Comparison of multiple-input single-output single-user ultra-wideband systems with pre-distortion

This paper presents a performance analysis of a baseband multiple-input single-output ultra-wideband system over scenarios CM1 and CM3 of the IEEE 802.15.3a channel model, incorporating four different schemes of pre-distortion: time reversal, zero-forcing pre-equaliser, constrained least squares pre-equaliser, and minimum mean square error pre-equaliser. For the third case, a simple solution based on the steepest-descent (gradient) algorithm is adopted and compared with theoretical results. The channel estimations at the transmitter are assumed to be truncated and noisy. Results show that the constrained least squares algorithm has a good trade-off between intersymbol interference reduction and signal-to-noise ratio preservation, providing a performance comparable to the minimum mean square error method but with lower computational complexity. Copyright (C) 2011 John Wiley & Sons, Ltd.

A scheme for synchronizing clocks connected by a packet communication network

Consider a communication system in which a transmitter equipment sends fixed-size packets of data at a uniform rate to a receiver equipment. Consider also that these equipments are connected by a packet-switched network, which introduces a random delay to each packet. Here we propose an adaptive clock recovery scheme able of synchronizing the frequencies and the phases of these devices, within specified limits of precision. This scheme for achieving frequency and phase synchronization is based on measurements of the packet arrival times at the receiver, which are used to control the dynamics of a digital phase-locked loop. The scheme performance is evaluated via numerical simulations performed by using realistic parameter values. (C) 2011 Elsevier By. All rights reserved.

Comunicación robusta punto a punto con módulos embebidos de radio frecuencia XBee

Máster Universitario en Sistemas Inteligentes y Aplicaciones Numéricas en Ingeniería (SIANI)

Nonlinear/electromagnetic co-simulation of microwaves and millimeter-waves links

The Ph.D. thesis describes the simulations of different microwave links from the transmitter to the receiver intermediate-frequency ports, by means of a rigorous circuit-level nonlinear analysis approach coupled with the electromagnetic characterization of the transmitter and receiver front ends. This includes a full electromagnetic computation of the radiated far field which is used to establish the connection between transmitter and receiver. Digitally modulated radio-frequency drive is treated by a modulation-oriented harmonic-balance method based on Krylov-subspace model-order reduction to allow the handling of large-size front ends. Different examples of links have been presented: an End-to-End link simulated by making use of an artificial neural network model; the latter allows a fast computation of the link itself when driven by long sequences of the order of millions of samples. In this way a meaningful evaluation of such link performance aspects as the bit error rate becomes possible at the circuit level. Subsequently, a work focused on the co-simulation an entire link including a realistic simulation of the radio channel has been presented. The channel has been characterized by means of a deterministic approach, such as Ray Tracing technique. Then, a 2x2 multiple-input multiple-output antenna link has been simulated; in this work near-field and far-field coupling between radiating elements, as well as the environment factors, has been rigorously taken into account. Finally, within the scope to simulate an entire ultra-wideband link, the transmitting side of an ultrawideband link has been designed, and an interesting Front-End co-design technique application has been setup.

Project-based learning using robots with open-source hardware and software

[EN]One of the main issues of the current education system is the lack of student motivation. This aspect together with the permanent change that the Information and Communications Technologies involve represents a major challenge for the teacher: to continuously update contents and to keep awake the student’s interest. A tremendously useful tool in classrooms consists on the integration of projects with participative and collaborative dynamics, where the teacher acts mainly as a guidance to the student activity instead of being a mere knowledge and evaluation transmitter. As a specific example of project based learning, the EDUROVs project consists on building an economic underwater robot using low cost materials, but allowing the integration and programming of many accessories and sensors with minimum budget using opensource hardware and software.

