Front Cover

Nonmotor Parkinson’s: The Hidden Face: Management and the Hidden Face of Related Disorders

Copyright

Contents

Contributors

Prefaces

Message from Professor Günther Deuschl, Europoean Academy of Neurology

Message from Professor Christopher G. Goetz, International Parkinson's and Movement Disorders Society

The Editors Words

Section 2B: Specific Nonmotor Symptoms in Parkinson's Disease, Part 2

Chapter Twenty-Five: Autonomic Dysfunction in Parkinson's Disease: Cardiovascular Symptoms, Thermoregulation, and Urogen ...

1. Introduction

2. Cardiovascular Symptoms

2.1. Blood Pressure and Pulse Reaction in Orthostasis

2.2. Influence of the Parkinson Therapy on Cardiovascular Regulation

2.3. Therapeutic Possibilities for Cardiovascular Problems

3. Thermoregulation Symptoms (Perspiration-Related Symptoms)

3.1. Therapy for Disturbances in Perspiration

4. Urinary Symptoms

4.1. Disturbances of Micturition

4.2. Urinary Incontinence

4.3. Therapy of Bladder Disturbances

5. Conclusion

References

Chapter Twenty-Six: The Gut and Nonmotor Symptoms in Parkinson's Disease

1. Introduction

2. GI Symptoms in PD

3. The Gut as Part of the Pathological Process in PD

4. The Gut-Brain Connection

5. Conclusion

Acknowledgments

References

Chapter Twenty-Seven: Constipation in Parkinson's Disease

1. Introduction

2. Constipation: A Prodromal Sign and a Risk Factor for PD

3. Microbiota and SIBO

4. Definition and Diagnostic Criteria

5. Epidemiology

6. Pathophysiology

7. Diagnosis

8. Motor Fluctuations and Constipation

9. Treatment (Table 3)

9.1. Newer Agents

9.2. Dyssinergic Defecation

10. Acute Emergency Admission

References

Further Reading

Chapter Twenty-Eight: Understanding and Treating Pain Syndromes in Parkinson's Disease

1. Background

2. Pain Pathophysiology in People With PD

3. Evaluation of Pain Syndromes in People With PD

4. Procedures for Treating Pain in People With PD

5. Pharmacological Therapy

6. Surgical Approaches

7. Rehabilitation

8. Conclusions

References

Further Reading

Chapter Twenty-Nine: Sexual Dysfunctions in Parkinson's Disease: An Underrated Problem in a Much Discussed Disorder

