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Neurologie up2date 2025; 08(01): 65-78
DOI: 10.1055/a-2127-6711
Bewegungsstörungen

Parkinson-Krankheit – nicht-motorische Symptome für die Praxis

Teil 1: Neuropsychiatrische und kardiovaskuläre Störungen
Wolfgang Jost 
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Nicht-motorische Symptome der Parkinson-Krankheit wie kognitive Einbußen, Depressionen, Schlafstörungen oder orthostatische Hypotonie treten oft bereits im Frühstadium auf und beeinflussen die Lebensqualität erheblich. Eine gezielte Diagnostik und individuell angepasste Therapie sind entscheidend, um diese Symptome zu erkennen und effektiv zu behandeln.

Kernaussagen

  • Nicht-motorische Störungen treten bei fast allen Parkinson-Patienten auf, viele sogar schon vor den motorischen Symptomen.

  • Kognitive Symptome treten ebenfalls häufig bei der Parkinson-Krankheit (PK) auf und können alle Schweregrade haben.

  • Depressive Symptome sind bei der PK häufig und werden oft nicht erkannt. Der WHO-5-Test ist ein einfacher Screening-Test.

  • REM-Schlaf-Verhaltensstörungen (RBD) sind ein wichtiges Frühsymptom bei der PK, niedrigdosiert Clonazepam zur Nacht gilt als Mittel der Wahl.

  • Über die Hälfte der PK-Patienten entwickeln im Krankheitsverlauf Halluzinationen. Hierbei sollte zuerst auf auslösende Medikamente verzichtet werde, die man ersetzen kann.

  • Impulskontrollstörungen treten im Verlauf immer häufiger auf, Dopaminagonisten gelten als die Medikamentengruppe mit der höchsten Wahrscheinlichkeit, diese auszulösen.

  • Eine orthostatische Hypotonie tritt bei sehr vielen Parkinson-Patienten, häufig schon sehr früh auf.

  • Parkinson-Patienten zeigen eine fehlende Nachtabsenkung des Blutdrucks, was bei einer eventuellen Blutdruckeinstellung berücksichtigt werden muss.

  • Zur Therapie der orthostatischen Hypotonie haben sich u.a. Anpassung der Medikation, Stützstrümpfe und die Gabe von Midodrin bewährt.



Publication History

Article published online:
06 March 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Next part of this series:

Parkinson-Krankheit – nicht-motorische Symptome für die PraxisNeurologie up2date 2025; 08(02): 121-136
DOI: 10.1055/a-2565-7885

 

