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Prominent Non-Motor Symptoms

 Clinically, NMS consists of four domains: neuropsychiatric (e.g., depression, anxiety, apathy, hallucinations, and dementia), autonomic (e.g., constipation, orthostatic hypotension, urinary changes, and sweating abnormalities), sleep (e.g., insomnia, sleep fragmentation, excessive daytime sleepiness, rapid eye movement. sleep disorder, and restless leg syndrome), and sensory dysfunction (e.g., pain and olfactory dysfunction). Such diversity of NMS may be consistent with the widespread distribution of αS pathology in the gut as well as brainstem and neocortex in PD brain, in which multiple populations of aminergic neurons may be affected, including serotonergic and noradrenergic neurons. Thus, the classic Parkinsonian motor syndrome is now regarded as but one unitary symptom type among many disparate symptoms of the synucleinopathies.    

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