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. 2025 Jan;18(1):1-16.
doi: 10.14802/jmd.24227. Epub 2024 Dec 20.

Non-Motor Fluctuations in Parkinson's Disease: Underdiagnosed Yet Important

Iro Boura  1   2   3 , Karolina Poplawska-Domaszewicz  3   4 , Cleanthe Spanaki  1   5 , Rosabel Chen  2   3 , Daniele Urso  2   3   6 , Riaan van Coller  7 , Alexander Storch  8   9 , Kallol Ray Chaudhuri  2   3
Affiliations

Non-Motor Fluctuations in Parkinson's Disease: Underdiagnosed Yet Important

Iro Boura et al. J Mov Disord. 2025 Jan.

Abstract

Non-motor fluctuations (NMFs) in Parkinson's disease (PD) significantly affect patients' well-being. Despite being identified over two decades ago, NMFs remain largely underrecognized, undertreated, and poorly understood. While they are often temporally associated with motor fluctuations (MFs) and can share common risk factors and pathophysiologic mechanisms, NMFs and MFs are currently considered distinct entities. The prevalence and severity of NMFs, often categorized into neuropsychiatric, sensory, and autonomic subtypes, vary significantly across studies due to the heterogeneous PD populations screened and the diverse evaluation tools applied. The consistent negative impact of NMFs on PD patients' quality of life underscores the importance of further investigations via focused and controlled studies, validated assessment instruments and novel digital technologies. High-quality research is essential to illuminate the complex pathophysiology and clinical nuances of NMFs, ultimately enhancing clinicians' diagnostic and treatment options in routine clinical practice.

Keywords: Advanced; Fluctuations; Non-motor; Parkinson’s disease; Therapy.

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Conflict of interest statement

Conflicts of Interest

The authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Prisma flowchart for a review of articles on Parkinson’s disease-related non-motor fluctuations. PubMed database on October 13, 2024.
Figure 2.
Figure 2.
Key features of autonomic and sensory NMFs. NMF, non-motor fluctuation.
None
See this image and copyright information in PMC

References

    1. Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol. 2009;8:464–474. - PubMed
    1. Prakash KM, Nadkarni NV, Lye WK, Yong MH, Tan EK. The impact of non-motor symptoms on the quality of life of Parkinson’s disease patients: a longitudinal study. Eur J Neurol. 2016;23:854–860. - PubMed
    1. Santos García D, de Deus Fonticoba T, Suárez Castro E, Borrué C, Mata M, Solano Vila B, et al. Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson’s disease patients: results from the COPPADIS study cohort. Parkinsonism Relat Disord. 2019;66:151–157. - PubMed
    1. Wang L, Xiong N, Huang J, Guo S, Liu L, Han C, et al. Protein-restricted diets for ameliorating motor fluctuations in Parkinson’s disease. Front Aging Neurosci. 2017;9:206. - PMC - PubMed
    1. Videnovic A, Noble C, Reid KJ, Peng J, Turek FW, Marconi A, et al. Circadian melatonin rhythm and excessive daytime sleepiness in Parkinson disease. JAMA Neurol. 2014;71:463–469. - PMC - PubMed

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