  • Literatur

  • 1 Storch A, Schneider CB, Wolz M. et al. Nonmotor fluctuations in Parkinson disease: Severity and correlation with motor complications. Neurology 2013; 80: 800-809
    CrossrefPubMedSearch in Google Scholar
  • 2 Riedel O, Klotsche J, Spottke A. et al. Frequency of dementia, depression, and other neuropsychiatric symp¬toms in 1.449 outpatients with Parkinson’s disease. J Neurol 2010; 257: 107-1082
    CrossrefPubMedSearch in Google Scholar
  • 3 Barone P, Antonini A, Colosimo C. et al. The PRIAMO study. A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord 2009; 24: 1641-1649
    CrossrefPubMedSearch in Google Scholar
  • 4 Gallagher DA, Schrag A. Psychosis, apathy, depression and anxiety in Parkinson’s disease. Neurobiol Dis 2012; 46: 581-589
    CrossrefPubMedSearch in Google Scholar
  • 5 Goldman JG, Holden SK, Litvan I. et al. Evolution of diagnostic criteria and assessments for Parkinson’s disease mild cognitive impairment. Mov Disord 2018; 33: 503-510
    CrossrefPubMedSearch in Google Scholar
  • 6 Emre M. Dementia in Parkinson’s disease: cause and treatment. Curr Opin Neurol 2004; 17: 399-404
    CrossrefPubMedSearch in Google Scholar
  • 7 Aarsland D, Bronnick K, Williams-Gray C. et al. Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology 2010; 75: 1062-1069
    CrossrefPubMedSearch in Google Scholar
  • 8 Yarnall AJ, Breen DP, Duncan GW. et al. Characterizing mild cognitive impairment in incident Parkinson disease. Neurology 2014; 82: 308-316
    CrossrefPubMedSearch in Google Scholar
  • 9 Broeders M, de Bie RM, Velseboer DC. et al. Evolution of mild cognitive impairment in Parkinson disease. Neurology 2013; 81: 346-352
    CrossrefPubMedSearch in Google Scholar
  • 10 Kalbe E, Rehberg SP, Heber I. et al. Subtypes of mild cognitive impairment in patients with Parkinson’s disease: evidence from the LANDSCAPE study. J Neurol Neurosurg Psychiatry 2016; 87: 1099-1105
    CrossrefPubMedSearch in Google Scholar
  • 11 Szeto JYY, Walton CC, Rizos A. et al. Dementia in long-term Parkinson’s disease patients: a multicentre retrospective study. NPJ Parkinson Dis 2020; 6: 2
    CrossrefPubMedSearch in Google Scholar
  • 12 Postuma RB, Berg D, Stern M. et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015; 30: 1591-1601
    CrossrefPubMedSearch in Google Scholar
  • 13 Kempster PA, O’Sullivan SS, Holton JL. et al. Relationships between age and late progression of Parkinson’s disease: a clinic-pathological study. Brain 2010; 133: 1755-1762
    CrossrefPubMedSearch in Google Scholar
  • 14 Willis AW, Schootman M, Knug N. et al. Predictors of survival in patients with Parkinson disease. Arch Neurol 2012; 69: 601-607
    CrossrefPubMedSearch in Google Scholar
  • 15 Aarsland D, Brønnick K, Ehrt U. et al. Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 2007; 78: 36-42
    CrossrefPubMedSearch in Google Scholar
  • 16 Skorvanek M, Goldman JG, Jahanshahi M. et al. Global scales for cognitive screening in Parkinson’s disease: Critique and recommendations. Mov Disord 2018; 33: 208-218
    CrossrefPubMedSearch in Google Scholar
  • 17 Dalrymple-Alford JC, MacAskill MR, Nakas CT. et al. The MoCA: well-suited screen for cognitive impairment in Parkinson disease. Neurology 2010; 75: 1717-1725
    CrossrefPubMedSearch in Google Scholar
  • 18 Fengler S, Kessler J, Timmermann L. et al. Screening for cognitive impairment in Parkinson’s disease: Improving the diagnostic utility of the MoCA through subtest weighting. PLoS One 2016; 11: e0159318
    CrossrefPubMedSearch in Google Scholar
  • 19 Scheffels JF, Fröhlich L, Kalbe E. et al. Concordance of Mini-Mental State Examination, Montreal Cognitive Assessment and Parkinson Neuropsychometric Dementia Assessment in the classification of cognitive performance in Parkinson’s disease. J Neurol Sci 2020; 412: 116735
