Early Parkinson's disease and non-motor issues.

Non motor symptoms (NMS) of PD are a key determinant of health, quality of life and societal cost of PD. Contrary to common perception, many NMS of PD occur early in PD and some may even predate the diagnosis of PD which is based on motor signs. These include olfactory deficit, sleep problems such as REM behaviour disorder, contipation and the more recently described male erectile dysfunction. The non motor quesionnaire (NMSQuest) and the recently validated NMS scale allow falgging and quantification of NMS of PD and therefore are important tools to comprehensively assess symptom load in PD.