The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta. However, non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression. Indeed, non-motor symptoms dominate the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy. By contrast with the dopaminergic symptoms of the disease, for which treatment is available, non-motor symptoms are often poorly recognised and inadequately treated. However, attention is now being focused on the recognition and quantitation of non-motor symptoms, which will form the basis of improved treatments. Some non-motor symptoms, including depression, constipation, pain, genitourinary problems, and sleep disorders, can be improved with available treatments. Other non-motor symptoms can be more refractory and need the introduction of novel non-dopaminergic drugs. Inevitably, the development of treatments that can slow or prevent the progression of Parkinson's disease and its multicentric neurodegeneration provides the best hope of curing non-motor symptoms.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(06)70373-8.pdf

Non-motor symptoms of Parkinson's disease: diagnosis and management

Aging with multimorbidity: a systematic review of the literature

https://onlinelibrary.wiley.com/doi/pdf/10.1002/j.2051-5545.2011.tb00014.x

Physical illness in patients with severe mental disorders.I. Prevalence, impact of medications and disparities in health care

http://repositorio.inger.gob.mx/jspui/bitstream/20.500.12100/17171/1/PIIS0140673614613477.pdf

The burden of disease in older people and implications for health policy and practice

Clinical Trials: A Practical Approach

Multimorbidity's many challenges

Background: Depression has been linked to the occurrence of a number of somatic diseases. There are no data for PD. Objective: To determine if depression is associated with a subsequent risk for PD. Methods: A retrospective cohort study design based in general practice was applied. All subjects diagnosed with depression between 1975 and 1990 were included and matched with subjects with the same birth year who were never diagnosed with depression. Follow-up ended at April 30, 2000. Hazard ratios (HR) and 95% CI were calculated using Cox proportional hazards models adjusted for age, sex, and socioeconomic status. Subgroups based on sex and age at diagnosis of depression were evaluated separately. Results: Among the 1,358 depressed subjects, 19 developed PD, and among the 67,570 nondepressed subjects, 259 developed PD. The HR (95% CI) for depressed vs nondepressed subjects was 3.13 (1.95 to 5.01) in multivariable analysis. Associations in subgroups were comparable with the overall association. Conclusion: A strong positive association was found between depression and subsequent incidence of D.

Increased risk of Parkinson's disease after depression: a retrospective cohort study.

The objective of this study was to determine the prevalence and incidence of the most frequent chronic health problems in relation to age in people with intellectual disabilities living in residential facilities in the Netherlands. A prospective cohort study was done with four data collections, each with an interval of one year. Data were collected by means of questionnaires which were completed by each person's physician. Striking results included the reported high prevalence and incidence of visual and hearing impairment, which was even more pronounced in people with Down's syndrome than in people with intellectual disability resulting from other causes. Gastrointestinal problems also appeared to have high incidence rates. Dementia was frequently reported in people with Down's syndrome aged 40 years and older. The results reflect the need for a more predictive policy which can anticipate health problems in people with intellectual disability.

M. van den Akker

Papers

Multimorbidity's many challenges

Increased risk of Parkinson's disease after depression: a retrospective cohort study.

Prevalence and incidence of health problems in people with intellectual disability.

Clusters of lifestyle behaviors : Results from the Dutch SMILE study

Evaluation of Charlson's comorbidity index in elderly living in nursing homes.