Parkinson Disease: Managing Non-Motor Symptoms

When treating patients with Parkinson disease (PD), the first symptoms clinicians often assess and manage are tremor, rigidity, bradykinesia, and postural instability. But what about the non-motor symptoms that accompany this condition?  “Unseen PD” symptoms impact every patient to some degree. In some cases, these symptoms can affect patients even more profoundly than motor symptoms. This issue of Practical Neurology provides an overview of the diagnosis and management of non-motor symptoms associated with PD, including strategies to address these symptoms.

Drs. Turner and Gorelick begin this issue with an overview of orthostatic hypotension in patients with PD, which is often unrecognized. They discuss the causes of orthostatic hypotension and how to manage this condition. 

Problems with sleeping impact almost every patient with PD, ranging from rapid eye movement sleep behavior disorder to restless legs syndrome and frank insomnia. Drs. Stone, Morgan, and Kaplish offer a comprehensive overview of these sleep issues along with practical management advice. 

Many individuals with PD experience urogenital symptoms, including urinary frequency and nocturia. These symptoms are often embarrassing for patients and are frequently dismissed or ignored by clinicians. Drs. Park and LeWitt provide an excellent summary of these symptoms with an emphasis on treatment strategies.

Hallucinations can be frightening for patients and their families. Drs. Patino and Mahajan describe how to assess patients who might be experiencing these symptoms. They also discuss how to identify and manage the cognitive decline which some patients with PD develop.  

Depression, apathy, and anxiety are common in people with PD. Drs. Hedeman, Herrema, and Gilbert review these frequently observed PD-related mood disorders and discuss treatment options for this population. 

Vision and eye abnormalities are an often-overlooked symptom in patients with PD. Drs. Chouhani, Hernandez Mondragon, Santos, and Antonio provide an overview of neuro-ophthalmologic findings seen in patients with PD. Their article includes commonly observed issues (eg, dry eye) as well as less frequently observed issues (eg, eyelid opening apraxia). They also discuss problems associated with the use of deep brain stimulation in this population.  

As we learn more about PD, it is likely that these seemingly disparate symptoms will be found to have a common cause, which may result in the streamlining of treatment options. The information shared in these articles should help clinicians navigate the current treatment landscape and care for individuals who experience non-motor symptoms associated with PD. 

Thank you to all of the authors for their contributions and for sharing their expertise regarding these non-motor symptoms associated with PD. We hope you enjoy reading this issue of Practical Neurology.