Since then, there has been an explosion of new information on non-motor aspects of the disease, and several patient questionnaires have emerged to screen for non-motor symptoms. It is now well established that Parkinson's disease involves many brain areas outside of the dopamine-mediated nigrostriatal system. Recently, alpha-synuclein and Lewy neurites have been identified in biopsies of salivary glands, submucosal layers of the esophagus, stomach, and colon, and in the skin of living patients.
This book will make clinicians aware of the numerous non-motor manifestations of Parkinson's disease and emphasize their importance. Awareness and knowledge of the non-motor features of Parkinson's have increased dramatically in the seven years since the publication of that first edition, making an update on Parkinson's disease and non-motor dysfunction more than necessary. Behavioral abnormalities may be intrinsic components of the disease process itself (depression and dementia), treatment-induced complications (psychosis and postoperative behavioral changes), or a combination of both (anxiety and obsessionality).
These autonomic features often develop in the later stages of the disease, but can also appear early, sometimes even before the classical motor components become visible. However, they are included here because they are often not covered in detail in the more traditional discussions of the motor features of PD.
Behavioral Dysfunction in Parkinson’s Disease
Autonomic Dysfunction in Parkinson’s Disease
Sleep-Related Dysfunction in Parkinson’s Disease
Sensory Dysfunction in Parkinson’s Disease
Other Nonmotor Dysfunction in Parkinson’s Disease
Andrea Antal Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Göttingen, Göttingen, Germany. Ivan Bodis-Wollner Parkinson's Disease and Related Disorders Clinic, Center of Excellence, State University of New York, Downstate Medical Center, Brooklyn, NY, USA. Movement Disorders Program, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Hubert H.
Division of Movement Disorders, Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA. Institut for psykiatri og menneskelig adfærd, Alpert Medical School ved Brown University, Providence, RI, USA. Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Department of Neurology, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY, USA Eric S. Division of Dermatology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Despite the impact of depression in PD and growing research regarding this topic, many questions remain unanswered regarding basic issues such as prevalence, diagnosis, risk factors, and potential treatments. This chapter reviews the current knowledge about depression in PD, and describes its epidemiology, etiology and treatment. Despite an increasing amount of research devoted to this topic, uncertainty still exists regarding many aspects of depression in PD.
Significant questions remain regarding some very basic issues, including how best to diagnose depression in PD, how often depression complicates PD, the risk factors for developing depression, and how best to treat depression. This chapter provides a current perspective on what is known about depression in PD and reviews its epidemiology, etiology, and treatment. Rather than providing an overall overview, the focus here is on updating the major research themes in this area.
Parkinson's disease • Depression • Dysthymia • Mania • Mesocorticolimbic pathway • Selective serotonin reuptake inhibitor • Tricyclic antidepressant • Pramipexole • Nortriptyline • Paroxetine • Electroconvulsive therapy.
Depression in Parkinson’s Disease
Autonomic Dysfunction in Parkinson’s Disease
Dysphagia is an often unrecognized complication that occurs in a large majority of patients with Parkinson's disease (PD). Effects of bolus consistency on swallowing time and safety in patients with Parkinson's disease. A randomized trial of three fluid aspiration interventions in patients with dementia or Parkinson's disease.
Levodopa induced ON-OFF motor fluctuations in Parkinson's disease related to rhythmic chewing movements of the jaw. Parkinson's disease (PD) is a degenerative disease that affects the central, autonomic, and enteric nervous systems (ENS).
Gastric Dysfunction in Parkinson’s Disease
Parkinson's disease (PD) is a common degenerative disease affecting the central, autonomic and enteric nervous systems (ENS) [ 1. The ENS plays a key role in the generation and coordination of antral contractions and peristalsis and in the regulation of gastric emptying . Interstitial cells of Cajal, located in the greater curvature of the stomach, act as a slow gastric pacemaker.
However, another group of investigators observed no differences in myoelectric activity between PD patients with and without upper gastrointestinal problems [25. However, α-synuclein deposits in the PD brain are not limited to dopaminergic neurons. Neuronal loss in the dorsal motor nucleus of the vagus nerve (DMNX) has been reported in PD patients with autonomic failure [33.
In PD patients with autonomic failure, moderate neuronal loss and the presence of Lewy bodies in the intermediolateral columns of the thoracic cord have been observed, in addition to neuronal loss in the sacral segments [35, 36. The peripheral GI effect of levodopa occurs despite concomitant treatment with a decarboxylase inhibitor, as there is some peripheral conversion to dopamine in the stomach [44, 45. Chronic exposure to levodopa can also alter DMNX activity in the medulla oblongata.
These results should encourage patients to take their medications while still in the “on” state to accelerate levodopa absorption and improve absorption of subsequent doses of levodopa. Furthermore, it would be reasonable to expect an increase in the likelihood of being underweight in the presence of H. Ropinirole versus bromocriptine in the treatment of early Parkinson's disease: a six-month interim report of a three-year study.
Effect of cervical vagotomy on catecholaminergic neurons in the cranial parasympathetic nervous system. The role of chronic infection and inflammation in the gastrointestinal tract in the etiology and pathogenesis of idiopathic parkinsonism. Central and enteric nervous system dysfunction may play a role in the development of these intestinal and anorectal abnormalities.
Intestinal Dysfunction in Parkinson’s Disease
Intestinal involvement in Parkinson's disease (PD) has been known since the initial description of the disease by James Parkinson in 1817. It is not known whether these abnormalities are also present in PD patients suffering from constipation. Anecdotal reports have described the efficacy of cholinomimetic agents, pyridostigmine [102] and neostigmine [103], in the treatment of constipation in PD, but no formal studies of these compounds in PD patients have been reported.
In one study, abdominal pelvic dyssynergia (or pelvic floor dyssynergia) was present in more than 60% of patients with Parkinson's disease. [47] Failure of the EAS and puborectalis muscles to relax during attempted defecation, causing functional outlet obstruction, was originally observed in patients. with PD by Mathers et al. Eradication of Helicobacter pylori and L-dopa absorption in patients with Parkinson's and motor fluctuations.
The presence of impaired sexual function has been found in adults with Parkinson's disease and will be the focus of this chapter. Studies have examined various aspects of sexual functioning in adults with Parkinson's disease and their partners. Of the participants in this sample, 55% of optimally treated patients with Parkinson's reported changes in sexual function.
Twenty-two men and 23 women with PD [40], seen consecutively at the outpatient neurology clinic at a University Hospital, were interviewed by one examiner using the Arizona Sexual Experiences (ASEX) scale [41. The prevalence of sexual dysfunction in patients with PD and their partners was surveyed in young-onset patients with PD and their spouses. Therapeutic interventions for the treatment of impaired sexual function in women with PD were not identified in this literature review.
The prevalence of impaired sexual function in adults with PD is greater than the general population. 6 ] prospectively evaluated lower urinary tract symptoms (LUTS) using the International Continence Society questionnaire in 110 patients (84 men) with PD. 15] studied 70 urologically symptomatic patients with PD and noted that patients' symptom index scores increased with disease severity.
![Fig. 3.4 ) [ 10 ] . This balance allows initiation, rein- rein-forcement, maintenance (direct pathway), and suppression (indirect pathway) of complex motor programs, when appropriate](https://thumb-ap.123doks.com/thumbv2/azdoknet/10579383.0/50.756.283.683.92.324/balance-initiation-forcement-maintenance-suppression-indirect-programs-appropriate.webp)
