Progress and Prospects in Parkinson's Research/Therapy/Symptomatic Relief/Non-Motor
PD is normally described, diagnosed and treated in terms of its motor symptoms, which can generally be attributed to dopamine deficiency. Equally important and often more troublesome to the patient are non-motor symptoms(NMS). These can fall into two main categories. The first is secondary effects of motor symptoms. For example postural and postural instability maybe a secondary consequence from the lack of muscle tone brought on by dysfunction in the control of movement by the basal ganglia. The second category is symptoms which cannot readily be attributed to a dopaminergic source and may hint at ramifications of the disease affecting other organs. For example feelings of giddiness when standing up suddenly (orthostatic hypotension) are generally attributed to a drop in blood pressure, which may in turn indicate a shortfall in the neurotransmitter noradrenaline. Also drooling results from the accumulation of saliva in the mouth following a reduction in the autonomic function of swallowing.
Chaudhuri and Quinn  have carried out a comprehensive review of NMS.
Many NMS may need specific targeted non-dopaminergic treatment, and the development of successful therapies for NMS will depend upon accurate,reproducible and robust means of quantification, an understanding of their prevalence and evolution with disease progression and their effect on QoL.
Shulman et al  evaluated the diagnosis and treatment of 101 randomly selected PD atients and concluded:-
This study demonstrates that during routine office visits, neurologists failed to identify the presence of depression, anxiety, and fatigue more than half of the time and failed to recognize sleep disturbance in 40% of patients. Awareness of the likelihood of underrecognition of behavioral symptoms in PD should generate approaches to improve diagnostic accuracy and facilitate timely therapeutic interventions.
Samay  evaluated the impact of PD on the autonomic nervous symptom and recorded associated symptoms in the Cardiovascular system, Skin and sweat glands, the Urinary tract, the Gastrointestinal tract, the Pupillary system and Neuroendocrine stuctures.
Kleiner-Fisman et al  developed a method of measuring non-motor symptoms based upon the use of questionnaires.
Solla et al  evaluated the hypothesis that there might be significanf gender variations in the onset of non-motor PD symptoms.
Based on a study of 156 Sardinian out-patients they found significant gender differences for cardiovascular symptoms, sleep/fatigue, mood/apathy, lack of motivation, sadness, altered interest in sex, depression, and anxiety.
The present study highlights the role of gender differences associated with the occurrence of motor and non-motor disorders and our findings indicate that spectrum and severity of non-motor symptoms may present with different gender distribution in PD patients, suggesting a possible sex-related effect.
Khedr et al  analysed the symptoms of 112 PD patients.
• Analysis of the data from the NMSS showed that mood/cognition was the most commonly affected domain (prevalence rate=87.5%), followed by sleep disturbance/fatigue second (78.6%). However, all other non-motor symptoms scored highly: gastrointestinal and urinary (76.8% for both), sexual dysfunction (73%), cardiovascular (70.5%) with significantly higher percentage in predominantly akinetic/rigid patients. Perceptual problems/hallucinations (9.9%) were infrequent in this population. Dementia was recorded in 22.3% of patients, most of them having a mild degree of dementia. UPDRS scores were correlated with total scores in both NMSQuest and NMSS.
Use the following links to query the PubMed, PubMed Central and Google Scholar databases using the Search terms:- Parkinson's_Disease Non-Motor.
This will list the latest papers on this topic. You are invited to update this page to reflect such recent results, pointing out their significance.
- Chaudhuri, K. Ray and Quinn,Niall pp 1-5 Full Text What are the non-motor symptoms of Parkinon's Disease? http://fds.oup.com/www.oup.com/pdf/13/9780199237234.pdf
- Shulman, L.M.; Taback, R. L.; Rabinstein, A. A. and Weiner, W. J. 2006 Abstract Parkinsonism & Related Disorders 8 (3) 193-197 Non-recognition of depression and other non-motor symptoms in Parkinson's disease. http://ukpmc.ac.uk/abstract/MED/12039431/reload=0;jsessionid=e0J8JBhl3GN1atVMNLp8.24
- Samay, Jain (2011) Full Text Parkinsonism Relat. Disord. 17 (2): 77–83 Multi-organ autonomic dysfunction in Parkinson disease http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021587/?tool=pmcentrez
- Kleiner-Fisman, Galit; Martine, Rebecca; Lang, Anthony E. snd Stern, Matthew B. (2011) Full TextParkinsons Dis. 2011; 292719.Development of a Non-Motor Fluctuation Assessment Instrument for Parkinson Disease.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153935/?tool=pmcentrez
- Solla, P.; Cannas, A.; Ibba, F.C.; Loi, F.; Corona, M,. Orofino, G.; Marrosu, M. G. and Marrosu, F. (2012)Abstract J. Neurol. Sci. 2012 Gender differences in motor and non-motor symptoms among Sardinian patients with Parkinson's disease. http://www.ncbi.nlm.nih.gov/pubmed/22935408
- Khedr, E. M.; El Fetoh, N. A.; Khalifa, H.; Ahmed, M. A. and El Beh, K. M. Clin. Neurol. (2012) Aug. Prevalence of non motor features in a cohort of http://www.ncbi.nlm.nih.gov/pubmed/22902078