Non-motor symptoms (NMS) significantly impact quality of life in Parkinson's disease and represent a major focus at MDS 2026. These symptoms often precede motor signs by years and may be underrecognized in clinical practice.
¶ Depression and Anxiety
- Prevalence: Up to 50% of PD patients
- Presentation: Low mood, anhedonia, worry, panic
- Treatment: SSRIs (citalopram, sertraline), SNRIs, cognitive behavioral therapy
- Note: May precede motor symptoms by decades
- Prevalence: 20-40% (visual hallucinations most common)
- Risk factors: Older age, cognitive impairment, antiparkinsonian meds
- Management: Reduce dopaminergic meds, add pimavanserin, quetiapine
- Prevalence: 30-50%
- Features: Loss of motivation, reduced goal-directed activity
- Differentiation: Distinguish from depression (anhedonia key)
- Prevalence: 50-60% of PD patients
- Features: Acting out dreams, vivid dreams, REM without atonia
- Significance: Strong predictor of synucleinopathy
- Treatment: Clonazepam, melatonin
- Prevalence: 60-90%
- Causes: Nocturnal akinesia, depression, medications
- Management: Sleep hygiene, timed dopaminergic dosing
- Prevalence: 30-50%
- Evaluation: Epworth Sleepiness Scale
- Causes: Medication, nocturnal sleep disruption
- Prevalence: 30-50%
- Symptoms: Lightheadedness, syncope, falls
- Management: Increase salt/fluid intake, compression stockings, fludrocortisone
- Prevalence: 60-80%
- Mechanism: Gastrointestinal alpha-synuclein deposition
- Management: Fiber, laxatives, prokinetics
- Prevalence: 45-70%
- Types: Urgency, frequency, nocturia
- Management: Anticholinergics, behavior modification
- Prevalence: 50-70%
- Types: Erectile dysfunction, reduced libido
- Contributing factors: Autonomic dysfunction, medications
- Prevalence: 90%+ (hyposmia/anosmia)
- Significance: Earliest marker, predicts PD development
- Evaluation: University of Pennsylvania Smell Identification Test
- Prevalence: 40-60%
- Types: Musculoskeletal, radicular, dystonic, central
- Treatment: Optimize dopaminergic therapy, analgesics
- Prevalence: 20-50%
- Types: Executive, attention, memory, visuospatial
- Progression: 50-80% develop dementia over time
- Prevalence: 30-80% (duration-dependent)
- Features: Executive dysfunction, visual hallucinations, fluctuations
- Management: Cholinesterase inhibitors (rivastigmine), avoid anticholinergics
- 30 items across 9 domains
- Validated, reproducible
- Used in clinical trials
- "Off" state associated with anxiety, pain, fatigue
- Under-recognized but treatable
- Screen systematically — Use validated tools
- Treat underlying causes — Optimize dopaminergic therapy
- Pharmacologic intervention — Symptom-specific
- Non-pharmacologic — Lifestyle modifications, therapy
- Multidisciplinary care — Neurology, psychiatry, sleep medicine