1. Parkinson's Disease and Hypersexuality

2. Neurobiology of HS in PD

3. Assessment and Investigation of SDs in Parkinson's Disease

4. Management of SDs in Parkinson's Disease

5. Concluding Remarks

References

Chapter Thirty: Osteoporosis: A Hidden Nonmotor Face of Parkinson's Disease

1. Introduction

1.1. Osteoporosis and Other NMS of PD

1.2. Why PD Patients Are More at Risk of Osteoporosis?

2. Diagnosis and Treatment

3. Conclusions

References

Further Reading

Chapter Thirty-One: Weight in Parkinson's Disease: Phenotypical Significance

1. Introduction

2. Body Weight Homeostasis and Changes in PD (Fig. 1)

3. Weight Measurement

4. Body Weight Status and Change in PD

4.1. Weight as a Risk Factor for PD

4.2. Weight Profile in PD

5. Changes in Body Weight in PD (Fig. 1)

6. Weight Gain and Obesity in PD

6.1. Dopaminergic System

6.2. Atypical Neuroleptics

6.3. Deep Brain Stimulation

6.4. Mechanism of Weight Gain After DBS

6.5. Other Potential Mechanisms for Weight Gain

7. Weight Loss in PD

7.1. Why Do Some PD Patients Lose Weight?

7.1.1. Nutritional Intake—Dysphagia and Motor Dexterity

7.1.2. Hormonal Factors

7.1.3. Energy Balance—Intake and Expenditure and Nutrition

7.1.4. Disease Severity

7.1.5. Gender and Age

7.1.6. Olfaction

7.1.7. Dementia/Depression/Hallucination

7.1.8. Structural Changes and Sarcopenia

7.1.9. Dopaminergic Medication

8. Significance of Low Body Weight and Weight Loss in PD

8.1. Nutritional Status, Frailty, and General Health

8.1.1. Body Weight and Dyskinesia

8.1.2. Weight-Related Gender Differences for Dyskinesia

8.1.3. Body Weight and Mortality and Quality of Life

9. Identifying Weight-Loser PD Patients—The Park-Olfaction-Weight Phenotype?

10. Conclusions

11. Recommendations and Implications on Disease Management

References

Further Reading

Chapter Thirty-Two: Visual Dysfunction in Parkinson's Disease

1. Introduction

2. Dopamine Pathways in Eye and Brain

3. Neuropathological Changes

4. Visual Dysfunction in PD

4.1. Visual Acuity

4.2. Color Vision

4.3. Visual Fields

4.4. Eye Movement

4.5. Stereopsis

4.6. Nystagmus

4.7. Blink Reflex

4.8. Pupil Reactivity

4.9. Contrast Sensitivity

4.10. Electroencephalography

4.11. Electroretinogram

4.12. Visual Evoked Potentials

4.13. Event-Related Potentials

4.14. Complex Visual Functions

4.15. Rapid Eye Movement Sleep Behavior Disorder

4.16. Visual Hallucinations

5. Discussion and Conclusions

5.1. Visual Features of PD

5.2. Differential Diagnosis

5.3. Visual Care of the Patient

References

Chapter Thirty-Three: Nonmotor Fluctuations in Parkinson's Disease

1. Epidemiology and Risk Factors of NMF

2. Clinical Presentation of NMF

2.1. Neuropsychiatric Symptoms

2.2. Autonomic Symptoms

2.3. Sensory Symptoms and Pain

2.4. Sleep and Fatigue

3. NMF and QoL

4. Pathophysiology of NMF

5. Management of NMF

5.1. Assessment Tools for NMS and NMF

5.2. Treatment of NMF

Acknowledgments

References

Chapter Thirty-Four: Acute Presentation of Nonmotor Symptoms in Parkinson's Disease

1. Introduction

2. Neuroleptic Malignant Syndrome

3. Serotonin Syndrome

4. Dopamine Agonist Withdrawal Syndrome

5. Dystonic Storm

6. Conclusion

References

Section 3: Therapeutics and Nonmotor Symptoms in Parkinson's Disease

Chapter Thirty-Five: Nonmotor Effects of Conventional and Transdermal Dopaminergic Therapies in Parkinson's Disease

1. Introduction

2. The Effect of Dopaminergic Therapies on NMS

2.1. Neuropsychiatric Symptoms

2.1.1. Depression

2.1.2. Anxiety

2.1.3. Apathy

2.1.4. Cognitive Impairment and Dementia

2.2. Autonomic Dysfunction

2.2.1. Gastrointestinal Dysfunction

2.2.2. Sexual Dysfunction

2.2.3. Urinary Dysfunction

2.3. Sleep Disorders

2.3.1. RBD

2.3.2. Restless Legs Syndrome and Periodic Limb Movement Disorder

2.3.3. Insomnia

2.4. Sensory Symptoms

2.4.1. Pain

2.4.2. Olfactory Dysfunction

2.5. Other Symptoms

2.5.1. Fatigue

3. The Unwanted Effect of Dopaminergic Therapies on NMS

3.1. Psychiatric and Behavioral NMS

3.1.1. Impulse Control Disorder

3.1.2. Punding

3.1.3. Psychosis

3.2. Other NMS

3.2.1. Orthostatic Hypotension

3.2.2. Excessive Daytime Sleepiness

3.2.3. Fibrotic Reactions With Ergot Dopamine Agonists

3.2.4. Peripheral Edema

4. Conclusions

Acknowledgments

References

Chapter Thirty-Six: Infusional Therapies, Continuous Dopaminergic Stimulation, and Nonmotor Symptoms

