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Dementia. Drugs used to treat Alzheimer's disease donepezil, tacrine, galantamine ; are also being investigated from this problem. Daytime Sleepiness. Modafinil Provigil ; , an agent used to treat narcolepsy, is proving to be very helpful for PD patients with sleepiness related to their disease. Drooling. In search of a simple solution for the problem of drooling, scientists have reported that injections of very small amounts of botulinum toxin A effectively reduce saliva production and drooling. In such small amounts the toxin is safe. Constipation. Cisapride is being investigated for relieving constipation. Voice Loss. A relatively simple procedure using collagen injections in the neck appears to be a safe and effective method of improving the voice and speech disorders caused by PD. The procedure augments the collagen in the vocal fold and works best in patients who can still initiate speech. A 2001 study reported improvements that lasted from two to seven months in 61% of patients. Impotence. Sildenafil Viagrq ; is proving to be very helpful for men who suffer from impotence from Parkinson's disease. However, the agent may worsen orthostatic hypotension, which may be a side effect of some of the PD medications.

1. Conti CR, Pepine CJ, Sweeney M. Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. J Cardiol 1999; 83: 29C34C. Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. JAMA 1999; 281: 421 Rowland DL, Boedhoe HS, Dohle G, Slob AK. Intracavernosal selfinjection therapy in men with erectile dysfunction: satisfaction and attrition in 119 patients. Int J Impot Res 1999; 11: 14551. Sharlip ID. Does natural erectile function improve following intracavernous injections of vasoactive drugs? Int J Impot Res 1997; 9: 193 Christiansen E, Guirguis WR, Cox D, Osterloh IH. Long-term efficacy and safety of oral Vuagra sildenafil citrate ; in men with erectile dysfunction and the effect of randomised treatment withdrawal. Int J Impot Res 2000; 12: 177 Cranston-Cuebas MA, Barlow DH, Mitchell W, Athanasiou R. Differential effects of a misattribution manipulation on sexually functional and dysfunctional men. J Abnorm Psychol 1993; 102: 52533. Barlow DH. Causes of sexual dysfunction: the role of anxiety and cognitive interference. J Consult Clin Psychol 1986; 54: 140 Cranston-Cuebas MA, Barlow DH. Cognitive and affective contributions to sexual functioning. Annu Rev Sex Res 1990: 119 61. Sbrocco T, Barlow DH. Conceptualizing the cognitive component of sexual arousal: implications for sexuality research and treatment. In: Salkovskis PM, editor. Frontiers of cognitive therapy. New York: The Guilford Press; 1996: 419 49. Sakheim DK, Barlow DH, Abrahamson DJ, Beck JG. Distinguishing between organogenic and psychogenic erectile dysfunction. Behav Res Ther 1987; 25: 379 Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The 717 and adderall. 1 Fahn S, Elton RL, members of the UPDRS Development Committee. Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, et al, eds. Recent developments in Parkinson's disease. Florham Park, New Jersey: MacMillan Healthcare Information, 1987; 2: 15363. Lang AE. Clinical rating scales and videotape analysis. In: Koller WC, Paulson G, eds. Therapy of Parkinson's disease, 2nd ed. New York: Marcel Dekker, 1995: 2146. 3 Hagell P, Widner H. Clinical rating of dyskinesias in Parkinson's disease: use and reliability of a new rating scale. Mov Disord 1999; 14: 44855. Cedarbaum JM, Silvestri M. Methods for assessing motor fluctuations in conducting clinical trials of antiparkinson agents. In: Clifford Rose F, ed. Parkinson's disease and the problems of clinical trials. London: Smith-Gordon, 1992: 7585. 