Table 3.
Summary of evidence for management of common non-motor symptoms of Parkinson's disease
| Symptom | Therapy | NICE guidelines5 | MDS EBM review27 | Comments |
|---|---|---|---|---|
| Depression | Pramipexole Consider antidepressant |
n/a | + | Optimise dopaminergic therapy SSRIs and venlafaxine effective |
| CBT | ||||
| Dementia | Cholinesterase inhibitor eg rivastigmine | + | + | May worsen tremor, GI/bladder AEs |
| Psychosis | Quetiapine | + | + | Usually first line |
| Clozapine | + | + | Requires FBC monitoring | |
| Postural hypotension | Midodrine Fludrocortisone |
+ | +/– | Reduce anti-hypertensives and other potential exacerbating drugs |
| Constipation | Macrogol Lubiprostone Probiotics and prebiotic fibre |
n/a | +/– +/– + |
Ensure good hydration Constipation may impact on medication absorption |
| Drooling | Glycopyrronium | + | + | Anticholinergics may cause cognitive AEs |
| BoNT injection to salivary glands | + | + | ||
| Nocturnal akinesia | Levodopa CR Rotigotine |
+ | + | |
| REM sleep behaviour disorder | Clonazepam Melatonin |
+ | n/a |
+ = recommended by guidance; +/– = possibly useful or evidence insufficient; AE = adverse effect; BoNT = botulinum neurotoxin; CBT = cognitive-behavioural therapy; CR = controlled release; FBC = full blood count; GI = gastrointestinal; MDS = International Parkinson and Movement Disorder Society; n/a = no recommendation; NICE = National Institute for Health and Care Excellence; REM = rapid eye movement; SSRIs = selective serotonin reuptake inhibitors.