1. Introduction

2. Background: Subcutaneous Apomorphine Infusion

2.1. Methodology

2.2. The Effect on Motor Symptoms

2.3. The Effect on Quality of Life

2.4. Safety

2.5. The Indications, the Contraindications, and the "Ideal" Patient

3. Effects on Nonmotor PD Symptoms

3.1. Effect of CSA on Total Nonmotor Symptom Burden

3.2. Apomorphine and Neuropsychiatric Symptoms

3.3. Apomorphine and Gastrointestinal Symptoms

3.4. Apomorphine and Sleep

3.5. Apomorphine and Sensory Symptoms

3.6. Apomorphine and Urinary and Sexual Dysfunction

3.7. Apomorphine and Impulse Control Disorders

4. Background: Levodopa-Carbidopa Intestinal Gel

4.1. Methodology

4.2. The Effect on Motor Symptoms

4.3. The Effect on Quality of Life

4.4. Safety

4.5. The Indications, the Contraindications, and the "Ideal" Patient

5. LCIG: Effects on Nonmotor PD Symptoms

5.1. Effect of LCIG on Total Nonmotor Symptom Burden

5.2. LCIG and Neuropsychiatric Symptoms

5.3. LCIG and Gastrointestinal Symptoms

5.4. LCIG and Sleep

5.5. LCIG and Sensory Symptoms

5.6. LCIG and Urinary and Sexual Dysfunction

5.7. LCIG and Impulse Control Disorders

6. Conclusions

References

Chapter Thirty-Seven: Deep Brain Stimulation and Nonmotor Symptoms

1. Introduction

2. Nonmotor Outcomes of DBS

3. Neurobehavioral Profiles and DBS

3.1. Cognition

3.2. Neuropsychiatric Complications

3.2.1. Emotional Reactivity, Depression, and Anxiety

3.2.2. Apathy

3.2.3. Hypomania

3.2.4. Psychosis/Hallucinations

3.2.5. Impulsive Behavior

3.2.6. Managing Expectations

4. Autonomic Dysfunction

4.1. Orthostatic Hypotension

4.2. Constipation

4.3. Urinary Dysfunction

5. Sleep Disorders

5.1. Insomnia, EDS, and Sleep Quality

5.2. REM Sleep Behavior Disorder

5.3. Restless Legs Syndrome/Periodic Leg Movements Disorder

6. Sensory Symptoms

References

Further Reading

Chapter Thirty-Eight: Noninvasive Brain Stimulation and Implications for Nonmotor Symptoms in Parkinson's Disease

1. Methods

2. Results

3. Discussion

Acknowledgment

References

Chapter Thirty-Nine: Botulinum Toxin Therapy for Nonmotor Aspects of Parkinson's Disease

1. Introduction

2. BoNT for Drooling

2.1. Prevalence

2.2. Mechanisms

2.3. Assessment

2.4. Therapy

2.5. BoNT Injections: Technical Aspects

2.6. Summary

3. Botulinum Toxin for Neurogenic Bladder

3.1. Prevalence

3.2. Mechanism

3.3. Assessment

3.4. Therapy

3.5. Technical Aspects

3.6. Summary

4. BoNT for GI Dysfunctions

4.1. Upper GI Tract

4.1.1. Gastroparesis

4.2. Lower GI Tract

4.2.1. Functional Outlet Constipation

4.3. Summary

5. BoNT for Pain Related to PD

6. Botulinum Toxin for Hyperhidrosis

7. Botulinum Toxin for Other Indications in PD

References

Chapter Forty: Nutrition and Nonmotor Symptoms of Parkinson's Disease

1. Introduction

2. Evidence for Nutritional Deficiencies in PD

2.1. Coenzyme Q10

2.2. Glutathione

2.3. Lithium

2.4. Thiamine

3. PD Increases Risk of Malnutrition

4. Diet and Risk of PD Incidence

5. An Intestinal Disease That Spreads to the Brain?

5.1. Digestive Enzyme Insufficiency

5.2. Celiac Disease

5.3. Helicobacter pylori

6. Symptom-Specific Nutritional Considerations

6.1. Constipation

6.2. Cognitive Impairment

6.3. Depression and Anxiety

6.4. Sleep Disorders

6.5. Dystonia

7. Drug-Nutrient Interactions

7.1. Levodopa

8. Assessment of Nutritional Status

9. Conclusions

References

Chapter Forty-One: Complementary and Alternative Medicine and Exercise in Nonmotor Symptoms of Parkinson's Disease

