Management of nonmotor symptoms in Parkinson disease
- Daniel Tarsy, MD
Daniel Tarsy, MD
- Professor of Neurology
- Harvard Medical School
Parkinson disease (PD) is a chronic, progressive neurodegenerative disease characterized by any combination of four cardinal signs: rest tremor, rigidity, akinesia, and gait disturbance. The clinical features most suggestive of idiopathic PD rather than an atypical or secondary parkinsonian syndrome include asymmetric or unilateral onset, the presence of resting tremor, and a clear-cut response to treatment with L-dopa.
In addition to these typical motor features, patients with PD may experience nonmotor symptoms related to the disease itself or to the medications used to treat it. These symptoms include psychosis, hallucinations, daytime sleepiness, depression, fatigue, and dementia.
Management of these nonmotor symptoms will be reviewed here. Dementia in PD and the clinical features of nonmotor symptoms in PD are discussed separately. (See "Cognitive impairment and dementia in Parkinson disease" and "Clinical manifestations of Parkinson disease", section on 'Nonmotor symptoms'.)
Other aspects of PD are reviewed elsewhere. (See "Etiology and pathogenesis of Parkinson disease" and "Diagnosis and differential diagnosis of Parkinson disease" and "Pharmacologic treatment of Parkinson disease" and "Nonpharmacologic management of Parkinson disease" and "Motor fluctuations and dyskinesia in Parkinson disease" and "Surgical treatment of Parkinson disease".)
Psychosis is a frequent complication of PD, and it is characterized mainly by visual hallucinations and delusions, which are often paranoid in flavor . Hallucinations are the most common manifestation, and they affect up to 40 percent of patients with PD, particularly those at an advanced stage of illness. Psychosis may be triggered by infection, delirium, dementia, or medications. The adverse effects of antiparkinson medications are probably the most important cause of psychosis in patients with PD. Underlying dementia predisposes to hallucinations and delusions, and psychosis is a risk factor for nursing home placement and mortality. (See "Clinical manifestations of Parkinson disease", section on 'Psychosis and hallucinations'.)
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