Clinical Approach of Diagnosis and Management of Non-Motor Symptoms in Parkinson’s Disease

Non-motor symptoms are common and clinically important manifestations of Parkinson disease (PD), often occurring from the prodromal stage and throughout the disease course. Although PD has traditionally been defined by motor features, non-motor symptoms substantially affect quality of life, functional independence, caregiver burden, and longterm outcomes. These symptoms are frequently underrecognized because patients may not attribute them to PD and clinicians may focus primarily on motor complications. This review summarizes a practical clinical approach to the diagnosis and management of major nonmotor symptoms in PD, with emphasis on applicability to routine neurological practice in Korea. The main domains covered include neuropsychiatric symptoms such as depression, anxiety, psychosis, and impulse control disorders; cognitive impairment; autonomic dysfunction; sleep disorders; pain; and fatigue. For each domain, appropriate screening tools, clinical assessment strategies, differential diagnostic considerations, and treatment options are reviewed. Pharmacological treatment should be individualized according to symptom pattern, disease stage, motor fluctuation, comorbidities, cognitive status, and potential adverse effects. Non-pharmacological interventions, including exercise, cognitive behavioral therapy, sleep hygiene, behavioral therapy for urinary symptoms, environmental modification for REM sleep behavior disorder, and multidisciplinary care, are also important components of management. Because non-motor symptoms are often interrelated, comprehensive and repeated assessment is essential. Early recognition, structured evaluation, individualized treatment, and patient-caregiver education may improve clinical outcomes and quality of life in patients with PD.