Emergence of nonmotor symptoms as the focus of research and treatment of Parkinson's disease: introduction to the special section on nonmotor dysfunctions in Parkinson's disease

Abstract

Parkinson's disease (PD) is traditionally characterized by the cardinal motor symptoms of tremor, rigidity, slowness of movement, and impairments of posture, gait, and balance. A relatively new focus of research and treatment is the nonmotor symptoms of the disease, following from recent understanding of the neuropathological stages. Disruptions of arousal, mood, sleep, and autonomic function before the first motor signs of PD implicate the lower brainstem, which is affected before the substantia nigra and dopaminergic system. In later stages of the disease, the pathology extends to the cortex, accompanied by impairments in cognition and perception. The articles in this special section advance our knowledge of the brain bases of the nonmotor symptoms of PD, including disrupted visual perception, impaired cognition across a range of domains, and psychiatric and artistic manifestations. Subtypes under investigation include those described by side of disease onset (left or right body side), predominant cognitive profile, and gender. Taken together, the articles in this special section reflect the field's growing focus on the nonmotor symptoms of PD, their brain bases, and the corresponding potential for their treatment.