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.
"Parkinson's disease (PD) is a neurodegenerative disorder characterized by tremor, rigidity, bradykinesia and postural instability . 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 . Diminished visual acuity, color vision and contrast sensitivity are some of the visual disturbances described in PD [3e5]. "
"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 . For instance, in a survey conducted by Parkinson's Movement (http://parkinsonsmovement.com), 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). "
[Show abstract][Hide abstract] 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.
"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 . Nonmotor symptoms contribute to severe disability, impaired QoL, and institutionalization , and can be more troublesome and disabling for the patient than motor complications . Recent work suggests some NMS are treatable using device-aided therapies   since they are often dopaminergic in origin. "
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