Trasduzione del segnale e poliamine nell'apoptosi di cellule cardiache

Introduction: Apoptotic cell death of cardiomyocytes is involved in several cardiovascular diseases including ischemia, hypertrophy and heart failure, thus representing a potential therapeutic target. Apoptosis of cardiac cells can be induced experimentally by several stimuli including hypoxia, serum withdrawal or combination of both. Several lines of research suggest that neurohormonal mechanisms play a central role in the progression of heart failure. In particular, excessive activation of the sympathetic nervous system or the renin-angiotensin-aldosterone system is known to have deleterious effects on the heart. Recent studies report that norepinephrine (NE), the primary transmitter of sympathetic nervous system, and aldosterone (ALD), which is actively produced in failing human heart, are able to induce apoptosis of rat cardiomyocytes. Polyamines are biogenic amines involved in many cellular processes, including apoptosis. Actually it appears that these molecules can act as promoting, modulating or protective agents in apoptosis depending on apoptotic stimulus and cellular model. We have studied the involvement of polyamines in the apoptosis of cardiac cells induced in a model of simulated ischemia and following treatment with NE or ALD. Methods: H9c2 cardiomyoblasts were exposed to a condition of simulated ischemia, consisting of hypoxia plus serum deprivation. Cardiomyocyte cultures were prepared from 1-3 day-old neonatal Wistar rat hearts. Polyamine depletion was obtained by culturing the cells in the presence of α-difluoromethylornithine (DFMO). Polyamines were separated and quantified in acidic cellular extracts by HPLC after derivatization with dansyl chloride. Caspase activity was measured by the cleavage of the fluorogenic peptide substrate. Ornithine decarboxylase (ODC) activity was measured by estimation of the release of 14C-CO2 from 14C-ornithine. DNA fragmentation was visualized by the method of terminal transferase-mediated dUTP nick end-labeling (TUNEL), and DNA laddering on agarose gel electophoresis. Cytochrome c was detected by immunoflorescent staining. Activation of signal transduction pathways was investigated by western blotting. Results: The results indicate that simulated ischemia, NE and ALD cause an early induction of the activity of ornithine decarboxylase (ODC), the first enzyme in polyamine biosynthesis, followed by a later increase of caspase activity, a family of proteases that execute the death program and induce cell death. This effect was prevented in the presence of DFMO, an irreversible inhibitor of ODC, thus suggesting that polyamines are involved in the execution of the death program activated by these stimuli. In H9c2 cells DFMO inhibits several molecular events related to apoptosis that follow simulated ischemia, such as the release of cytochrome c from mitochondria, down-regulation of Bcl-xL, and DNA fragmentation. The anti-apoptotic protein survivin is down-regulated after ALD or NE treatement and polyamine depletion obtained by DFMO partially opposes survivin decrease. Moreover, a study of key signal transduction pathways governing cell death and survival, revealed an involvement of AMP activated protein kinase (AMPK) and AKT kinase, in the modulation by polyamines of the response of cardiomyocytes to NE. In fact polyamine depleted cells show an altered pattern of AMPK and AKT activation that may contrast apoptosis and appears to result from a differential effect on the specific phosphatases that dephosphorylate and switch off these signaling proteins. Conclusions: These results indicate that polyamines are involved in the execution of the death program activated in cardiac cells by heart failure-related stimuli, like ischemia, ALD and NE, and suggest that their apoptosis facilitating action is mediated by a network of specific phosphatases and kinases.

Advanced signal and receiver design for next generation OFDM systems

This thesis deal with the design of advanced OFDM systems. Both waveform and receiver design have been treated. The main scope of the Thesis is to study, create, and propose, ideas and novel design solutions able to cope with the weaknesses and crucial aspects of modern OFDM systems. Starting from the the transmitter side, the problem represented by low resilience to non-linear distortion has been assessed. A novel technique that considerably reduces the Peak-to-Average Power Ratio (PAPR) yielding a quasi constant signal envelope in the time domain (PAPR close to 1 dB) has been proposed.The proposed technique, named Rotation Invariant Subcarrier Mapping (RISM),is a novel scheme for subcarriers data mapping,where the symbols belonging to the modulation alphabet are not anchored, but maintain some degrees of freedom. In other words, a bit tuple is not mapped on a single point, rather it is mapped onto a geometrical locus, which is totally or partially rotation invariant. The final positions of the transmitted complex symbols are chosen by an iterative optimization process in order to minimize the PAPR of the resulting OFDM symbol. Numerical results confirm that RISM makes OFDM usable even in severe non-linear channels. Another well known problem which has been tackled is the vulnerability to synchronization errors. Indeed in OFDM system an accurate recovery of carrier frequency and symbol timing is crucial for the proper demodulation of the received packets. In general, timing and frequency synchronization is performed in two separate phases called PRE-FFT and POST-FFT synchronization. Regarding the PRE-FFT phase, a novel joint symbol timing and carrier frequency synchronization algorithm has been presented. The proposed algorithm is characterized by a very low hardware complexity, and, at the same time, it guarantees very good performance in in both AWGN and multipath channels. Regarding the POST-FFT phase, a novel approach for both pilot structure and receiver design has been presented. In particular, a novel pilot pattern has been introduced in order to minimize the occurrence of overlaps between two pattern shifted replicas. This allows to replace conventional pilots with nulls in the frequency domain, introducing the so called Silent Pilots. As a result, the optimal receiver turns out to be very robust against severe Rayleigh fading multipath and characterized by low complexity. Performance of this approach has been analytically and numerically evaluated. Comparing the proposed approach with state of the art alternatives, in both AWGN and multipath fading channels, considerable performance improvements have been obtained. The crucial problem of channel estimation has been thoroughly investigated, with particular emphasis on the decimation of the Channel Impulse Response (CIR) through the selection of the Most Significant Samples (MSSs). In this contest our contribution is twofold, from the theoretical side, we derived lower bounds on the estimation mean-square error (MSE) performance for any MSS selection strategy,from the receiver design we proposed novel MSS selection strategies which have been shown to approach these MSE lower bounds, and outperformed the state-of-the-art alternatives. Finally, the possibility of using of Single Carrier Frequency Division Multiple Access (SC-FDMA) in the Broadband Satellite Return Channel has been assessed. Notably, SC-FDMA is able to improve the physical layer spectral efficiency with respect to single carrier systems, which have been used so far in the Return Channel Satellite (RCS) standards. However, it requires a strict synchronization and it is also sensitive to phase noise of local radio frequency oscillators. For this reason, an effective pilot tone arrangement within the SC-FDMA frame, and a novel Joint Multi-User (JMU) estimation method for the SC-FDMA, has been proposed. As shown by numerical results, the proposed scheme manages to satisfy strict synchronization requirements and to guarantee a proper demodulation of the received signal.

