Non-Motor Symptoms of Parkinson's Disease: Diagnosis and Management

Non-motor symptoms (NMS) of Parkinson's disease (PD) are a key determinant of health, quality of life (QoL) and societal cost of PD. They are often less appreciated than motor symptoms but are importantsources of disability for manyPDpatients. Literature search was performed using the reference databases Medline, Science Citation Index andEMBASE. The keywords used were 'non-motor symptoms', Parkinson's disease, olfaction and constipation. Papers discovered by this search werereviewed, as were references cited therein. Contrary to common perception, many NMS of PD occur early in PD and some may even predate thediagnosis of PD that is based on motor signs. These include olfactory deficit, sleep problems such as rapid eye movement behaviour disorder, constipation and the more recently described male erectile dysfunction.There is compelling evidence that nonmotor symptoms of PD play a dominant role in the QoL and disability of PD patients and the QoLof their 'informal' carers. Effective clinical management of PD thereforedemands that these symptoms be identified and to the extent possible treated.Keywords: Non motor symptoms, Parkinson's disease, Non motor questionnaire, Constipation, Olfaction, male erectile dysfunctio