    CrossrefPubMedSearch in Google Scholar
  • 20 Schneider JS, Elm JJ, Parashos SA. et al. Predictors of cognitive outcomes in early Parkinson disease patients: The national institutes of health exploratory trials in Parkinson disease (NET-PD) experience. Parkinsonism Rel Disord 2010; 16: 507-512
    CrossrefPubMedSearch in Google Scholar
  • 21 Ehrt U, Broich K, Larsen JP. Use of drugs with anticholinergic effect and impact on cognition in Parkinson’s disease: a cohort study. J Neurol Neurosurg Psychiatry 2010; 81: 160-165
    CrossrefPubMedSearch in Google Scholar
  • 22 Witjas T, Kaphan E, Azulay JP. et al. Nonmotor fluctuations in Parkinson’s disease: frequent and disabling. Neurology 2002; 59: 408-413
    CrossrefPubMedSearch in Google Scholar
  • 23 Mattis PJ, Tang CC, Ma Y. et al. Network correlates of the cognitive response to levodopa in Parkinson disease. Neurology 2011; 77: 858-865
    CrossrefPubMedSearch in Google Scholar
  • 24 Emre M, Aarsland D, Albanese A. et al. Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351: 2509-2518
    CrossrefPubMedSearch in Google Scholar
  • 25 Ravina B, Putt M, Siderowf A. et al. Donepezil for dementia in Parkinson’s disease: a randomised, double blind, placebo controlled, crossover study. J Neurol Neurosurg Psychiatry 2005; 76: 934-939
    CrossrefPubMedSearch in Google Scholar
  • 26 Wesnes KA, McKeith I, Edgar C. et al. Benefits of rivastigmine on attention in dementia associated with Parkinson disease. Neurology 2005; 65: 1654-1656
    CrossrefPubMedSearch in Google Scholar
  • 27 Wood LD, Neumiller JJ, Setter SM. et al. Clinical review of treatment options for select nonmotor symptoms of Parkinson’s disease. Am J Geriatr Pharmacother 2010; 8: 294-315
    CrossrefPubMedSearch in Google Scholar
  • 28 Dubois B, Tolosa E, Katzenschlager R. et al. Donepezil in Parkinson’s disease dementia: a randomized, double-blind efficacy and safety study. Mov Disord 2012; 27: 1230-1238
    CrossrefPubMedSearch in Google Scholar
  • 29 Inzelberg R, Bonuccelli U, Schechtman E. et al. Association between amantadine and the onset of dementia in Parkinson’s disease. Mov Disord 2006; 21: 1375-1379
    CrossrefPubMedSearch in Google Scholar
  • 30 Emre M, Tsolaki M, Bonuccelli U. et al. Memantine for patients with Parkinson’s disease dementia or dementia with Lewy bodies: a randomized, double-blind, placebo-controlled trial. Lancet Neurol 2010; 9: 969-977
    CrossrefPubMedSearch in Google Scholar
  • 31 Goetz CG, Ouyang B, Negron A. et al. Hallucinations and sleep disorders in PD. Neurology 2010; 75: 1773-1779
    CrossrefPubMedSearch in Google Scholar
  • 32 Leroi I, Overshott R, Byrne EJ. et al. Randomized controlled trial of memantine in dementia associated with Parkinson’s disease. Mov Disord 2009; 24: 1217-1240
    CrossrefPubMedSearch in Google Scholar
  • 33 Seppi K, Weintraub D, Coelho M. et al. The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord 2011; 26: S42-S80
    CrossrefPubMedSearch in Google Scholar
  • 34 Kalbe E, Folkerts AK. Kognitives Training bei Parkinson-Patienten – eine neue Therapieoption?. Fortschr Neurol Psychiatr 2016; 84: S24-S35
    Thieme ConnectPubMedSearch in Google Scholar
  • 35 Leung IH, Walton CC, Hallock H. et al. Cognitive training in Parkinson disease: A systematic review and meta-analysis. Neurology 2015; 85: 1843-1851
    CrossrefPubMedSearch in Google Scholar
  • 36 Ophey A, Giehl K, Rehberg S. et al. Effects of working memory training in patients with Parkinson’s disease without cognitive impairment: A randomized controlled trial. Parkinsonism Relat Disord 2020; 72: 13-22
    CrossrefPubMedSearch in Google Scholar
