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      Non-motor Parkinson's: integral to motor Parkinson's, yet often neglected

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          Abstract

          Non-motor symptoms are a key component of Parkinson's disease, possibly representing a clinical biomarker of its premotor phase. The burden of non-motor symptoms can define a patient's health-related quality of life. Non-motor symptoms substantially increase the cost of care—requiring increased hospitalisation and treatment—and pose a major challenge to healthcare professionals. However, clinicians often regard non-motor symptoms and their management as peripheral to that of the motor symptoms. Here, we address the clinical issues and unmet needs of non-motor symptoms in Parkinson's disease.

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          Stages in the development of Parkinson's disease-related pathology.

          Heiko Braak, Estifanos Ghebremedhin, Udo Rüb … (2004)
          The synucleinopathy, idiopathic Parkinson's disease, is a multisystem disorder that involves only a few predisposed nerve cell types in specific regions of the human nervous system. The intracerebral formation of abnormal proteinaceous Lewy bodies and Lewy neurites begins at defined induction sites and advances in a topographically predictable sequence. As the disease progresses, components of the autonomic, limbic, and somatomotor systems become particularly badly damaged. During presymptomatic stages 1-2, inclusion body pathology is confined to the medulla oblongata/pontine tegmentum and olfactory bulb/anterior olfactory nucleus. In stages 3-4, the substantia nigra and other nuclear grays of the midbrain and forebrain become the focus of initially slight and, then, severe pathological changes. At this point, most individuals probably cross the threshold to the symptomatic phase of the illness. In the end-stages 5-6, the process enters the mature neocortex, and the disease manifests itself in all of its clinical dimensions.
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            What contributes to quality of life in patients with Parkinson's disease?

            A. SCHRAG, M Jahanshahi, N Quinn (2000)
            To identify the factors that determine quality of life (QoL) in patients with idiopathic Parkinson's disease in a population based sample. Quality of life (QoL) is increasingly recognised as a critical measure in health care as it incorporates the patients' own perspective of their health. All patients with Parkinson's disease seen in a population based study on the prevalence of parkinsonism were asked to complete a disease-specific QoL questionnaire (PDQ-39) and the Beck depression inventory. A structured questionnaire interview and a complete neurological examination, including the Hoehn and Yahr scale, the Schwab and England disability scale, the motor part of the unified Parkinson's disease rating scale (UPDRS part III), and the mini mental state examination were performed by a neurologist on the same day. The response rate was 78%. The factor most closely associated with QoL was the presence of depression, but disability, as measured by the Schwab and England scale, postural instability, and cognitive impairment additionally contributed to poor QoL. Although the UPDRS part III correlated significantly with QoL scores, it did not contribute substantially to predicting their variance once depression, disability, and postural instability had been taken into account. In addition, patients with akinetic rigid Parkinson's disease had worse QoL scores than those with tremor dominant disease, mainly due to impairment of axial features. Depression, disability, postural instability, and cognitive impairment have the greatest influence on QoL in Parkinson's disease. The improvement of these features should therefore become an important target in the treatment of the disease.
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              Neuropathology of Parkinson's disease.

              L Forno (1996)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pract Neurol
                Journal ID (iso-abbrev): Pract Neurol
                Journal ID (hwp): practneurol
                Journal ID (publisher-id): pn
                Title: Practical Neurology
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 1474-7758
                ISSN (Electronic): 1474-7766
                Publication date (Print): October 2014
                Publication date (Electronic): 3 April 2014
                Volume: 14
                Issue: 5
                Pages: 310-322
                Affiliations
                [1 ]Department of Neurology, National Parkinson Foundation Centre of Excellence, King's College Hospital, and Kings College , London, UK
                [2 ]Institute of Pharmaceutical Science, King's College London , London, UK
                Author notes
                [Correspondence to ] Professor K Ray Chaudhuri, Department of Neurology, National Parkinson Foundation Centre of Excellence, King's College Hospital, and Kings College, 9th Floor Ruskin Wing, Denmark Hill, London SE5 9RS, UK; ray.chaudhuri@ 123456nhs.net
                Article
                Publisher ID: practneurol-2013-000741
                DOI: 10.1136/practneurol-2013-000741
                PMC ID: 4174166
                PubMed ID: 24699931
                SO-VID: bc91030f-1aed-45bf-b89b-f5b59bc4e8d2
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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                Subject: Review
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                Keywords: parkinson's disease,non motor symptoms,nmsquest
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                Keywords: parkinson's disease, non motor symptoms, nmsquest

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