Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment

Lancet Neurol. 2009 May;8(5):464-74. doi: 10.1016/S1474-4422(09)70068-7.


Several studies, including work from the Parkinson's disease (PD) non-motor group and others, have established that the non-motor symptoms of PD are common, occur across all stages of PD, are under-reported, and are a key determinant of quality of life. Research suggests that the non-motor symptoms of the disease are frequently unrecognised by clinicians and remain untreated. Even when identified, there is a common perception that many of these symptoms are untreatable. The role of dopaminergic drugs in treating the various non-motor problems of PD, although clinically recognised, has received little attention. In this Review, we investigate the dopaminergic basis of the range of non-motor symptoms that occur in PD such as depression, apathy, sleep disorders (including rapid-eye movement sleep behaviour disorder), and erectile dysfunction. We discuss the evidence that these symptoms are treatable, at least in part, with various dopaminergic strategies and, where relevant, we also refer to the use of deep-brain stimulation of appropriate targets in the brain. This Review provides a comprehensive overview of the management of this challenging aspect of PD.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / therapeutic use
  • Behavioral Symptoms / etiology
  • Behavioral Symptoms / physiopathology
  • Behavioral Symptoms / therapy
  • Brain / physiopathology
  • Deep Brain Stimulation
  • Dopamine / metabolism*
  • Dopamine Agents / therapeutic use
  • Gastrointestinal Diseases / etiology
  • Gastrointestinal Diseases / physiopathology
  • Gastrointestinal Diseases / therapy
  • Humans
  • Pain / etiology
  • Pain / physiopathology
  • Pain Management
  • Parkinson Disease / complications
  • Parkinson Disease / physiopathology*
  • Parkinson Disease / therapy*
  • Sexual Dysfunction, Physiological / etiology
  • Sexual Dysfunction, Physiological / physiopathology
  • Sexual Dysfunction, Physiological / therapy
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / physiopathology
  • Sleep Wake Disorders / therapy
  • Urologic Diseases / etiology
  • Urologic Diseases / physiopathology
  • Urologic Diseases / therapy
  • Visual Perception / physiology


  • Antiparkinson Agents
  • Dopamine Agents
  • Dopamine