1. Part 1: Complementary and Alternative Medicine (CAM) in Nonmotor Symptoms (NMS) of Parkinson Disease (PD)

1.1. Qigong and Taichi in NMS of PD

1.2. Dance in NMS of PD

1.3. Yoga/Mindfulness on NMS in PD

1.4. Miscellaneous CAM Interventions on NMS in PD

1.5. Acupuncture for NMS in PD

2. Part 2: Exercise on NMS in PD

2.1. Exercise Effects on Quality of Life as Measured by PDQ39 in PD

2.2. Exercise Effects on Sleep/Fatigue in PD

2.3. Exercise Effects on Depression in PD

2.4. Exercise Effects on Cognition in PD

3. Part 3: Therapy: PT and OT Effects on NMS

4. Conclusions

References

Chapter Forty-Two: Speech, Voice, and Communication

1. Introduction

2. Classical Description

3. Communication

4. Language

5. Subtypes

6. Assessments

7. Treatment

8. Into the Future

9. Conclusion

References

Chapter Forty-Three: Swallowing Dysfunctions in Parkinson's Disease

1. Background of Swallowing Disabilities

1.1. Epidemiology

1.2. Pathoanatomy and Pathophysiology

1.3. Pathomechanism and Symptomatology

2. Clinical Implications of Dysphagia and Relevance for Quality of Life

3. Dysphagia Assessment

3.1. Self-Awareness and Clinical Identification

3.2. Clinical Predictors

3.3. Dysphagia Screenings, Clinical and Instrumental Assessment

3.3.1. Patient Questionnaires

3.3.2. Clinical Screening and Evaluation

3.3.3. Instrumental Swallowing Evaluation

4. Dysphagia Treatment

5. Summary and Referrals

References

Chapter Forty-Four: Palliative Care and Nonmotor Symptoms in Parkinson's Disease and Parkinsonism

1. Introduction: What Is Palliative Care?

2. Palliative Care in Parkinson's Disease

3. Natural History of PD and Palliative Care

4. Key Strategies for Management

4.1. Assessments

4.2. Interventions Related to NMS

4.3. Multidisciplinary Approach

5. New Initiatives

6. Palliative Care in Parkinsonism: MSA and PSP

7. Conclusions

Acknowledgments

References

Chapter Forty-Five: Personalized Medicine and Nonmotor Symptoms in Parkinson's Disease

1. Introduction (Correction 1)

2. Genetics

3. Pharmacogenetics

4. Age and Personalized Medicine

5. Comorbidities

6. Lifestyle

7. Body Weight

8. Personality and Perception of Treatment

9. Pharmacoeconomics

10. Biomarker-Driven Nonmotor Subtype-Specific Treatment of PD and Personalized Medicine

11. Conclusions

References

Section 4: Nonmotor Symptoms in Parkinsonism and Related Disorders

Chapter Forty-Six: Nonmotor Features in Atypical Parkinsonism

1. Introduction

2. NMS in MSA

2.1. Autonomic Dysfunction

2.2. Other NMS in MSA

3. NMS in PSP and CBD

3.1. Progressive Supranuclear Palsy

3.2. Corticobasal Degeneration

3.3. Cognition and Neuropsychiatric/Behavioral Symptoms in PSP/CBD

3.4. Other NMS in PSP/CBD

4. NMS and Quality of Life in AP

5. Treatment of NMS in AP

5.1. Autonomic Dysfunction

5.2. Cognitive Impairment

5.3. Others

6. Conclusion

References

Chapter Forty-Seven: Nonmotor Symptoms in Vascular and Other Secondary Parkinsonism

1. Vascular Parkinsonism

1.1. Cognitive Impairment and Dementia in Patients With VP

1.2. Affective Symptoms

1.3. Psychotic Symptoms

1.4. Autonomic Insufficiency

1.5. Sleep Disorders

1.6. Sensory Symptoms

2. Normal Pressure Hydrocephalus

2.1. Cognitive Impairment

2.2. Neuropsychiatric Disturbances

2.3. Urinary Dysfunction

2.4. Sleep Disorders

2.5. Sensory Symptoms

3. Toxin-Induced Parkinsonism

3.1. Manganese

3.2. Mercury

3.3. Carbon Monoxide

3.4. Carbon Disulfide

4. Drug-Induced Parkinsonism

4.1. Cognitive Impairment

4.2. Autonomic Disturbances

4.3. Sleep Disorders

4.4. Sensory Symptoms

5. Conclusion

References

Further Reading

Chapter Forty-Eight: Nonmotor Symptoms in Dystonia

1. Introduction

2. NMS in Dystonia-Plus Syndromes

2.1. DYT 3 (X-Linked Dystonia-Parkinsonism)

2.1.1. Cognition

2.1.2. Neuropsychiatric Disorders and Autonomic Dysfunction

2.2. DYT 5 (Dopamine-Responsive Dystonia)

2.3. DYT 11 (Myoclonus-Dystonia)

2.4. DYT 12 (Rapid-Onset Dystonia-Parkinsonism)

3. NMS in Early-Onset Dystonia

3.1. DYT 1 (Early-Onset Torsion Dystonia, Oppenheim Dystonia)

4. NMS in Focal Dystonia

4.1. Blepharospasm

4.2. Cervical Dystonia

4.3. Focal Hand Dystonia

5. Conclusion

References

Chapter Forty-Nine: Nonmotor Symptoms in Essential Tremor and Other Tremor Disorders

