Journal of Neurology

, 255:33 | Cite as

Early Parkinson’s disease and non-motor issues

  • K. Ray Chaudhuri
  • Yogini Naidu


Non motor symptoms (NMS) of PD are a key determinant of health, quality of life and societal cost of PD. Contrary to common perception, many NMS of PD occur early in PD and some may even predate the diagnosis of PD which is based on motor signs. These include olfactory deficit, sleep problems such as REM behaviour disorder, contipation and the more recently described male erectile dysfunction. The non motor quesionnaire (NMSQuest) and the recently validated NMS scale allow falgging and quantification of NMS of PD and therefore are important tools to comprehensively assess symptom load in PD.

Key words

Non Motor Parkinson’s disease Olfaction RBD Constipation 


  1. 1.
    Parkinson J (1817) An essay on the Shaking palsy. Sherwood, Neely and Jones, LondonGoogle Scholar
  2. 2.
    Chaudhuri KR, Healy D, Schapira AHV (2006) The non motor symptoms of Parkinson’s disease. Diagnosis and management. Lancet Neurology 5:235–245PubMedCrossRefGoogle Scholar
  3. 3.
    Schrag A, Jahanshahi M, Quinn N (2000) What contributes to quality of life in patients with Parkinson’s disease? J Neurol Neurosurg Psychiatry 69:308–312PubMedCrossRefGoogle Scholar
  4. 4.
    Hely MA, Morris JGL, Reid WGJ, Trafficante R (2005) Sydney multicenter study of Parkinson’s disease: Non-L-dopa-responsive problems dominate at 15 years. Mov Disord 20:190–199PubMedCrossRefGoogle Scholar
  5. 5.
    Aarsland D, Larsen JP, Tandberg E, Laake K (2000) Predictors of nursing home placement in Parkinson’s disease: a population-based, prospective study. J Am Geriatr Soc 48:938–942PubMedGoogle Scholar
  6. 6.
    Shulman LM, Taback RL, Rabinstein AA, Weiner WJ (2002) Non-recognition of depression and other non-motor symptoms in Parkinson’s disease. Parkinsonism Relat Disord 8:193–197PubMedCrossRefGoogle Scholar
  7. 7.
    O’Sullivan SS, Williams DR, Gallagher DA, Massey LA, Silveira-Moriyama L, Lees AJ (2008) Non motor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord 23:101–106PubMedCrossRefGoogle Scholar
  8. 8.
    Tolosa E, Compta Y, Gaig C (2007) The premotor phase of Parkinson’s disease. Parkinsonism Relat Disord 13(Suppl):S2–S7PubMedCrossRefGoogle Scholar
  9. 9.
    Stacy M, Bowron A, Guttman M, Hauser R, Hughes K, Larsen JP, et al. (2005) Identification of motor and non motor wearing off in Parkinson’s disease: comparison of a patient questionnaire versus a clinician assessment. Mov Disord 20:726–733PubMedCrossRefGoogle Scholar
  10. 10.
    Chaudhuri KR, Martinez-Martin P, Schapira AHV, Stocchi F, Sethi K, Odin P, et al. (2006) An international multicentre pilot study of the first comprehensive self-completed non-motor symptoms questionnaire for Parkinson’s disease: The NMSQuest study. Mov Disord 21:916–923PubMedCrossRefGoogle Scholar
  11. 11.
    Martinez-Martin P, Schapira AHV, Stocchi F, Sethi K, Odin P, Macphee G, et al. (2007) Prevalence of non motor symptoms in Parkinson’s disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Mov Disord 22:1623–1629PubMedCrossRefGoogle Scholar
  12. 12.
    Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P, et al. (2007) The metric properties of a novel non-motor symptoms scale for Parkinson’s disease: results from an international pilot study. Mov Disord 22:1901–1911PubMedCrossRefGoogle Scholar
  13. 13.
    Grosset D, Taurah L, Burn DJ, MacMahon D, Forbes A, Turner K, et al. (2007) A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson’s disease left untreated at diagnosis. J Neurol Neurosurg Psychiatry 78:465–469PubMedCrossRefGoogle Scholar
  14. 14.
    Braak H, Del Tredici K, Rüb U, de Vos RAI, Jansen Steur ENH, Braak E (2003) Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 24:197–210PubMedCrossRefGoogle Scholar
  15. 15.
    Del Tredici K, Braak H (2004) Idiopathic Parkinson’s disease: staging an a-synucleinopathy with a predictable path anatomy. In: Kahle P, Haass C (eds) Molecular mechanisms in Parkinson’s disease. Georgetown, TX: Landes Bioscience, pp 1–32Google Scholar
  16. 16.
    Benarroch EE (1999) Central neurotransmitters and neuromodulators in cardiovascular regulation. In: Mathias CJ, Bannister R (eds) Autonomic Failure. 4th Ed. Oxford University Press, Oxford/New York, Chapter 5, pp 37–44Google Scholar
