Nonmotor complications of Parkinson disease

Nonmotor manifestations are integral components of Parkinson disease (PD), and they often have a greater impact on disability and quality of life than the motor features that currently define the illness. Nonmotor features of PD, such as dementia, may be an intrinsic feature of the disorder and persist regardless of the medication state (ie, they continue to manifest in the "on" or "off" state); some nonmotor features, such as psychotic symptoms, may be iatrogenic complications of pharmacologic intervention for the treatment of the motor manifestations of PD. Iatrogenic complications, such as psychosis and impulse control disorders, may respond to modification of the PD treatment regimen at the risk of worsening motor symptoms. Thus, a balance must be struck between controlling nonmotor manifestations and motor features of the disease.