  • 37 Storch A, Ebersbach G, Fuchs G. et al. Depression bei Morbus Parkinson – Epidemiologie, Klinik, Pathophysiologie und Diagnostik. Fortschr Neurol Psych 2008; 76: 715-724
    Search in Google Scholar
  • 38 Goodarzi Z, Mrklas KJ, Roberts DJ. et al. Detecting depression in Parkinson disease. Neurology 2016; 87: 426-437
    CrossrefPubMedSearch in Google Scholar
  • 39 Martinez-Martin P, Leentjens AF, de Pedro-Cuesta J. et al. Accuracy of screening instruments for detection of neuropsychiatric syndromes in Parkinson’s disease. Mov Disord 2016; 31: 270-279
    CrossrefPubMedSearch in Google Scholar
  • 40 Schneider CB, Pilhatsch M, Rifati M. et al. Utility of the WHO-five well-being index as a screening tool for depression in Parkinson's disease. Mov Disord 2010; 25: 777-783
    CrossrefPubMedSearch in Google Scholar
  • 41 Goetz CG, Leurgans S, Pappert EJ. et al. Prospective longitudinal assessment of hallucinations in Parkinson’s disease. Neurology 2001; 57: 2078-2082
    CrossrefPubMedSearch in Google Scholar
  • 42 Mai AS, Chao Y, Xiao B. et al. Risk of suicidal ideation and behavior in individuals with Parkinson disease: a systematic review and meta-analysis. JAMA Neurol 2024; 81: 10-18
    CrossrefPubMedSearch in Google Scholar
  • 43 Nazem SN, Siderowf AD, Duda JE. et al. Suicidal and death ideation in Parkinson’s disease. Mov Disord 2008; 23: 1573-1579
    CrossrefPubMedSearch in Google Scholar
  • 44 Koo BB, Chow CA, Shah DR. et al. Demoralization in Parkinson disease. Neurology 2018; 90: e1613-e1617
    CrossrefPubMedSearch in Google Scholar
  • 45 Nagayama H, Maeda T, Uchiyama T. et al. Anhedonia and its correlation with clinical aspects in Parkinson’s disease. J Neurol Sci 2017; 372: 403-407
    CrossrefPubMedSearch in Google Scholar
  • 46 Pontone GM, Williams JR, Anderson KE. et al. Prevalence of anxiety disorders and enxiety subtypes in patients with Parkinson’s disease. Mov Disord 2009; 24: 1333-1338
    CrossrefPubMedSearch in Google Scholar
  • 47 Bazo-Alvarez JC, Nimmons D, Walters K. et al. Risk of Parkinson's disease in people with new onset anxiety over 50 years – incidence and associated features. Br J Gen Pract 2024; 74: e482-e488
    CrossrefPubMedSearch in Google Scholar
  • 48 Quelhas R, Costa M. Anxiety, depression, and quality of life in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 2009; 21: 413-419
    CrossrefPubMedSearch in Google Scholar
  • 49 Storch A, Schneider C, Ebersbach G. et al. Depression beim idiopathischen Parkinson-Syndrom – Teil 2: Therapie und Management. Fortschr Neurol Psych 2010; 78: 456-467
    Thieme ConnectPubMedSearch in Google Scholar
  • 50 Menza M, Dobkin RD, Marin H. et al. A controlled trial of antidepressants in patients with Parkinson disease and depression. Neurology 2009; 72: 886-892
    CrossrefPubMedSearch in Google Scholar
  • 51 Bonuccelli U, Meco G, Fabbrini G. et al. A non-comparative assessment of tolerability and efficacy of duloxetine in the treatment of depressed patients with Parkinson’s disease. Expert Opin Pharmacother 2012; 13: 2269-2280
    CrossrefPubMedSearch in Google Scholar
  • 52 Richard IH, McDermott MP, Kurlan R. et al. A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease. Neurology 2012; 78: 1229-1236
    CrossrefPubMedSearch in Google Scholar
  • 53 Weintraub D, Mayandadi S, Mamikonyan E. et al. Atomoxetine for depression and other neuropsychiatric symptoms in Parkinson disease. Neurology 2010; 75: 448-455
    CrossrefPubMedSearch in Google Scholar
  • 54 Maruyama T. New treatment of depression in Parkinson’s disease. Int J Psychiatry Clin Pract 2003; 7: 25-27
    CrossrefPubMedSearch in Google Scholar
  • 55 Barone P, Scarzella L, Marconi R. et al. Pramipexole versus sertraline in the treatment of depression in Parkinson’s disease. J Neurol 2006; 253: 601-607
    CrossrefPubMedSearch in Google Scholar
