Abstract
Parkinson's disease is predominantly classified as a movement disorder. Beyond the textbook definition of rigidity, tremors, and bradykinesia, Parkinson's disease encompasses an entire entity of non-motor symptom complexes that can precede the motor features by many years. Despite their significant clinical importance, the awareness of non-motor symptoms is quite negligible. Sleep disorders, gastrointestinal dysfunction, olfactory disturbances, anxiety, and depressive episodes are some of the most common non-motor presentations. The wide-spread occurrence of olfactory symptoms and the low cost of the assessment, is favoring olfactory dysfunction as a potential biomarker in Parkinson's. Sleep disorders may manifest before the motor and autonomic symptoms and might be linked to concomitant sleeping disorders like insomnia, REM sleep disorders, restless leg syndrome, narcolepsy, or obstructive sleep apnea. Non-motor symptoms can deteriorate the quality of life in Parkinson’s patients. Early detection of non-motor symptoms can help in the diagnosis of Parkinson’s disease and can fairly improve the survival and prognosis of these patients.
Highlights
BackgroundThe characteristic feature of Parkinson’s disease (PD) is the loss of dopaminergic neurons in the substantia nigra and the presence of alpha-synuclein protein Lewy body, named after the German neuropathologist Friedrich Heinrich Lewy
The hypothesis surrounding OSA is PD related loss of functioning neurons in myofibers and their subsequent atrophy, degeneration of the peripheral nerves innervating the oropharyngeal muscles, alpha-synuclein deposition in the fibers of the vagus nerve, supplying the laryngeal and pharyngeal muscles, and the episodic upper airway movement disorders caused by nocturnal dyskinesia may play a pivotal role in the development of obstructive sleep apnea
Despite the growing awareness of PD's non-motor symptoms, most clinical trials still focus on motor symptoms as the primary consequence
Summary
The characteristic feature of Parkinson’s disease (PD) is the loss of dopaminergic neurons in the substantia nigra and the presence of alpha-synuclein protein Lewy body, named after the German neuropathologist Friedrich Heinrich Lewy. The three most common non-motor symptoms in Parkinson's disease have been analyzed below from 50 review studies. Deficits in the sense of smell may precede clinically relevant motor symptoms by many years and can be used as an early assessment tool for Parkinson's disease. Sleep disorders like olfactory dysfunctions can occur years before the appearance of motor features [38]. The hypothesis surrounding OSA is PD related loss of functioning neurons in myofibers and their subsequent atrophy, degeneration of the peripheral nerves innervating the oropharyngeal muscles, alpha-synuclein deposition in the fibers of the vagus nerve, supplying the laryngeal and pharyngeal muscles, and the episodic upper airway movement disorders caused by nocturnal dyskinesia may play a pivotal role in the development of obstructive sleep apnea. PD- Parkinson's disease; REM- rapid eye movement; SDB- sleep-disordered breathing; RBD- REM sleep behavior disorder; EDS- excessive daytime sleepiness
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