Fiber-Optic Technologies for Wireline and Wireless In-building Networks

This doctoral dissertation aims to establish fiber-optic technologies overcoming the limiting issues of data communications in indoor environments. Specific applications are broadband mobile distribution in different in-building scenarios and high-speed digital transmission over short-range wired optical systems. Two key enabling technologies are considered: Radio over Fiber (RoF) techniques over standard silica fibers for distributed antenna systems (DAS) and plastic optical fibers (POFs) for short-range communications. Hence, the objectives and achievements of this thesis are related to the application of RoF and POF technologies in different in-building scenarios. On one hand, a theoretical and experimental analysis combined with demonstration activities has been performed on cost-effective RoF systems. An extensive modeling on modal noise impact both on linear and non-linear characteristics of RoF link over silica multimode fiber has been performed to achieve link design rules for an optimum choice of the transmitter, receiver and launching technique. A successful transmission of Long Term Evolution (LTE) mobile signals on the resulting optimized RoF system over silica multimode fiber employing a Fabry-Perot LD, central launch technique and a photodiode with a built-in ball lens was demonstrated up to 525m with performances well compliant with standard requirements. On the other hand, digital signal processing techniques to overcome the bandwidth limitation of POF have been investigated. An uncoded net bit-rate of 5.15Gbit/s was obtained on a 50m long POF link employing an eye-safe transmitter, a silicon photodiode, and DMT modulation with bit and power loading algorithm. With the insertion of 3x2N quadrature amplitude modulation constellation formats, an uncoded net-bit-rate of 5.4Gbit/s was obtained on a 50 m long POF link employing an eye-safe transmitter and a silicon avalanche photodiode. Moreover, simultaneous transmission of baseband 2Gbit/s with DMT and 200Mbit/s with an ultra-wideband radio signal has been validated over a 50m long POF link.

Intrazelluläre Lokalisation und synaptische Ausschüttung der Neurotrophine in hippokampalen Neuronen und die Bedeutung von BDNF bei hippokampaler synaptischer Plastizität

