited by 47
Safinamide in the treatment of Parkinson's disease
Schapira, A. H. V. (2010) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2010.511612 · Cited by 47
“Parkinson’s disease (PD) is a common neurodegenerative disease that manifests with a range of motor and non-motor clinical features [1,2].”
BackgroundSelf-citationNonmotor presentations of multiple system atrophy
Colosimo, C. (2011) · Nature Reviews Neurology · doi:10.1038/nrneurol.2011.5 · Cited by 47
Parkinson's Disease: Barriers and Facilitators to Optimizing Function
Pretzer‐Aboff, I., Galik, E. M., & Resnick, B. M. (2009) · Rehabilitation Nursing · doi:10.1002/j.2048-7940.2009.tb00249.x · Cited by 47
Calcium dysregulation in Parkinson’s disease
Schapira, A. H. V. (2013) · Brain · doi:10.1093/brain/awt180 · Cited by 47
“Non-dopaminergic neuronal loss in Parkinson’s disease is associated with a considerable clinical burden that increases with disease progression and becomes the predominant determinant of quality of life, and the requirements and costs for long-term care in these patients (Chaudhuri et al., 2006).”
Self-citationProton MR Spectroscopy for Diagnosis and Evaluation of Treatment Efficacy in Parkinson Disease
Mazuel, L., Chassain, C., Jean, B., Pereira, B., Cladière, A., Spéziale, C., & Durif, F. (2015) · Radiology · doi:10.1148/radiol.2015142764 · Cited by 47
Smith, N. J. (2015) · Frontiers in Pharmacology · doi:10.3389/fphar.2015.00275 · Cited by 47
“…interaction between GPR37 expression and affective disorders is also relevant to PD, as PD patients often experience non-motor symptoms involvingmood, sleep, memory and learning and sensorimotor disturbances, as well as olfactory and gastrointestinal perturbations (Chaudhuri et al., 2006).”
BackgroundAssociation of Restless Legs Syndrome With Incident Parkinson’s Disease
Szatmári, S., Bereczki, D., Fornadi, K., Kalantar‐Zadeh, K., Kovesdy, C. P., & Molnar, M. Z. (2016) · SLEEP · doi:10.1093/sleep/zsw065 · Cited by 49
Does REM sleep behavior disorder change in the progression of Parkinson’s disease?
Figorilli, M., Marquès, A., Vidal, T., Delaby, L., Meloni, M., Pereira, B., Lambert, C., Puligheddu, M., Durif, F., & Fantini, M. L. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2019.12.013 · Cited by 47
Córneo, E. D. S., Silveira, G. D. B., Scussel, R., Corrêa, M. E. A. B., Abel, J. D. S., Luiz, G. P., Feuser, P. E., Silveira, P. C. L., & Machado‐de‐Ávila, R. A. (2020) · Colloids and Surfaces B Biointerfaces · doi:10.1016/j.colsurfb.2020.111302 · Cited by 47
Frandsen, R. A. V., Baandrup, L., Kjellberg, J., Ibsen, R., & Jennum, P. (2014) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2014.07.012 · Cited by 46
“However, other regions of the brain are affected that are associated with non-motor symptoms [8], such as mood changes, depression [9], hallucinations, and sleep complaints including a type of increased motor”
Background
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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