  17. 17.
    Rye DB, Jankovic J (2002) Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 58:341–346PubMedGoogle Scholar
  18. 18.
    Saper C, Chou TC, Scammell TE (2001) The sleep switch: hypothalamic control of sleep and wakefulness. Trends in Neurosci 24:726–731CrossRefGoogle Scholar
  19. 19.
    Diederich NJ, Goetz CG, Stebbins GT (2005) Repeated visual hallucinations in Parkinson’s disease as disturbed external/internal perceptions: Focused review and a new integrative model. Mov Disord 20:130–140PubMedCrossRefGoogle Scholar
  20. 20.
    Ansari KA, Johnson A (1975) Olfactory function in patients with Parkinson’s disease. J Chronic Dis 28(9):493–497PubMedCrossRefGoogle Scholar
  21. 21.
    Doty RL, Stern MB, Pfeiffer C, Gollomp SM, Hurtig HI (1992) Bilateral olfactory dysfunction in early stage treated and untreated idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 55(2):138–142PubMedCrossRefGoogle Scholar
  22. 22.
    Ponsen MM, Stoffers D, Booij J, van Eck-Smit BL, Wolters ECh, Berendse HW (2004) Idiopathic hyposmia as a preclinical sign of Parkinson’s disease. Ann Neurol 56(2):173–181PubMedCrossRefGoogle Scholar
  23. 23.
    Ross W, Petrovitch H, Abbott RD, Tanner CM, Popper J, Masaki K, et al. (2005) Association of olfactory dysfunction with risk of future Parkinson’s disease. Mov Disord 20(Suppl 10):P439 (Abstract)CrossRefGoogle Scholar
  24. 24.
    Hawkes C (2003) Olfaction in neurodegenerative disorders. Mov Disord 18:364–372PubMedCrossRefGoogle Scholar
  25. 25.
    Montgomery EB, Baker KB, Lyons K, et al. (1999) Abnormal performance on the PD test battery by asymptomatic first-degree relatives. Neurology 52:757–762PubMedGoogle Scholar
  26. 26.
    Khan NL, Katzenschlager R, Watt H, Bhatia KP, Wood NW, Quinn N, Lees AJ (2004) Olfaction differentiates parkin disease from early-onset parkinsonism and Parkinson disease. Neurology 62(7):1224–1226PubMedGoogle Scholar
  27. 27.
    Clarimon J, Pagonabarraga J, Paisan-Ruiz C, Campolongo A, Pascual-Sedano B, Marti-Masso J-F, Singleton AB, Kulisevsky J (2008) Tremor dominant parkinsonism: clinical description and LRRK 2 mutation screening. Mov Disord 23:518–523PubMedCrossRefGoogle Scholar
  28. 28.
    Louis ED, Marder K, Tabert MH, Devananand DP (2008) Mild parkinsonian signs are associated with lower olfactory test scores in the community dwelling elderly. Mov Disord 23:524–530PubMedCrossRefGoogle Scholar
  29. 29.
    Friedman JH, Amick MM (2007) Rhinorhoea is increased in Parkinson’s disease. Mov Disord 23:452–454CrossRefGoogle Scholar
  30. 30.
    Schenck CH, Bundlie SR, Mahowald MW (1996) Delayed emergence of a parkinsonian disorder in 38 % of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder. Neurology 46:388–393PubMedGoogle Scholar
  31. 31.
    Olson EJ, Boeve BF, Silber MH (2000) Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 123:331–339PubMedCrossRefGoogle Scholar
  32. 32.
    Eisensehr I, Linke R, Noachtar S, Schwarz J, Gildehaus FJ, Tatsch K (2000) Reduced striatal dopamine transporters in idiopathic rapid eye movement sleep behaviour disorder. Comparison with Parkinson’s disease and controls. Brain 123:1155–1160PubMedCrossRefGoogle Scholar
  33. 33.
    Stiasny-Kolster K, Doerr Y, Moller JC, Hoffken H, Behr TM, Oertel WH, Mayer G (2005) Combination of ‘idiopathic’ REM sleep behaviour disorder and olfactory dysfunction as possible indicator for alpha-synucleinopathy demonstrated by dopamine transporter FP-CIT-SPECT. Brain 128(Pt 1):126–137PubMedCrossRefGoogle Scholar
  34. 34.
    Unger MM, Moeller JC, Stiasny-Kolster K, Mankel K, Berg D, Walter U, Hoeffken H, Mayer G, Oertel W (2008) Assessment of idiopathic rapid-eyemovement sleep behavior disorder by transcranial sonography, olfactory function test, and FP-CIT-SPECT. Mov Disord 23(4):596–599PubMedCrossRefGoogle Scholar
  35. 35.
    Uchiyama M, Isse K, Tanka K, et al. (1995) Incidental Lewy body disease in patients with REM sleep behaviour disorder. Neurol 45:709–712Google Scholar
  36. 36.
    Wolters and Braak J (2006) Parkinson’s disease: premotor clinico-pathological correlations. Neural Trans 70:309–319CrossRefGoogle Scholar
  37. 37.
