Sintomi non motori nella malattia di Parkinson : procedure per la diagnosi, la terapia e la riabilitazione

Parkinson's disease is the most frequent among movement disorders. The efforts of neurologist and neurorehabilitator are finalized to riduce the disability in time. The physician involved in the care of these patients knows that the disease may present itself also with extramotor symptoms, which condition a more difficult management of the patient. The non-motor symptoms are classified in four categories in order of management importance: 1) disautonomic, 2) cognitive, 3) affective and 4) sensitive. These symptoms are more frequent and difficult to manage in late stage of disease, except for affective type, which may be precox and adaptive at the communication of the diagnosis or sometime precede it. The more frequent disautonomic symptoms are: constipation, symptoms related to the uro-genital sphere, the cardio-pressor regulation (orthostatic hypotension), the thermoregulation, sialorrhea dysphagia and seborrhoea. The cognitive symptoms: isolate (bradyphrenia, alteration of executive function) or dementia with or without delirium and allucinosis. The affective symptoms: depression, agitation, anxiety, panic attacks. The sensitive symptoms: pain, dysesthesia, paresthesia with bizzarre features (cold sensation, numbness, interior agitation). There are other symptoms which are not framing in the previous categories: sleep, respiratory and circulatory disorders (venous and lymphatic), which have different causal factors: emotional-affective, motor and iatrogenic. The therapeutic intervention on these symptoms is of essential importance in the management of the patient with Parkinson's disease, with a great impact on his quality of life. Here are analyzed the diagnostic and therapeutic procedures for each symptom.