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| ==Non-motor symptoms in Parkinson's disease== | |||
| Although the most obvious symptoms of Parkinson's affect movement, there is an increasing realisation in clinical practice that non-motor symptoms are at least as important in successful management. <ref>{{cite journal | author = Allain H | title = Depression in Parkinson's disease. | journal = BMJ | volume = 320 | pages = 1287-1288 | year = 2000| id = PMID 10807601}}</ref> Accurate diagnosis is made difficult by the overlap between organic symptoms of Parkinson's disease and non-motor symptoms, and it is becoming clear that without the use of objective measures, underdiagnosis is likely to occur. <ref>{{cite journal | author = Shulman LM| title = Non-recognition of depression and other non-motor symptoms in Parkinson's disease.| journal = Parkinsonism Relat Disord| volume = 8 | issue = 3 |pages = 193-197 | year = 2000| id = PMID 12039431}}</ref> For instance, a Parkinsonian individual with low energy, flat affect, and sexual dysfunction could easily be diagnosed as ], despite these symptoms resulting from their neurological disease rather than a mood disorder. Improving treatment of non-motor symptoms such as sleep disturbance and hallucinations could significantly improve quality of life for this group. | |||
| ==Depression in Parkinson's Disease== | |||
| ] is the most commonly occurring non-motor symptom in Parkinson's disease. It is thought to occur in about half of all cases and is increasingly thought to be a consequence of the disease rather than an emotional reaction to disability. <ref>{{cite journal | author = McDonald W| title = Prevalence, Etiology, and Treatment of Depression in | |||
| Parkinson’s Disease | journal = Biol Psychiatry| volume = 54| pages = 363-375 | year = 2003| id = PMID 12893111}}</ref> What is called "depression" in this context may actually differ from depression that occurs in healthy people without Parkinson's disease. There is evidence that whilst the severity of depression in patients with Parkinson's disease can be as severe as that seen in primary mental health, it appears to be qualitatively different. For instance, in a recent study comparing neurologically healthy people with depression and Parkinson's patients with depression, the Parkinson's group reported less sadness, loss of pleasure, guilt, and less loss of energy. <ref>{{cite journal | author = Ehrt U | title = Depressive symptom profile in Parkinson’s disease: | |||
| a comparison with depression in elderly patients | |||
| without Parkinson’s disease| journal = Int J Geriar Psychiatry| volume = 21| issue = 3| pages = 252-258 | year = 2006| id = PMID 16477585 }}</ref> | |||
| *] or ]<br>Note: 70% of individuals with Parkinson's disease diagnosed with pre-existing depression go on to develop anxiety; 90% of Parkinson's disease patients with pre-existing anxiety subsequently develop depression); | |||
| *] or ]: abulia translates from Greek as the absence or negative of will; apathy is an absence of feeling or desire | |||
| ] disturbances: | |||
| *]; both voluntary and involuntary motor responses are significantly slowed. | |||
| *], characterized by difficulties in: differential allocation of attention, impulse control, set shifting, prioritizing, evaluating the salience of ambient data, interpeting social cues, and subjective time awareness. This complex is present to some degree in most Parkinson's patients; it may progress to: | |||
| *]: a later development in approximately 20-40% of all patients, typically starting with slowing of thought and progressing to difficulties with abstract thought, memory, and behavioral regulation. | |||
| *]; ] is more impaired than ]. Prompting elicits improved recall. | |||
| *medication effects: some of the above cognitive disturbances are improved by dopaminergic medications, while others are actually worsened <ref>{{cite journal | |||
| |author=Michael J Frank | |||
| |title= Dynamic Dopamine Modulation in the Basal Ganglia: A Neurocomputational Account of Cognitive Deficits in Medicated and Non-mediacated Parkinsonism | |||
| |journal=] | |||
| |year=2005 | volume=17 | pages= 51–73 | |||
| |url=http://www.u.arizona.edu/~mfrank/pubs-abstr.html#Frank05 | |||
| }}</ref> | |||
| ]: | |||
| *Excessive daytime ]; | |||
| *Initial, intermediate, and terminal insomnia; | |||
| *Disturbances in REM sleep: disturbingly vivid dreams, and REM Sleep Disorder, characterized by acting out of dream content; | |||
| ==] disturbances== | |||
| *Patients with Parkinson's disease have impairments in their ability to carry out a visual search. This can have particular relevance when driving, and people with Parkinson's have been shown to be less accurate in spotting landmarks and roadsigns whilst driving. <ref>{{cite journal | |||
| |author=Uc EY | |||
| |title= Impaired visual search in drivers with Parkinson's disease | |||
| |journal=] | |||
| |year=2006 | pages= EPub ahead of print | |||
| |url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=16969860 | |||
| }}</ref> | |||
| *impaired visual ], spatial reasoning, ] discrimination, convergence insufficiency (characterized by ]) and ] | |||
| *] and fainting; usually attributable orthostatic hypotension, a failure of the autonomous nervous system to adjust blood pressure in response to changes in body position | |||
| *impaired ] (the awareness of bodily position in three-dimensional space) | |||
| *loss of sense of ] (]), | |||
| *]: neuropathic, muscle, joints, and tendons, attributable to tension, dystonia, rigidity, joint stiffness, and injuries associated with attempts at accommodation | |||
| ] disturbances: | |||
| *] and ]; | |||
| *], typically in later disease progression | |||
| *] and ]dysmotility: severe enough to endanger comfort and even health | |||
| *]: characterized by profound impairment of sexual arousal, behavior, orgasm, and drive is found in mid and late parkinson disease. Current data addresses male sexual function almost exclusively. | |||
| ==References== | |||
| <div class="references-small"><references/></div> | |||
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