    Henderson M, Lu Y, Wang S, Cartwright H, Halliday GM (2003) Olfactory deficits and sleep disturbances in Parkinson’s disease: a case–control survey. JNNP 74:956–958Google Scholar
  38. 38.
    Abbott RD, Petrovitch H, White LR, et al. (2001) Frequency of bowel movements and the future risk of Parkinson’s disease. Neurology 57:456–462PubMedGoogle Scholar
  39. 39.
    Burn DJ (2002) Beyond the iron mask; towards better recognition and treatment of depression associated with Parkinson’s disease. Mov Disord 17:445–454PubMedCrossRefGoogle Scholar
  40. 40.
    Remy P, Doder M, Lees A, Turjanski N, Brooks D (2005) Depression in Parkinson’s disease: loss of dopamine and noradrenaline innervation in the limbic system. Brain 128(Pt 6):1314–1322PubMedCrossRefGoogle Scholar
  41. 41.
    Lauterbach EC, Freeman A, Vogel RL (2004) Differential DSM-III psychiatric disorder prevalence profiles in dystonia and Parkinson’s disease. J Neuropsychiatry Clin Neurosci 16:29–36PubMedGoogle Scholar
  42. 42.
    Nilsson FM, Kessig LV, Bolwig TG (2001) Increased risk of developing Parkinson’s disease for patients with major affective disorders. Acta Psychiatr Scand 104:380–386PubMedCrossRefGoogle Scholar
  43. 43.
    Schurmann AG, van den Akker H, Ensinck KTJL, Metsemakers FH, Knottnerus JA, Leentjens FG, et al. (2002) Increased risk of Parkinson’s disease after depression: a retrospective cohort study. Neurology 58:1501–1504Google Scholar
  44. 44.
    Okun M, Walter BL, McDonald WM, Tenover JL, Green J, Juncos JL, DeLong MR (2002) Beneficial effects of testosterone replacement for the non motor symptoms of Parkinson’s disease. Arch Neurol 59(11):1750–1753PubMedCrossRefGoogle Scholar
  45. 45.
    Gao X, Chen H, Schwarzschild MA, Glasser DB, Logroscino G, Rimm EB, Ascerio A (2007) Erectile function and the risk of Parkinson’s disease Am J Epidemiol 166(12):1446–1450PubMedCrossRefGoogle Scholar
  46. 46.
    Goldstein DS, Holmes C, Li ST, Bruce S, Metman LV, Cannon RO 3rd (2000) Cardiac sympathetic denervation in Parkinson disease. Ann Intern Med 133:338–347PubMedGoogle Scholar
  47. 47.
    Singleton A, Gwinn-Hardy K, Sharabi Y, Li ST, Holmes C, Dendi R, et al. (2004) Association between cardiac denervation and parkinsonism caused by alpha-synuclein gene triplication. Brain 127(Pt 4):768–772PubMedCrossRefGoogle Scholar
  48. 48.
    Abbott RD, Ross GW, White LR, Tanner CM, Nelson JS, Petrovicth H, et al. (2005) Excessive daytime sleepiness and the future risk of Parkinson’s disease. Mov Disord 20(Suppl 10):S101 (P 341)Google Scholar
  49. 49.
    Benarroch EE, Schmeichel AM, Sandroni P, Low PA, Parisi JE (2006) Involvement of vagal autonomic nuclei in multiple system atrophy and Lewy body disease. Neurology 66:378–383PubMedCrossRefGoogle Scholar
  50. 50.
    Spiegel J, Storch A, Jost WH (2006) Early diagnosis of Parkinson’s disease/J Neurol 253(Suppl 4):IV/2–IV/7CrossRefGoogle Scholar
  51. 51.
    Dhawan V, Williams A, Pal S, DiMarco A, Martinez-Martin P, Tobias A, Chaudhuri KR (2006) Sleep dysfunction in untreated Parkison’s disease. J Neurol Sci 248:158–162PubMedCrossRefGoogle Scholar
  52. 52.
    Siderowf A, Jdennings D, Connolly J, Doty R, Mareck K, Stern M (2007) Risk factors for Parkinson’s disease and impaired olfaction in relatives of patients with Parkisnon’s disease. Mov Disord 22:2249–2255PubMedCrossRefGoogle Scholar
  53. 53.
    Lerner A, Bagic A (2008) Olfactory pathogenesis of idiopathic Parkinson’s disease revisited. Movement disorders 23:1076–1084PubMedCrossRefGoogle Scholar
  54. 54.
    Cersosimo MG, Benarroch EE (2008) Neural control of the gastrointestinal system: Implications for Parkinson’s disease. Mov Disord 23:1065–175PubMedCrossRefGoogle Scholar
  55. 55.
    Fujishiro H, Frigerio R, Burnett M, Klos KJ, Josephs KA, DelleDonne A, Parisi JE, Ahlskog JE, Dickson DW (2008) Cardiac sympathetic denervation correlates with clinical and pathologic stages of Parkinson’s disease. Mov Disord 23:1085–1092PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.9th Floor Ruskin WingKings College HospitalLondonUK
  2. 2.National Parkinson Foundation Centre of Excellence, Kings College HospitalUniversity Hospital Lewisham, Guy’s King’s and St Thomas’ School of MedicineLondonUK

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