Diagnosis and pharmacological management of Parkinson’s disease: summary of SIGN guidelines

Neuropsychiatric symptoms Depression, anxiety, apathy Hallucinations, illusions, delusions* Dementia, cognitive impairment* Compulsive and impulsive behaviours* Sleep disorders Insomnia* Sleep fragmentation* Excess daytime somnolence* Restless legs syndrome REM (rapid eye movement) sleep behaviour disorder Vivid dreaming* "Acting out" dreams, often including vocalisation when asleep Autonomic disorders Bladder disturbance: nocturia, urgency, frequency Heat or cold intolerance* Excess sweating* Orthostatic hypotension* Sexual dysfunction* Drooling of saliva Gastrointestinal disorders (overlap with autonomic) Dysphagia Ageusia (absence of taste) Constipation or incomplete emptying of bowel* Sensory disorders Pain, paraesthesia Impaired olfaction Other symptoms Fatigue* Pain* Diplopia Seborrhoea Weight loss *May be intrinsic to disease and/or precipitated by, or related to, drug treatment for Parkinson's disease Who should diagnose Parkinson's disease? Identification of disease modifying treatments for Parkinson's disease Identification of more sensitive and specific investigations for diagnosing Parkinson's disease Characterisation of the monogenic forms of parkinsonism in more detail, specifically with regard to genetic counselling for families Investigation of whether some monogenic forms of parkinsonism are distinct from what is considered to be idiopathic Parkinson's disease Identification of more effective treatments for motor complications and for cognitive, psychiatric, and other non-motor symptoms Comparison of effectiveness and safety of rasagiline and selegiline in early and advanced Parkinson's disease Examination of the impact of age on efficacy of drugs used in Parkinson's disease Identification of better strategies for prognostic modelling to help inform patients and their carers Identification of the most efficient and cost effective model of delivering health care to patients in the UK