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Several years ago, Eric Ahlskog published a colorful and cogent review entitled “Beating a dead horse.” He argued that “we have reached the point of diminishing therapeutic returns with drugs acting on dopamine systems and more dopaminergic medications will provide only modest incremental benefit over current therapies.”1 Ahlskog argued correctly that excessive focus on dopaminergic features and pathology led to neglect of crucial nondopaminergic/nonmotor clinical features and pathologies. This argument was based, in part, on the perception that most of the nonmotor symptoms (NMS) in Parkinson disease (PD) would be related to degeneration in nondopamine responsive systems and that improvements in dopaminergic therapy would have little impact on NMS. Accumulated evidence now indicates the need to modify this concept.
Footnotes
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Letters: Rapid online correspondence
- Response to Ahlskog
- Dopaminergic treatment of non-motor Parkinson's disease symptoms
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