Die Mitglieder der Neurotrophin-Familie (NGF, BDNF, NT-3 und NT-4) sind sekretierte Neuropeptide, die eine bedeutende Rolle bei der Entwicklung von Nervenzellen und bei der Modulation der synaptischen Transmission spielen. Wenngleich eine aktivitätsabhängige Sekretion von BDNF bereits gezeigt werden konnte, wurden die subzelluläre Expression und die Ausschüttung der anderen Neurotrophine bislang nur unzureichend charakterisiert. Um die Expression und die Ausschüttung aller Neurotrophine unter identischen Bedingungen untersuchen zu können, wurde in der vorliegenden Arbeit das Expressionsmuster und die synaptische Ausschüttung GFP-markierter Neurotrophine in dissoziierten hippokampalen Neuronen mit Hilfe der konfokalen Fluoreszenz-Videomikroskopie zeitaufgelöst untersucht. Zwei Phänotypen konnten unterschieden werden: der distale vesikuläre Expressionstyp mit Neurotrophin-beinhaltenden Vesikeln in distalen Neuriten, und der proximale Expressionstyp mit einer diffusen Neurotrophin-Verteilung in den Neuriten und Neurotrophin-beinhaltenden Vesikeln im Soma des Neurons und in den proximalen Dendriten. Der distale vesikuläre Phänotyp entsprach einer Verteilung des entsprechenden Neurotrophins in die sekretorischen Granula des aktivitätsabhängigen Sekretionsweges, während der proximale Phänotyp den Transport eines Neurotrophins in den konstitutiven Sekretionsweg widerspiegelte. Alle Neurotrophine erreichten in hippokampalen Neuronen prinzipiell beide Sekretionswege. Jedoch gelangten BDNF und NT-3 mit einer größeren Effizienz in den regulierten Sekretionsweg als NT-4 und NGF (BDNF: in 98% aller Zellen, NT-3: 85%, NT-4: 23% und NGF: 46%). Neurotrophine besitzen, wie es für sekretorische Peptide üblich ist, eine Vorläufersequenz, die während der Reifung des Proteins proteolytisch abgespalten wird. Die Fusion dieser Präpro-Sequenz von BDNF mit der Sequenz des maturen NT-4 bewirkte einen effizienteren Transport von NT-4 in die sekretorischen Granula des regulierten Sekretionsweges, und zeigte die große Bedeutung der Präpro-Sequenz für das zelluläre Verteilungsmuster von Neurotrophinen. In Neuronen, in denen die Neurotrophine in den regulierten Sekretionsweg transportiert wurden, konnte eine aktivitätsabhängige Sekretion der Neurotrophine an postsynaptische Strukturen glutamaterger Synapsen beobachtet werden. Die aktivitätsabhängige postsynaptische Ausschüttung der Neurotrophine zeigte eine Heterogenität in der Kinetik der Sekretion (exponentieller Abfall des Neurotrophin-Signals mit Zeitkonstanten von tau = 121 bis 307s). Die Präinkubtion mit dem Protonen-Ionophor Monensin, welcher die Neutralisation des intragranulären pH-Wertes und somit die Solubilisierung der dicht gepackten Proteinstrukturen in den Vesikeln erzwingt, erhöhte die Geschwindigkeit der Neurotrophin-Ausschüttung auf den Wert des unter physiologischen Bedingungen schnellsten Neurotrophins NT-4. Dennoch blieb die Geschwindigkeit der Neurotrophin-Ausschüttung im Vergleich zur Neurotransmitter-Ausschüttung langsam (tau = 13 ± 2 s). Diese Daten belegen eindeutig, dass die Neutralisation der sekretorischen Granula die Geschwindigkeit der Neurotrophin-Ausschüttung kritisch determiniert und die Geschwindigkeit der Neurotrophin-Ausschüttung im Vergleich zur konventionellen Neurotransmitter-Ausschüttung langsam erfolgt. Des Weiteren konnte gezeigt werden, dass das Neurotrophin BDNF effizient in distale vesikuläre Strukturen von CA1 Pyramidenzellen organotypischer Schnittkulturen des Hippokampus sortiert wird. Die basalen elektrischen Eigenschaften von CA1 Pyramidenzellen BDNF-defizienter Mäuse sind vergleichbar zu den Eigenschaften von Wildtyp Mäusen. Sowohl das Eigenpotential der CA1 Pyramidenzellen, die Form der Aktionspotentiale als auch die evozierten Antworten der CA1 Pyramdenzellen auf eine gepaarte präsynaptische Stimulation der Schaffer-Kollateralen zeigten bei BDNF-/- -, BDNF+/- - und BDNF+/+ -Mäusen keine signifikanten Unterschiede. Die Fähigkeit der CA1 Pyramidenzellen auf eine hochfrequente Reizung mit einer Langzeitpotenzierung (LTP) der postsynaptischen Ströme zu reagieren ist jedoch bei den BDNF-defizienten Mäusen beinträchtigt. Eine verminderte Induktion von LTP war in den BDNF-defizienten Mäusen nach tetanischer Stimulation der präsynaptischen Schaffer-Kollateralen und simultaner postsynaptischer Depolarisation der CA1 Pyramidenzelle zu beobachten.

