ZenToks Publication

Chapter 20

Unmasking the Hidden Burden: Improving Detection of Non- Motor Symptoms in Idiopathic Parkinson’s Disease through Screening and ClinicalWorkflows

Abstract/Preface

Idiopathic Parkinson’s disease is increasingly recognized as a complex multisystem disorder extending beyond its classical motor manifestations. Non-motor symptoms (NMS) including neuropsychiatric disturbances, cognitive impairment, autonomic dysfunction, and sleep disorders often precede motor onset and contribute significantly to disease burden, reduced quality of life, and increased caregiver stress. Despite their clinical importance, NMS remain underdiagnosed, particularly in resource-limited settings such as India, due to high patient load, lack of structured screening, limited awareness among primary care physicians, and sociocultural stigma surrounding mental health symptoms. This chapter highlights the broad spectrum of non-motor manifestations and their underlying pathophysiology involving both dopaminergic and non-dopaminergic systems. It emphasizes the importance of early detection, given the prognostic implications of NMS in disease progression and treatment response. Standardized tools such as the Non-Motor Symptoms Questionnaire (NMSQuest), Non-Motor Symptoms Scale (NMSS), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), SCOPA-Sleep, and autonomic symptom questionnaires are discussed as practical instruments for systematic assessment. In addition, targeted screening for frequently overlooked symptoms such as fatigue, pain, and olfactory dysfunction is emphasized to improve early detection and comprehensive assessment. The chapter further proposes integration of structured screening into routine clinical workflows through OPD-based models, primary care involvement, and multidisciplinary approach. It also explores the role of digital health technologies, including telemedicine and mobile applications, in enhancing early detection and longitudinal monitoring. Key barriers within the Indian healthcare system are identified, along with actionable strategies such as clinician training, patient education, and development of culturally adapted screening tools. In conclusion, improving recognition and management of non-motor symptoms through standardized screening and integrated care pathways is essential for delivering holistic, patient-centered care in Idiopathic Parkinson’s disease.