Proposed phenotypes within Parkinson’s disease. Amended from Sauerbier et al.44
| Presentation based on proposed phenotypes | Dominant NMS presentation | Subgroups possible clinical relevance |
|---|---|---|
| Park cognitive | (Amnestic) Mild cognitive impairment | High risk of developing dementia |
| Park apathy | Apathy | Apathy could be treated with dopaminergic drugs |
| Park depression/anxiety | Major depression, anxiety-depression and anxiety | Often associated with motor fluctuations and treatment with longer acting dopaminergic drugs would be useful |
| Park sleep | Excessive daytime sleepiness, insomnia, REM sleep behaviour disorder, narcoleptic phenotype with or without cataplexy | In the narcoleptic subtype, dopamine agonists (particularly D3 active) should be avoided as the treatment might lead to ‘sleep attacks’ |
| Park pain | Central pain, off period related pain | Central pain might respond to opioids; off period related pain might respond to long acting dopaminergic drugs |
| Park fatigue | Fatigue | Emerging evidence of serotonergic origin/involvement; possible role of serotonergic agents? |
| Park autonomic | Gastrointestinal tract dysfunction, genito-urinary disorders, adrenergic (postural hypotension, also includes post prandial and post exercise hypotension) | Consider noradrenergic therapy and Metaiodobenzylguanidine myocardial imaging |
NMS = non-motor symptoms; REM = rapid eye movement.