Prominent Non-Motor Symptoms

In recent years, non-motor signs of Parkinson's disease (PD) have gained ever greater attention. Pain is among these non-motor sensory symptoms, which also occurs in PD patients. While persistent pain among PD patients may be caused by motor symptoms, independent of these symptoms has also been documented. Extensive co-morbidity among syndromes of chronic pain and mood and anxiety disorders has been identified. The key pathophysiological mechanism involved in PD-associated nociceptive abnormalities is dysfunction in endogenous pain inhibition caused by a dopaminergic deficiency in the basal ganglia, particularly in the striatum and mesolimbic areas. The cognitive and affective functions induced by dompaminergic (DA) neurotransmission are substantially similar, in addition to the anatomical similarities between the brain regions associated with the pain response and those comprising the dopamine system. Neurotransmission of DA plays an important role in prediction of outcome, attention, inhibition of response and motivation as well as in anxiety-related affective symptoms and depression.    

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