The Nonmotor Features of Parkinson's Disease

Nataliya Titova, Mubasher A. Qamar, Kallol Ray Chaudhuri*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

56 Citations (Scopus)


Nonmotor symptoms (NMS) of Parkinson's disease (PD) were recognized by the great James Parkinson himself who mentioned symptoms such as sleep dysfunction, delirium, dementia, and dysautonomia, in his seminal 1817 essay, "An Essay on the Shaking Palsy" (). In spite of the key impact of PD NMS on quality of life, there was little holistic research and awareness till the validation and use of comprehensive tools such as the NMS questionnaire, scale, and the revised version of the unified PD rating scale. Research studies using these tools highlighted the key impact of the burden of NMS on quality of life of PD patients and the need for NMS to be routinely assessed in clinic. We now define PD as a motor and nonmotor disorder, and the natural history includes a long prodromal phase of PD dominated by a range of NMS. The prodromal phase is the subject of much research particularly in relation to neuroprotection and identifying subjects at risk. Use of NMS tools has also validated burden grading of NMS with cutoff values, which can be used as outcome measure in clinical trials. Finally, the complex multineurotransmitter dysfunction that is seen in PD has been shown to manifest clinically as nonmotor subtypes. Recognition of such subtypes is likely to lead to the emergence of personalized and precision medicine in PD. Key Points: •Virtually every patient with PD will have NMS, and these can range from 8 to 12 different symptoms.•NMS can be caused by the disease process and can be drug induced. Origin of NMS is due to a multineurotransmitter deficit in the brain and periphery, not just dopamine.•NMS can be measured in clinic by validated tools and clinical examination should include patient declared NMS questionnaire for screening as recommended by the Movement Disorders Society.•NMS burden can be graded using validated cutoff scores on NMS questionnaire and scales and can be used as outcome measure in clinical trials.•Nonmotor subtypes of PD are emerging and are being supported by specific biomarkers.•NMS can be treated by dopaminergic and nondopaminergic strategies.

Original languageEnglish
Pages (from-to)33-54
JournalInternational Review of Neurobiology
Early online date4 Apr 2017
Publication statusE-pub ahead of print - 4 Apr 2017


  • Classification
  • Nonmotor subtypes
  • Nonmotor symptoms burden
  • Nonmotor symptoms questionnaire
  • Nonmotor symptoms scale
  • Parkinson's disease
  • Quality of life


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