Non-motor signs in Parkinson’s disease: a review

Abstract

The traditional pathological description of PD as a pre-synaptic degenerative process affecting dopaminergic neurons in the substantia nigra pars compacta (SNc) of the midbrain with formation of Lewy bodies (LB) has changed dramatically in the last decade since functional and neuropathological studies showed the occurrence of extensive extranigral involvement 1 . Among these investigations, the seminal study of Braak et al. 2 suggested that the degenerative process in the PD starts in the caudal regions of the brainstem and the olfactory bulb, progressing in the caudal-rostral direction. The involvement of the SNc occurs, according to this hypothesis, on the third of a six-stage process that begins in the dorsal motor nuclei of the glossopharyngeal and vagus nerves and the olfactory bulb. Although it demonstrates the occurrence of this peculiar pathological distribution, the study fails to make the clinical correlation between any of these changes and motor or non-motor manifestations. On the other hand, even considering this caveat, it was one of the studies that formed the basis and motivated the dissemination of the concept of the existence of non-motor signs (NMS), especially dysautonomia, olfaction and sleep disorders, as part of the disease, sometimes even preceding the classic motor symptoms of PD.The motor aspects of PD typically have a slow progression and direct correlation with the presence of neuronal degeneration in the SNc, but they do not represent the actual beginning of the degenerative process. This process is, in fact, in full progression, despite been apparently silent when one seeks only for motor signs 3 . EXTRANIGRAL DEGENERATIONThe notion of PD as a multisystemic disease, not restricted to the nigrostriatal tract is not new, however the cited ABSTRACTDuring the past decade the view of Parkinson's disease (PD) as a motor disorder has changed significantly and currently it is recognized as a multisystem process with diverse non-motor signs (NMS). In addition to been extremely common, these NMS play a major role in undermining functionality and quality of life. On the other hand, NMS are under recognized by physicians and neglected by patients. Here, we review the most common NMS in PD, including cognitive, psychiatric, sleep, metabolic, and sensory disturbances, discuss the current knowledge from biological, epidemiological, clinical, and prognostic standpoints, highlighting the need for early recognition and management.Keywords: Parkinson's disease, non-motor signs, dementia, hyposmia, psychosis. RESUMONo decorrer da última década, a visão da doença de Parkinson (DP) como um distúrbio de movimento puro mudou significativamente, sendo atualmente reconhecida como um processo multisistêmico com diversos sinais não motores (SNM). Além de serem extremamente comuns, estes SNM têm um impacto muito significativo na limitacão funcional e da qualidade de vida na DP. Por outro lado, os SNM são mal reconhecidos pelos clínicos e negligenciados pelos pacientes. Nessa revisão os SNM mais comuns na DP fo...

Individualized guidance and telephone monitoring in a self-supervised home-based physiotherapeutic program in Parkinson

“…In this sense, it is suggested that in our study the total PDQ-39 score decreased significantly, mainly due to the observed decrease in the mobility domain score. In addition, the intervention was effective for two domains related to physical aspects (mobility and bodily discomfort) commonly affected in PD (28) and for a non-motor symptom (emotional well-being), which usually plays an important role in the functionality and QoL (1).…”

“…Parkinson's disease (PD) is a progressive neurodegenerative disease associated with motor, cognitive, behavioral and social repercussions (1,2). These can imply loss of autonomy and independence of the individual, negatively influencing their quality of life (QoL) (3)(4)(5).…”

The Assessment of Non-Motor Symptoms in Idiopathic Parkinson’s Disease

“…RBD has been reportedly present in 42-58% of all IPD patients. Patients with RBD have a 65% risk of development of IPD in the next ten years, making RBD specific clinical marker for premotor IPD 8,19 . In the present study, consistent with the literature, the rate of RBD was found to be 51.5%, which is compatible with the literature.…”

Unusual motor and non-motor symptoms and signs in the early stage of Parkinson’s disease

“…In fact, PD patients may present with a variety of motor and non-motor signs and symptoms that are considered uncommon or rare 1,3,4,5 . The motor signs in this series included tremor with an unusual presentation reported by three patients.…”

“…Difficulty with precise description and interpretation, as well as atypical forms of tremor, pain, other modalities of sensation, and secondary signs of RA syndrome make the initial diagnosis even more challenging but may also be clues for the active pursuit of non-obvious cardinal signs of the disease. Improved after watch was switched to contralateral wrist, while on L-dopa; 3,4,5 refered by the patients as "the shirt's button sign", "wet pillow sign", and "short jacket's sleeve sign".…”