Non-motor Parkinson disease: new concepts and personalised management

Nataliya Titova and K Ray Chaudhuri
Med J Aust 2018; 208 (9): . || doi: 10.5694/mja17.00993
Published online: 21 May 2018



  • Most patients with Parkinson disease (PD) have non-motor symptoms (NMS), and on average these can range from four to 19 different symptoms.
  • NMS dominate the prodromal phase of PD and some may serve as clinical biomarkers of PD.
  • NMS can be dopaminergic, non-dopaminergic, of genetic origin or drug induced.
  • Clinical assessment of NMS should include the NMS Questionnaire (completed by patients) for screening, as recommended by the International Parkinson and Movement Disorders Society and other international societies.
  • The total number of NMS in a patient with PD constitutes the NMS burden, which can be graded using validated cut-off scores on the NMS Questionnaire and Scale and can be used as an outcome measure in clinical trials.
  • Despite NMS burden having a major effect on the quality of life of patients and carers, a large European study showed that NMS are often ignored in the clinic.
  • The syndromic nature of PD is underpinned by non-motor subtypes which are likely to be related to specific dysfunction of cholinergic, noradrenergic, serotonergic pathways in the brain, not just the dopaminergic pathways.
  • NMS can be treated by dopaminergic and non-dopaminergic strategies, but further robust studies supported by evidence from animal models are required.
  • The future of modern treatment of PD needs to be supported by the delivery of personalised medicine.


  • Nataliya Titova1
  • K Ray Chaudhuri2

  • 1 Pirogov Russian National Research Medical University, Moscow, Russia
  • 2 Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK



We thank the National Institute of Health Research Biomedical Research Centre and the Institute of Psychiatry, Psychology and Neuroscience at Kings College London for supporting research cited in this article, and the MDS Non-Motor Parkinson’s Disease Study Group.

Competing interests:

No relevant disclosures.


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