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Non-motor features have a great impact on progression and quality of life in individuals with Parkinson's disease. Current treatments for PD are limited and apomorphine is one of the advanced therapies available with advantageous effects on motor complications. Several studies have suggested that apomorphine has potential benefits in PD patients beyond its established role in the treatment of motor fluctuations and levodopa-induced dyskinesia. This review examines the efficacy of apomorphine in the treatment of non-motor symptoms (NMS), describing recent studies that highlight its possible effect on cognition. Despite a limited number of studies, the available evidence shows that apomorphine has an overall beneficial effect on NMS of PD patients, including neuropsychiatric symptoms, sleep disturbances, pain, urinary dysfunction, and impulse control disorders. If the effects of apomorphine on amyloid deposition are confirmed in the future, its place in the armamentarium of PD treatment could see a shift towards younger and non-demented PD patients.

A wide range of sleep dysfunction complicates Parkinson’s disease during its course from prodromal to palliative stage. It is now increasingly acknowledged that sleep disturbances are thus integral to the disease and pose a significant burden impacting on quality of life of patients. Sleep fragmentation, restless legs syndrome, nocturia, and nocturnal pain are regarded as one of the main components of night-time sleep dysfunction with possible secondary impact on cognition and well-being. The role of dopaminergic therapies, particularly using a continuous drug delivery strategy in managing some of these sleep issues, have been reported but the overall concept remains unclear. This review provides an overview of several aspects of night-time sleep dysfunction in Parkinson’s disease and describes all available published open-label and blinded studies that investigated the use of rotigotine transdermal patch targeting sleep. Blinded studies have suggested beneficial effects of rotigotine transdermal patch on maintenance insomnia and restless legs syndrome in Parkinson’s disease patients. Open-label studies support these observations and also suggest beneficial effects on nocturia and nocturnal pain.

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Nonmotor symptoms (NMS) are integral to Parkinson's disease (PD) and the management can often be challenging. In spite of the growing evidence that NMS have a key impact on the quality of life of patients and caregivers, most clinical trials still focus on motor symptoms as primary outcomes. As a consequence strong evidence-based treatment recommendations for NMS occurring in PD are spare. In this chapter, the current data addressing the treatment of major NMS such as sleep, cognitive and autonomic dysfunction, and depression and anxiety are described.

Rapid recruitment of participants is essential for the execution of clinical trials in Alzheimer’s disease (AD). Our objective was to improve site-led recruitment and screen-failure rates for clinical trials in AD by developing a novel patient pre-screening model. Information relating to sources of patient pre-screening activities was collated from recruitment data sources across two interventional and eight observational clinical trials in AD. The most efficient sources of recruitment were via the Cognitive Disorders Clinics, Join Dementia Research (JDR) website and referrals across research teams within the department. Adaptations to the patient identification and pre-screening processes led to a significant increase in identification of patients and recruitment to studies: 800% increase in patient identification and 430% increase in patient enrolment 2015–2018. Our model has also been consistently shown to decrease screen-failure rate (IONIS MAPTRx trial - local screen-fail rate of 40% compared with 70% rest of the world; ENGAGE - 50% screened were randomised locally compared with 27% globally). We have developed a novel pre-screening model which we have shown to consistently increase patient identification numbers, improve recruitment and decrease screen-failure rates. Implementation on a wider scale could significantly reduce costs and delays incurred by the majority of AD clinical trials.