5 Defer GL, Widner H, Marie RM, et al. The Conference Participants: Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease CAPSIT-PD ; . Mov Disord 1999; 14: 57284. Melamed E, Olanow CW, Nutt JG, et al. Dyskinesias assessment workshop: reports from the working groups. Mov Disord 1999; 14 suppl 1 ; : 6973. 7 Goetz CG, Stebbins GT, Blasucci LM, et al. Efficacy of a patient training videotape on motor fluctuations for on-off diaries in Parkinson's disease. Mov Disord 1997; 12: 103941. Alvarez L, Macias R, Guridi J, et al. Dorsal subthalamotomy for Parkinson's disease. Mov Disord 2001; 16: 728. Pahwa R, Wilkinson S, Smith D, et al. High-frequency stimulation of the globus pallidus for the treatment of Parkinson's disease. Neurology 1997; 49: 24953. Peschanski M, Defer G, N'Guyen JP, et al. Bilateral motor improvement and alteration of L-dopa effect in two patients with Parkinson's disease following intrastriatal transplantation of foetal ventral mesencephalon. Brain 1994; 117: 48799. Wenning G, Odin P, Morrish P, et al. Short- and long-term survival and function of unilateral intrastriatal dopaminergic grafts in Parkinson's disease. Ann Neurol 1997; 42: 95107. Gibb WRG, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 1988; 51: 74552. Folstein M, Folstein S, McHugh P. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 18998. Norman G, Streiner D. Biostatistics: the bare essentials, 2nd ed. Hamilton: BC Decker, 2000. 15 Fayers PM, Machin D. Quality of life: assessment, analysis and interpretation. West Sussex: John Wiley and Sons, 2000. 16 Bland JM, Altman DG. Multiple significance tests: the Bonferroni method. BMJ 1995; 310: 170. Paulson HL, Stern MB. Clinical manifestations of Parkinson's disease. In: Watts RL, Koller WC, eds. Movement disorders: neurological principle and practice. New York: McGraw-Hill, 1997: 18399. 18 Denny AP, Behari M. Motor fluctuations in Parkinson's disease. J Neurol Sci 1999; 165: 1823. Fine J, Duff J, Chen R, et al. Long-term follow-up of unilateral pallidotomy in advanced Parkinson's disease. N Engl J Med 2000; 342: 170814. Hagell P, Piccini P, Bjorklund A, et al. Dyskinesias following neural transplantation in Parkinson's disease. Nat Neurosci 2002; 5: 6278. Parkin SG, Gregory RP, Scott R, et al. Unilateral and bilateral pallidotomy for idiopathic Parkinson's disease: a case series of 115 patients. Mov Disord 2002; 17: 68292. Parkinson Study Group. Evaluation of dyskinesias in a pilot, randomized, placebo-controlled trial of remacemide in advanced Parkinson's disease. Arch Neurol 2001; 58: 16608. Marinus J, Visser M, Stiggelbout AM, et al. Activity-based diary for Parkinson's disease. Clin Neuropharmacol 2002; 25: 4350. Hauser RA, Friedlander J, Zesiewicz TA, et al. A home diary to assess functional status in patients with Parkinson's disease with motor fluctuations and dyskinesias. Clin Neuropharmacol 2000; 23: 7581.
1. Sadovsky R et al. Int J Clin Pract. 2001; 55: 115-128. Levitra vardenafil ; prescribing information. Bayer Pharmaceuticals Corp: West Haven, Conn; 2005. 3. Viahra sildenafil ; prescribing information. Pfizer Inc: New York, NY; 2005. 4. Cialis tadalafil ; prescribing information. Lilly ICOS LLC: Indianapolis, Ind and Bothell, Wash; 2005. 5. Shabsigh R et al. J Urol. 2003; 169 suppl ; : 247. Abstract 954. 6. Guay AT et al. Endocr Pract. 2003; 9: 77-95. Guay AT et al. J Androl. 2001; 22: 793-797. Jiann B et al. Int J Impot Res. 2004; 16: 64-68. Sadovsky R et al. J Manag Care. 1999; 5: 333-341. Ralph D, McNicholas T. BMJ. 2000; 321: 499-503.

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