Comment: Why do nondopaminergic features in Parkinson disease matter?
Abstract
Parkinson disease (PD) is a progressive multisystem disorder affecting both dopaminergic and nondopaminergic neurons. Whereas dopaminergic (mainly motor) symptoms are well-defined, the nondopaminergic symptoms (mainly nonmotor, such as depression, cognitive decline, anxiety, apathy, fatigue, sleep disorders, sensory symptoms, postural control deficits, orthostatic hypotension, and urogenital and gastrointestinal symptoms) are frequently missed or neglected during routine clinical visits; consequently, they are underinvestigated and undertreated. The neglect of nondopaminergic symptoms is surprising because 1) they occur in almost all patients with PD throughout the course of the disease1 and can even precede the occurrence of the classic motor symptoms; 2) they affect almost all aspects of daily life; and 3) they have a greater effect on health-related quality of life than dopaminergic symptoms.2 During the last decade, several initiatives have addressed this deficit with specific assessment procedures for application in clinical practice and research.1
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References
1.
Martinez-Martin P, Schapira AHV, Stocchi F, et al. Prevalence of nonmotor symptoms in Parkinson's disease in an international setting: study using nonmotor symptoms questionnaire in 545 patients. Mov Disord 2007;22:1623–1629.
2.
Visser M, van Rooden SM, Verbaan D, Marinus J, Stiggelbout AM, van Hilten JJ. A comprehensive model of health-related quality of life in Parkinson's disease. J Neurol 2008;255:1580–1587.
3.
van der Heeden JF, Marinus J, Martinez-Martin P, van Hilten JJ. Importance of nondopaminergic features in evaluating disease severity of Parkinson disease. Neurology 2014;82:412–418.
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© 2014 American Academy of Neurology.
Publication History
Published online: January 3, 2014
Published in issue: February 4, 2014
Funding Information
Study funding: No targeted funding reported.Disclosure: W. Maetzler receives funding from the European Union (SENSE-PARK, no. 288557, 2011–2014; Moving beyond, no. 316639, 2012–2016), from the Michael J. Fox Foundation, and the local University. He received funding from the Robert Bosch Foundation (2008–2011) and speaker honoraria from GlaxoSmithKline. Go to Neurology.org for full disclosures.
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