Non-motor symptoms in Parkinson's disease: a practical approach

Non-motor symptoms of Parkinson's disease (PD) drive disability, reduce quality of life and increase healthcare resource use. Yet, they are often under-recognised in time-limited clinics. We outline an evidence-informed approach for everyday neurology. We propose brief previsit process followed by in-visit prioritisation of one or two high-impact symptoms and simple education/resources for the rest. Psychosis requires clinicians to address triggers, simplify dopaminergic therapy and use PD-safe antipsychotics when required. Mood and anxiety benefit from optimised dopaminergic regimens, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, counselling, exercise and online cognitive-behavioural programmes. Cognitive impairment warrants regular screening and medication review; cholinesterase inhibitors are indicated for dementia. Sleep management includes treating contributing factors, hygiene measures and cautious hypnotic use. Pain and autonomic dysfunction require pragmatic, stepwise strategies tailored to real-world practice. We include special considerations for atypical Parkinsonism and caregiver needs. Integrating these steps into routine visits improves safety, function and patient-carer well-being.