Treatment strategies for nonmotor manifestations of Parkinson's disease

Abstract

To date, Parkinson's disease tends to have been perceived mainly as a disorder affecting the extrapyramidal motor system and leading to tremor, bradykinesia, rigidity, and -in later stages -postural instability. However, it is now apparent that patients frequently experience additional clinical symptoms, such as pain, autonomic and sensory dysfunction, neuropsychiatric disorders and sleep disorders. These symptoms often impair patients' quality of life to a greater extent than the motor symptoms. Treatment of these nonmotor features is mandatory and directly improves quality of life. Unfortunately, hardly any double-blind, randomized, controlled studies are available, with the consequence that most recommendations are not based on the highest level of evidence.

Cardiovascular autonomic dysfunction in Parkinson's disease

“…If orthostatic hypotension is symptomatic and repeated intake of fluids and modifications in the PD medication do not bring about considerable symptom relief, there are various treatments available, presented in Table 2 [42]. These therapies are often used depending upon their implementation levels and acceptance, independent of the level of orthostatic hypotension, and in some cases in combination.…”

Treatment of dysautonomia in extrapyramidal disorders

“…One key therapeutic concept is the hypersensitivity of these patients to depressor agents, requiring a careful titration of the doses on an individual basis. For those patients with proven residual sympathetic tone, as in MSA, central sympatholytics such as clonidine may provide an alternative [48]. Repeated 24 h ambulatory blood pressure monitoring is recommended for evaluation of therapeutic efficiency [57].…”

“…Parkinson's disease (PD) and other extrapyramidal disorders are clinically characterized by non-motor symptoms which include behavioural, sleep or perception dysfunctions as well as dysautonomia [48,70,71]. The prevalence of dysautonomia in PD varies between 14 and 80% depending on the population and methodology.…”

View point: Etiology in Parkinson's disease. Dual hit or spreading intoxication

“…Nowadays, it is well known that PD patients also suffer from non-motor symptoms [2,3] which considerably impair their quality of life [4]. Non-motor symptoms comprise disturbances of olfaction, vision, sleep and the autonomic nervous system [5].…”