Treatment of Parkinson's disease: focus on quality of life issues.

The vast majority of Parkinson's disease (PD) treatment discussions focus on two areas: pharmacotherapy and surgery. Why? These treatments produce relatively easily measurable outcomes concerning traditional diagnostic criteria: motor rating scores and "on" times. However, despite the expanding number of drugs and surgery, there is dwindling incremental improvement from the best motor outcomes available even 40 years ago. Over the same time period, recognition of the clinical scope of this syndrome has expanded tremendously. Much of this scope impacts on quality of life and is treatable. Two arenas with great potential impact on quality of life are mental health and activity/exercise. Early in the course of PD, depression and expectations about impending demise impact significantly on the quality of life of patients. Initial responses to medical therapy may also dictate patients' expectations. Later, the two most devastating features may be motor instability/falls/injury and dementia. Mounting evidence for the benefits of treatment aimed at these arenas is accumulating and revolves around recognition and facilitating healthy routines that may mitigate future negative clinical phenomenon. Keys concerning mental health include education with realistic expectations and identification/treatment of mood and sleep disorders. Effective pro-active treatment regimens for instability and dementia include activity/exercise advocacy.