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Non-motor Symptoms in Parkinson’s Disease
Thermoregulatory dysfunction associated with excessive sweating Society, non-motor domains have been expanded, reflecting the
can be very bothersome in PD. Symptoms can include heat and cold increasing number of requests from neurologists to better address
intolerance, head and neck sweating and dry skin (particularly on the patient needs. n
lower extremities). These symptoms, while less severe than some
other symptoms from a medical perspective, have been associated
Angelo Antonini is a Physician at the Parkinson Institute
with physical, social and emotional impairment.
in Milan, Medical Co-ordinator for Information Technology
and Clinical Research in the Department of Neuroscience
Scales to Assess Non-motor Symptoms
at the Hospital ‘Istituti Clinici di Perfezionamento’ in
Milan and a Professor of Neurology at the University
Scales have been proposed for NMS evaluation addressing
of Milan-Bicocca. His research interests include
individual aspects such as sleep, cognition, mood, behaviour and neuroimaging as well as cognitive and behavioural
quality of life. Recently, the first comprehensive, self-completed NMS
aspects of Parkinson’s disease. His research also focuses
on the use of continuous subcutaneous infusion of
questionnaire for PD (NMSQuest) has been developed and validated.
apomorphine and subthalamic nucleus deep brain stimulus (STN-DBS) in the treatment
It considers 30 items distributed in nine different domains: of serious motor fluctuations and dyskinesia of patients suffering from advanced
gastrointestinal, urinary, memory, hallucinations, depression/anxiety,
Parkinson’s disease. During his academic career, he has published over 150 peer-
reviewed manuscripts, over 200 abstracts and several book chapters. He serves as
sexual function, cardiovascular, sleep disorders and miscellany. The
a reviewer for several neurology journals and is on the Editorial Board of Movement
total number of examined patients is small and additional data are Disorders. He has received several awards for his research in the field of Parkinson’s
needed to assess the relevance of NMS features for PD disability.
disease. Professor Antonini earned his MD from the University of Rome ‘La Sapienza’.
Indeed, in the new UPDRS scale, revised by the Movement Disorders
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2003;18:1139–45. 9. Riedel O, Klotsche J, Spottke A, et al., J Neurol, 2003;61:40–45
2. Aarsland D, Larsen JP, Tandberg E, Laake K, J Am Geriatr Soc, 2008;255:255–64. 16. Hobson DE, Lang AE, Martin WR, et al., JAMA,
2000;48:938–42. 10. Aarsland D, Andersen K, Larsen JP, et al., Neurology, 2002;287:455–63.
3. Shiba M, Bower JH, Maraganore DM, et al., Mov Disord, 2001;56:730–36. 17. Antonini A, Neurol Sci, 2007;28(Suppl. 1):S6–S8.
2000;15:669–77. 11. Buter TC, van den Hout A, Matthews FE, et al., Neurology, 18. Goldstein DS, Lancet Neurol, 2003;2:669–75.
4. Iranzo A, Molinuevo JL, Santamaria J, et al., Lancet Neurol, 2008;70:1017–22. 19. Braune S, Reinhardt M, Schnitzer R, et al., Neurology,
2006;5:572–7. 12. Slaughter JR, Slaughter KA, Nichols, et al., J Neuropsychiatry 1999;53:1020–25.
5. Martinez-Martin P, Schapira AH, Stocchi F, et al., Mov Disord, Clin Neurosci, 2001;13:187–96. 20. Abbott RD, Petrovich H, White LR, et al., Neurology,
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Related Article
Cognitive Impairment in 873 Patients with Idiopathic Parkinson’s Disease. Results from the
German Study on Epidemiology of Parkinson’s Disease with Dementia (GEPAD)
Riedel O, et al., J Neurol, 2008;255(2):255–64.
Parkinson’s disease (PD) is often accompanied by non-motor Using standardised cut-off scores, the prevalence of cognitive
complications such as dementia, depression and psychotic impairment in the study sample as measured by various methods
symptoms, which worsen the prognosis and increase the personal was 17.5% by MMSE (≤24), 41.8% by CDT (≥3) and 43.6% by PANDA
and socioeconomic burden of disease. Prevalence estimates of (≤14), and 28.6% met the DSM-IV criteria for dementia. All estimates
these complications are quite variable and are lacking for the increased with age and PD severity. Gender was an inconsistent
outpatient care sector. contributor, while illness duration had no significant impact on
cognition. Multiple regression analyses revealed PD severity to be
As part of a larger, nationwide, cross-sectional epidemiological the strongest predictor of dementia risk (odds ratio [OR] 4.3; 95%
study in 315 neurological outpatient settings in Germany, this confidence interval [CI] 2.1–9.1), while neuropsychiatric syndromes
article estimates the frequency of dementia and cognitive had independent although modest additional contributions (OR 2.5,
impairment in 873 outpatients meeting the UK Brain Bank criteria 95% CI 1.6–3.8). Estimates of cognitive impairment and dementia in
for idiopathic PD. Assessments were based on a clinical interview PD patients are largely dependent on the diagnostic measure used.
and neuropsychological assessments, including the Hoehn & Yahr Using established clinical diagnostic standards for dementia, the
rating and Unified Parkinson’s Disease Rating Scale (UPDRS). overall rate on routine outpatient neurological care is 28.6%, but
Cognitive impairment was assessed by the Mini-Mental State using more sensitive neuropsychological measures, rates for
Exam (MMSE), Clock Drawing Test (CDT) and the Parkinson cognitive impairment might be up to two-fold higher. The MMSE
Neuropsychometric Dementia Assessment (PANDA), and the revealed strikingly low sensitivity. Neuropsychiatric syndromes, in
clinician’s diagnosis of dementia was based on the diagnostic addition to PD severity and age, have an independent – although
criteria of Diagnostic and Statistical Manual of Mental Disorders, modest – additional contribution to patients’ risk of cognitive
Fourth Edition (DSM-IV). impairment and dementia. n
EUROPEAN NEUROLOGICAL REVIEW 27
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