Innovative architecture of on-board and on-ground radio systems for space communication

The radio communication system is one of the most critical system of the overall satellite platform: it often represents the only way of communication, between a spacecraft and the Ground Segment or among a constellation of satellites. This thesis focuses on specific innovative architectures for on-board and on-ground radio systems. In particular, this work is an integral part of a space program started in 2004 at the University of Bologna, Forlì campus, which led to the completion of the microsatellite ALMASat-1, successfully launched on-board the VEGA maiden flight. The success of this program led to the development of a second microsatellite, named ALMASat-EO, a three-axis stabilized microsatellite able to capture images of the Earth surface. Therefore, the first objective of this study was focused on the investigation of an innovative, efficient and low cost architecture for on-board radio communication systems. The TT&C system and the high data rate transmitter for images downlink design and realization are thoroughly described in this work, together with the development of the embedded hardware and the adopted antenna systems. Moreover, considering the increasing interest in the development of constellations of microsatellite, in particular those flying in close formations, a careful analysis has been carried out for the development of innovative communication protocols for inter-satellite links. Furthermore, in order to investigate the system aspects of space communications, a study has been carried out at ESOC having as objective the design, implementation and test of two experimental devices for the enhancement of the ESA GS. Thus, a significant portion of this thesis is dedicated to the description of the results of a method for improving the phase stability of GS radio frequency equipments by means of real-time phase compensation and a new way to perform two antennas arraying tracking using already existing ESA tracking stations facilities.

Cerebro-corticale und subcorticale Prozessierung vestibulärer Informationen im intakten und lädierten System der Ratte (Micro-PET-Studie)

In dieser Studie wurde anhand des Modells der Ratte das Gleichgewichtssystem auf cerebro-corticaler Ebene untersucht, und das Verhalten des Gehirns nach akuten sowie chronischen Ausfällen mit funktioneller Bildgebung untersucht. rnMit der Positronen-Emissions-Tomographie (PET) kann die Metabolismusrate bestimmter Gehirnareale gemessen werden. Narkotisierte Tiere wurden unter galvanischer vestibulärer Stimulation im PET gemessen und die Ergebnisse wurden mit Kontrollstimulations-Messungen verglichen. Es konnten verschiedene Areale, die eine erhöhte Stoffwechselaktivität aufwiesen, ermittelt werden. Dazu gehören der somatosensorische und der insuläre Cortex, Teile des auditorischen Cortexes, der anteriore cinguläre sowie der entorhinale Cortex. Subcorticale Strukturen wie der Hippocampus, die Amygdala sowie die latero-dorsalen thalamischen Kerne wiesen ebenfalls erhöhten Stoffwechsel unter vestibulärer Stimulation auf. rnBei dieser PET-Studie handelt es sich um die erste funktionell-bildgebende Studie, die Verarbeitung vestibulärer Informationen bei Ratten in vivo darstellt. Die anatomische Verbindung der gefundenen Areale wurde mit anterograden und retrograden neuronalen Tracings unterstützt. rnDarüber hinaus wurde markiertes Gewebe, welches die Verbindung zwischen thalamischen und cerebro-corticalen Kernen der vestibulären Verschaltung aufweist, immunhistochemisch auf dessen Neurotransmission hin untersucht. Das katecholaminergen und dem opioidergen System wurde untersucht. Eine Beteiligung katecholaminerger Transmitter konnte nicht nachgewiesen werden. Neurone im somatosensorischen Cortex, die positiv auf einen Opioid-Rezeptor-Antikörper getestet wurden erhalten anterograd markierte Terminale aus dem thalamischen Kern LDDM, der mittels der PET als vestibulär identifiziert werden konnte. rnBasierend auf den Ergebnissen der ersten bildgebenden Studie wurde in einer zweiten funktionell-bildgebenden Studie die zentral-vestibuläre Verschaltung unterbrochen, indem relevante thalamische Kerngebiete (LDDM, LDVL) elektrolytisch zerstört wurden. Die Stoffwechselaktivität wurde anschließend bei diesen Tieren an verschiedenen Zeitpunkten nach der Läsion im PET unter vestibulärer Stimulation gemessen. Die Stoffwechselaktivität dieser Tiere wurde mit der Stoffwechselaktivität von Kontroll-Tieren verglichen. rnBei dieser Studie wurde zum ersten Mal, mittels funktioneller Bildgebung gezeigt, welche Bereiche des Gehirns nach akuter und chronischer Läsion des vestibulären Systems an Kompensationsmechanismen beteiligt sind. Alle Gehirnareale, die in verschiedenen Zeitfenstern (1, 3, 7 und 20 Tage nach Läsion) erhöhten Metabolismus aufweisen, sind Teil der vestibulären Verschaltung. Es handelt sich dabei um Areale der Okulomotorik und des räumlichen Gedächtnisses: das Postsubiculum, den Colliculus superior, das mediale Corpus geniculatum, den entorhinalen Cortex sowie die Zona incerta.rn