  • 56 Szegedi A, Hillert A, Wetzel H. et al. Pramipexole, a dopamine agonist, in major depression: antidepressant effects and tolerability in an open-label study with multiple doses. Clin Neuropharmacol 1997; 20: 536-545
    CrossrefSearch in Google Scholar
  • 57 Leentjens AF. The role of dopamine agonists in the treatment of depression in patients with Parkinson’s disease: a systematic review. Drugs 2011; 71: 273-286
    CrossrefPubMedSearch in Google Scholar
  • 58 Dobkin RD, Menza M, Allen LA. et al. Cognitive-behavioral therapy for depression in Parkinson’s disease: A randomized, controlled trial. Am J Psychiatry 2011; 168: 1066-1074
    CrossrefPubMedSearch in Google Scholar
  • 59 Fénelon G, Alves G. Epidemiology of psychosis in Parkinson’s disease. J Neurol Sci 2010; 289: 12-17
    CrossrefPubMedSearch in Google Scholar
  • 60 Papapetropoulos S, Mash DC. Psychotic symptoms in Parkinson’s disease. From description to etiology. J Neurol 2005; 252: 753-764
    CrossrefPubMedSearch in Google Scholar
  • 61 Fenelon G, Mahieux F, Huon R. et al. Hallucinations in Parkinson’s disease: Prevalence, phenomenology and risk factors. Brain 2000; 123: 733-745
    CrossrefPubMedSearch in Google Scholar
  • 62 Lenka A, Ingalhalikar M, Shah A. et al. Abnormalities in the white matter tracts in patients with Parkinson disease and psychosis. Neurology 2020; 94: e1876-e1884
    CrossrefPubMedSearch in Google Scholar
  • 63 Poletti M, Perugi G, Logi C. et al. Dopamine agonists and delusional jealousy in Parkinson’s disease: A cross-sectional prevalence study. Mov Disord 2012; 27: 1679-1682
    CrossrefPubMedSearch in Google Scholar
  • 64 Merims D, Shabtai H, Korczyn AD. et al. Antiparkinsonian medication is not a risk factor for the development of hallucinations in Parkinson’s disease. J Neural Transm 2004; 111: 1447-1453
    CrossrefPubMedSearch in Google Scholar
  • 65 Friedman JH. Parkinson’s disease psychosis 2010: a review article. Parkinsonism Rel Disord 2010; 16: 553-560
    CrossrefPubMedSearch in Google Scholar
  • 66 Pierelli F, Adipietro A, Soldati G. et al. Low dosage clozapine effects on L-dopa induced dyskinesias in parkinsonian patients. Acta Neurol Scand 1998; 97: 295-299
    CrossrefPubMedSearch in Google Scholar
  • 67 Pollak P, Tison F, Rascol O. et al. Clozapine in drug induced psychosis in Parkinson’s disease: a randomised, placebo controlled study with open follow up. J Neurol Neurosurg Psychiatry 2004; 75: 689-695
    CrossrefPubMedSearch in Google Scholar
  • 68 Kurlan R, Cummings J, Raman R. et al. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology 2007; 68: 1356-1363
    CrossrefPubMedSearch in Google Scholar
  • 69 Kitten AK, Hallowell SA, Saklad SR. et al. Pimavanserin: a novel drug approved to treat Parkinson’s disease psychosis. Innov Clin Neurosci 2018; 15: 16-22
    PubMedSearch in Google Scholar
  • 70 Meltzer HY, Mills R, Revell S. et al. Pimavanserin, a serotonine(2A) receptor inverse agonist for the treatment of Parkinson’s diseases psychosis. Neuropsychopharmacology 2010; 35: 881-892
    CrossrefPubMedSearch in Google Scholar
  • 71 Cummings J, Isaacson S, Mills R. et al. Pimavanserin for patients with Parkinson’s disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet 2014; 383: 533-540
    CrossrefPubMedSearch in Google Scholar
  • 72 Markham A. Pimavanserin: First global approval. Drugs 2016; 76: 1053-1057
    CrossrefPubMedSearch in Google Scholar
  • 73 Evidente VGH, DeKarske D, Coate B. et al. The effects of treatment with pimavanserin on activities of daily living in patients with Parkinson's disease psychosis: a 16-week, single-arm, open-label study. Ther Adv Neurol Disord 2024; 17
    CrossrefPubMedSearch in Google Scholar