1. Introduction

2. Essential Tremor

2.1. Cognitive Deficit

2.2. Psychiatric Features

2.2.1. Depression

2.2.2. Anxiety

2.2.3. Personality

2.3. Sleep

2.4. Sensory Abnormalities

2.4.1. Olfaction

2.4.2. Hearing

3. Dystonic Tremor

3.1. Olfaction

3.2. Mood Disorders

3.3. Sleep Disorders

3.4. Autonomic Symptoms

3.5. Cognition

3.6. Quality of Life

4. Orthostatic Tremor

4.1. Cognition and Affective Features

4.2. Quality of Life

5. Lesional Tremor: Thalamic, Cerebellar, and Brain Stem Lesions

5.1. Thalamic Tremor

5.2. Cerebellar Tremor

5.3. Brain Stem Lesional Tremor

6. Conclusions

References

Chapter Fifty: Nonmotor Symptoms in Huntington Disease

1. Introduction

2. Behavioral Disturbances

3. Cognitive Dysfunction

4. Management

5. Conclusions

References

Chapter Fifty-One: Nonmotor Symptoms in Amyotrophic Lateral Sclerosis: A Systematic Review

1. Introduction

2. Methods

2.1. Search Strategy

2.2. Inclusion/Exclusion Criteria

2.3. Quality Assessment

2.4. Data Analysis

3. Results

3.1. Studies

3.2. Neuropsychiatric

3.3. Autonomic

3.4. Gastrointestinal

3.5. Vascular

3.6. Others

3.7. Nonmotor Symptoms and Quality of Life

4. Discussion

Acknowledgments

References

Chapter Fifty-Two: Nonmotor Manifestations of Wilson's Disease

1. NMS in WD

1.1. Psychiatric and Behavioral Abnormality

1.2. Pattern of Psychiatric and Cognitive Manifestation in WD

1.3. Other Psychiatric Disorder

1.4. Imaging Abnormalities

2. Treatment of Psychiatric Manifestation in WD

2.1. Cognitive Impairment

3. Imaging

3.1. Sleep in WD

3.2. Autonomic Disturbance in WD

3.3. Influence of Nonmotor Manifestations in Quality of Life in WD

3.4. Our Experience of NMS in Subjects With WD in Bangur Institutes of Neurosciences, Kolkata, India (Tables 2 and 3)

4. Discussion

5. Conclusion

References

Chapter Fifty-Three: Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics

1. Introduction

2. Sensory Aspects of Tic Disorders

3. Behavioral Problems in Tic Disorders: Comorbid ADHD

4. Behavioral Problems in Tic Disorders: Comorbid Obsessive-Compulsive Symptoms and Obsessive-Compulsive Disorder

5. Behavioral Disturbances in Tic Disorders: Comorbid Anxiety and Depression

6. Behavioral Disturbances in Tic Disorders: Comorbid Impulse Control Disorders, Impulsive Behaviors, and "Impulsive" ...

7. Behavioral Disturbances in Tic Disorders: Comorbid Autistic Spectrum Disorders

8. Sleep Disorders

9. Conclusions

References

Further Reading

Section 5: Nonmotor Parkinson's and Future Directions

Chapter Fifty-Four: Nonmotor Parkinson's and Future Directions

1. Introduction

2. Animal Models

3. Overcoming Barriers Toward the Understanding of NMS in PD

4. Validation of the Nonmotor Subtypes of PD (Using Multimodal Biomarkers)

5. Better Evidence Base for Treatment of Specific NMS in PD

6. Make NMS Assessment (Including Burden Grading) an Obligatory Assessment intheClinic

7. Personalized Medicine

8. Exploration of the Role of Exercise and Complementary Medicine in the Management of NMS in PD

9. Conclusions

References

Back Cover