Parkinson’s disease

Abstract:

Parkinson's disease (PD) is a common neurodegenerative condition, affecting 2–3% of those >65 years of age. Although it is classically defined as a movement disorder, patients also experience a range of non-motor symptoms, reflecting pathology that is more widespread than originally thought and affecting the peripheral and autonomic nervous system as well as the brainstem and cortex. Some non-motor symptoms can occur years before motor problems emerge, and there is interest in better defining this prodromal state to enable future disease-modifying therapies to be used at an early stage. Patients differ in the extent of non-motor and motor symptoms at presentation, and in the speed at which these evolve. This is at least partly because of genetic factors and is to some extent predictable in early disease. In this article, we discuss the natural history of PD and provide an update on its genetic and pathological basis before reviewing motor and non-motor symptomatology. We discuss currently available therapies and their complications, before going on to review new therapeutic developments and the need to target these precisely to particular disease subtypes that are now better defined at an early disease stage.