  • 74 Weintraub D, Chiang C, Kim HM. Association of antipsychotic use with mortality risk in patients with Parkinson disease. JAMA Neurol 2016; 73: 535-541
    CrossrefPubMedSearch in Google Scholar
  • 75 Santangelo G, Garramone F, Baiano C. et al. Personality and Parkinson’s disease: A meta-analysis. Parkinsonism Relat Disord 2018; 49: 67-74
    CrossrefPubMedSearch in Google Scholar
  • 76 Reiff J, Jost WH. Drug-induced impulse control disorders in Parkinson’s disease. J Neurol 2011; 258: S323-S327
    CrossrefPubMedSearch in Google Scholar
  • 77 O’Sullivan SS. Dopamine Dysregulation Syndrome: An overview of its epidemiology, mechanisms and management. CNS Drugs 2009; 23: 157-170
    CrossrefPubMedSearch in Google Scholar
  • 78 Cilia R, Siri C, Canesi M. et al. Dopamine dysregulation syndrome in Parkinson’s disease: from clinical and neuropsychological characterisation to management and long-term outcome. J Neurol Neurosurg Psychiatry 2014; 85: 311-318
    CrossrefPubMedSearch in Google Scholar
  • 79 Santangelo G, Barone B, Trojano L. et al. Pathological gambling in Parkinson’s disease. A comprehensive review. Parkinsonism Relat Disord 2013; 19: 645-653
    CrossrefPubMedSearch in Google Scholar
  • 80 Voon V, Mehta AR, Hallet M. Impulse control disorders in Parkinson’s disease: recent advances. Curr Opin Neurol 2011; 24: 324-330
    CrossrefPubMedSearch in Google Scholar
  • 81 Weintraub D, Koester J, Potenza MN. et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol 2010; 67: 589-595
    CrossrefPubMedSearch in Google Scholar
  • 82 Barbosa PM, Grippe T, Lees AJ. et al. Compulsive sexual behaviour in Parkinson’s disease is associated with higher doses of levodopa. J Neurol Neurosurg Psychiatry 2018; 89: 1121-1123
    CrossrefPubMedSearch in Google Scholar
  • 83 Corvol JC, Artaud F, Cormier-Dequaire F. et al. Longitudinal analysis of impulse control disorders in Parkinson disease. Neurology 2018; 91: e189-e201
    CrossrefPubMedSearch in Google Scholar
  • 84 Garcia-Ruiz PJ, Martinez Castrillo JC, Alonso-Canovas A. et al. Impulse control disorder in patients with Parkinson’s diesase under dopamine agonist therapy: a multicentre study. J Neurol Neurosurg Psychiatry 2014; 85: 840-844
    CrossrefPubMedSearch in Google Scholar
  • 85 Soileau LG, Talbot NC, Storey NR. et al. Impulse control disorders in Parkinson's disease patients treated with pramipexole and ropinirole: a systematic review and meta-analysis. Neurol Sci 2024; 45: 1399-1408
    CrossrefPubMedSearch in Google Scholar
  • 86 Ray N, Strafella AP. Dopamine, reward, and frontostriatal circuitry in impulse control disorders in Parkinson’s disease: insights from functional imaging. Clin EEG Neurosci 2010; 41: 87-93
    CrossrefPubMedSearch in Google Scholar
  • 87 Weintraub D, Stewart S, Shea JA. et al. Validation of the questionnaire for impulsive-compulsive disorders in Parkinson’s disease (QUIP). Mov Disord 2009; 24: 1461-1467
    CrossrefPubMedSearch in Google Scholar
  • 88 Zesiewicz TA, Sullivan KL, Arnulf I. et al. Practice parameter: treatment of nonmotor symptoms of Parkinson disease: report of the quality standards subcommittee of the American academy of Neurology. Neurology 2010; 74: 924-931
    CrossrefPubMedSearch in Google Scholar
  • 89 Thomas A, Bonanni L, Gambi F. et al. Pathological gambling in Parkinson disease is reduced by amantadine. Ann Neurol 2010; 68: 400-404
    CrossrefPubMedSearch in Google Scholar
  • 90 Rajalingam R, Fasano A. Punding in Parkinson's disease: an update. Mov Disord Clin Pract 2023; 10: 1035-1047
    CrossrefPubMedSearch in Google Scholar
  • 91 Evans AH, Katzenschlager R, Paviour D. et al. Punding in Parkinson’s disease: its relation to the dopamine dysregulation syndrome. Mov Disord 2004; 19: 397-405
    CrossrefPubMedSearch in Google Scholar