Management of non-motor symptoms in Parkinson's disease: Lessons through a cultural lens

Parkinson's disease (PD) affects individuals across diverse cultural, linguistic, and socioeconomic backgrounds worldwide. While non-motor symptoms (NMS) are among the most disabling features of PD, the influence of culture on their recognition, reporting, and management remains underexplored. This review examines cultural factors that shape the experience and care of NMS in PD, with particular attention to Asian populations, which have historically received limited focus in health disparities literature. Drawing on evidence from diverse global populations, we explore how cultural beliefs, stigma, family dynamics, spirituality, language, and trust in healthcare systems influence symptom interpretation, help-seeking behaviors, treatment engagement, caregiving, and end-of-life decision-making. Sensitive symptoms such as bladder, bowel and sexual dysfunction, as well as mental health symptoms may be underreported because of stigma, shame, or cultural norms. Immigrant populations may avoid "bothering" healthcare providers, while language barriers and mistrust can further impede communication and access to care. Cultural values also influence decision-making preferences. In contrast to Western models that prioritize individual autonomy, some patients prefer family-centered decision-making, with designated family members guiding healthcare choices. Concepts such as filial piety, "familismo", and culturally defined gender roles (superwoman schema and stoic masculinity) shape caregiving and acceptance of treatment recommendations. Culturally enabled care is essential to equitable and person-centered PD management and can improve communication, reduce disparities, foster trust, and enhance quality of life for people living with PD and their families. Further research is urgently needed to better understand how culture intersects with NMS management and to develop culturally enabled models of care.