AHV; National Institute for Clinical Excellence. Non-motor symptoms of Parkinson's disease: diagnosis and management

Movement Disorders Unit, Kings College Hospital, Guy's King's and St Thomas' School of Medicine, London, UK.
The Lancet Neurology (Impact Factor: 21.9). 04/2006; 5(3):235-45. DOI: 10.1016/S1474-4422(06)70373-8
Source: PubMed


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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    • "Parkinson's disease (PD) is a neurodegenerative disorder characterized by tremor, rigidity, bradykinesia and postural instability [1]. In addition to motor symptoms, non-motor symptoms such as apathy, anxiety, depression, fatigue, memory disturbances, sensory impairment, sleep disorders and autonomic disturbances contribute to the morbidity [2]. Diminished visual acuity, color vision and contrast sensitivity are some of the visual disturbances described in PD [3e5]. "
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    ABSTRACT: Though Parkinson's disease (PD) is primarily a disease of the basal ganglia, recent evidence suggests that PD affects the retina. The study was designed to evaluate the thickness of retinal nerve fiber layer (RNFL) and thickness and volume of the macula in PD and hence explore the utility of optical coherence tomography (OCT) in studying retinal changes in PD. A prospective, hospital based evaluation of 30 patients with PD and 30 healthy controls was carried out. Various parameters such as RNFL, central macular thickness (CMT), central and total macular volumes (TMV) and retinal thickness were analyzed using OCT. (a) RNFL thickness was not significantly different between the patients and controls. A significant negative correlation was found between the RNFL thickness in the right nasal superior sector and the UPDRS motor score. (b) CMT was found to be significantly reduced in the right eye and a negative correlation with the UPDRS motor score was noted. (c) TMV was significantly greater in patients compared to the controls. (d) The outer retinal layer in the right nasal quadrant and the right inferior quadrants were found to be significantly thinner in patients with PD. We did not find any significant abnormality in the RNFL thickness in patients with PD. Decreased CMT in patients with PD and a significant negative correlation of RNFL thickness and CMT with severity of PD suggest a remote possibility of dopaminergic depletion in the retina. However long term studies are warranted to validate our findings. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Parkinsonism & Related Disorders 08/2015; 21(10). DOI:10.1016/j.parkreldis.2015.08.002 · 3.97 Impact Factor
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    • "There is good evidence that patient priorities in symptomatology do not consistently match those of the treating physician's. Patients often put greater emphasis on "soft signs" rather than the more readily quantifiable and overt symptomatology [7]. For instance, in a survey conducted by Parkinson's Movement (, there was little correlation between patient-reported quality of life and motor symptoms, suggesting that motor symptoms, the most visible to a physician, are an inadequate measure upon which to base treatment decisions (figure 1). "
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    ABSTRACT: Parkinson's Disease (PD) involves well known motor symptoms such as tremor, rigidity, bradykinesia, and altered gait but there are also non-locomotory motor symptoms (e.g., changes in handwriting and speech) and even non-motor symptoms (e.g., disrupted sleep, depression) that can be measured, monitored, and possibly better managed through activity based monitoring technologies. This will enhance quality of life (QoL) in PD through improved self-monitoring, and also provide information which could be shared with a health care provider to help better manage treatment. Until recently, non-motor symptoms ("soft signs") had been generally overlooked in clinical management yet these are of primary importance to patients and their QoL. Day-to-day variability of the condition, the high variability in symptoms between patients, and the isolated snapshots of a patient in periodic clinic visits makes better monitoring essential to the proper management of PD. Continuously monitored patterns of activity, social interactions, and daily activities could provide a rich source of information on status changes, guiding self correction and clinical management. The same tools can be useful in earlier detection of PD and will improve clinical studies. Remote medical communications in the form of telemedicine, sophisticated tracking of medication use, and assistive technologies that directly compensate for disease related challenges are examples of other near term technology solutions to PD problems. Ultimately, a sensor technology is no good if it is not used. The Parkinson's community is a sophisticated early adopter of useful technologies and a group for which engineers can provide near term gratifying benefits.
    08/2015; DOI:10.1109/JBHI.2015.2464354
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    • "Alongside motor symptoms, people with PD also experience non-motor symptoms (NMS) such as: pain, drooling; choking/ swallowing difficulties; constipation; bladder dysfunction; cognitive impairment; hallucinations; depression/anxiety; sexual dysfunction; insomnia, which occur from disease onset [8]. Nonmotor symptoms contribute to severe disability, impaired QoL, and institutionalization [9], and can be more troublesome and disabling for the patient than motor complications [10]. Recent work suggests some NMS are treatable using device-aided therapies [11] [12] since they are often dopaminergic in origin. "
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    ABSTRACT: Navigate PD was an educational program established to supplement existing guidelines and provide recommendations on the management of Parkinson's disease (PD) refractory to oral/transdermal therapies. It involved 103 experts from 13 countries overseen by an International Steering Committee (ISC) of 13 movement disorder specialists. The ISC identified 71 clinical questions important for device-aided management of PD. Fifty-six experts responded to a web-based survey, rating 15 questions as 'critically important;' these were refined to 10 questions by the ISC to be addressed through available evidence and expert opinion. Draft guidance was presented at international/national meetings and revised based on feedback. Key take-home points are: • Patients requiring levodopa >5 times daily who have severe, troublesome 'off' periods (>1-2 h/day) despite optimal oral/transdermal levodopa or non-levodopa-based therapies should be referred for specialist assessment even if disease duration is <4 years. • Cognitive decline related to non-motor fluctuations is an indication for device-aided therapies. If cognitive impairment is mild, use deep brain stimulation (DBS) with caution. For patients who have cognitive impairment or dementia, intrajejunal levodopa infusion is considered as both therapeutic and palliative in some countries. Falls are linked to cognitive decline and are likely to become more frequent with device-aided therapies. • Insufficient control of motor complications (or drug-resistant tremor in the case of DBS) are indications for device-aided therapies. Levodopa-carbidopa intestinal gel infusions or subcutaneous apomorphine pump may be considered for patients aged >70 years who have mild or moderate cognitive impairment, severe depression or other contraindications to DBS. Copyright © 2015. Published by Elsevier Ltd.
    Parkinsonism & Related Disorders 07/2015; DOI:10.1016/j.parkreldis.2015.07.020 · 3.97 Impact Factor
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