An Update on the Management of Parkinson's Disease

Shen-Yang Lim, MBBS, FRACP; Susan H. Fox, MRCP (UK), PhD


Geriatrics and Aging. 2008;11(4):215-222. 

In This Article

Abstract and Introduction


Parkinson's disease (PD) is characterized by the presence of bradykinesia, rigidity, and rest tremor. Nonmotor symptoms are also very common in PD and may result in significant disability. Many approaches are available to reduce symptoms. In this article we provide an update on the management of PD. We also discuss the limitations of current treatments.

Abstract and Introduction


Parkinson's disease (PD) is the most common cause of parkinsonism and affects 1% of the population over age 60; all races are affected. Diagnosis is based on a careful history and physical examination.[1] There are no diagnostic laboratory tests or imaging studies, although tests may be performed to exclude other disorders that may mimic parkinsonism (e.g., cerebrovascular disease, normal pressure hydrocephalus). Parkinsonism induced by neuroleptics or antiemetics is important to exclude because it may be reversible. The loss of nigrostriatal dopaminergic neurons is associated with the core motor features of PD including bradykinesia, rigidity and rest tremor (although the latter is absent in about 20% of cases). Nonmotor symptoms (NMS) have been increasingly recognized in PD and include neuropsychiatric, autonomic, sensory, and sleep disorders. Some NMS can even precede the motor symptoms of PD by many years (e.g., rapid-eye-movement sleep behaviour disorder).[2] Support and education of patients are critical. Patients should understand that PD is a slowly progressive neurodegenerative disease, and that many approaches are available to reduce symptoms, including medication and nonpharmacological approaches.


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