Oblique ionograms automatic scaling and eikonal based ray tracing

A method for automatic scaling of oblique ionograms has been introduced. This method also provides a rejection procedure for ionograms that are considered to lack sufficient information, depicting a very good success rate. Observing the Kp index of each autoscaled ionogram, can be noticed that the behavior of the autoscaling program does not depend on geomagnetic conditions. The comparison between the values of the MUF provided by the presented software and those obtained by an experienced operator indicate that the procedure developed for detecting the nose of oblique ionogram traces is sufficiently efficient and becomes much more efficient as the quality of the ionograms improves. These results demonstrate the program allows the real-time evaluation of MUF values associated with a particular radio link through an oblique radio sounding. The automatic recognition of a part of the trace allows determine for certain frequencies, the time taken by the radio wave to travel the path between the transmitter and receiver. The reconstruction of the ionogram traces, suggests the possibility of estimating the electron density between the transmitter and the receiver, from an oblique ionogram. The showed results have been obtained with a ray-tracing procedure based on the integration of the eikonal equation and using an analytical ionospheric model with free parameters. This indicates the possibility of applying an adaptive model and a ray-tracing algorithm to estimate the electron density in the ionosphere between the transmitter and the receiver An additional study has been conducted on a high quality ionospheric soundings data set and another algorithm has been designed for the conversion of an oblique ionogram into a vertical one, using Martyn's theorem. This allows a further analysis of oblique soundings, throw the use of the INGV Autoscala program for the automatic scaling of vertical ionograms.

A Kinetostatic Formulation for Load-Flow Visualization in Compliant Mechanisms

Load flow visualization, which is an important step in structural and machine assembly design may aid in the analysis and eventual synthesis of compliant mechanisms. In this paper, we present a kineto-static formulation to visualize load flow in compliant mechanisms. This formulation uses the concept of transferred forces to quantify load flow from input to the output of a compliant mechanism. The magnitude and direction of load flow in the constituent members enables functional decomposition of the compliant mechanism into (i) Constraints (C): members that are constrained to deform in a particular direction and (ii) Transmitters (T): members that transmit load to the output. Furthermore, it is shown that a constraint member and an adjacent transmitter member can be grouped together to constitute a fundamental building block known as an CT set whose load flow behavior is maximally decoupled from the rest of the mechanism. We can thereby explain the deformation behavior of a number of compliant mechanisms from literature by visualizing load flow, and identifying building blocks.

Amelioration of portal hypertension and the hyperdynamic circulatory syndrome in cirrhotic rats by neuropeptide Y via pronounced splanchnic vasoaction

Splanchnic vasodilation triggers the development of the hyperdynamic circulatory syndrome in portal hypertension. Neuropeptide Y (NPY), a sympathetic co-transmitter of norepinephrine, improves contractility in mesenteric arteries of pre-hepatic portal hypertensive rats. Therefore, we investigated the effect of NPY on mesenteric arterial contractility in vitro and in vivo in cirrhotic ascitic rats, as well as the vasoactive pathways involved.

Nonmotor disturbances in Parkinson's disease

Nonmotor disturbances (NMDs) affect most patients with Parkinson's disease (PD) and often have a profound impact on their quality of life. NMDs such as depression, anxiety, fatigue, REM sleep behavior disorder, constipation, delayed gastric emptying, altered olfaction and pain can precede the onset of motor symptoms. Other NMDs, including hallucinations, dementia, excessive daytime sleepiness, insomnia, orthostatic hypotension and bladder disturbances, typically appear later in the course of PD. For most NMDs of PD, nondopaminergic and non-nigrostriatal mechanisms (e.g. neurodegeneration of other transmitter systems in the cortex and brainstem, side effects of medications, genetic and psychosocial factors) are considered more relevant than the 'classical' dopaminergic-nigrostriatal dysfunction. The recognition of NMDs requires a high degree of clinical suspicion, the use of specific questionnaires and ancillary tests. Pharmacological and nonpharmacological approaches can be effective, but for most forms of treatment of NMDs, the scientific evidence is limited.