Neuropsychiatric aspects of Parkinson’s disease

Abstract

Throughout the natural history of Parkinson's Disease (PD), from the pre-diagnostic phase to end stage disease, neuropsychiatric manifestations represent a core feature of the disease. This review summarises current knowledge on the features of depression, anxiety, apathy, fatigue, impulse control disorders (ICDs) and psychosis in PD. These co-morbidities are common and still frequently under-recognised. Their impact on quality of life is considerable, with depression having been shown to be the main determinant of health-related quality of life in PD patients. As well as formal diagnostic criteria, multiple scales have been developed to allow for assessment of these symptoms in both the clinic and research settings. The evidence base for treatment is variable, with increasing evidence for pharmacological and non-pharmacological treatment options for depression, but less robust evidence for the treatment of other neuropsychiatric features. Imaging studies are increasingly providing insight into the neural basis of these symptoms, with the hope that this insight will translate into treatments that can benefit patients.

Clinically relevant connectivity features define three subtypes of Parkinson's disease patients

“…Focusing on the S‐depression subtype, we found widespread disrupted functional connectivity both within the motor‐ and depression‐related connectivity patterns as well as outside of these two patterns, covering the frontal‐temporal and parietal‐occipital regions. Several studies demonstrated that the neural bases of depression in PD patients was likely to be diffuse, and has been referred to as disrupted structure or function in frontal, temporal and occipital regions (Feldmann et al, 2008; Gou et al, 2018; Mayberg et al, 1990; Nagy & Schrag, 2019), which corresponded with our findings and indicated serious brain damage in the S‐depression subtype. Additionally, enhanced functional connectivity in the cerebellum and thalamus was also observed in the S‐depression subtype.…”

“…In addition, the S‐motor subtype exhibited moderately disrupted local and global functions in the depression‐related pattern. Depression is a general neuropsychiatric symptom in PD (Nagy & Schrag, 2019). Although the S‐motor subtype was characterized by motor impairments, they might present with depression‐related symptoms, which was supported by the relatively higher depression‐related scores in the S‐motor subtype compared with normal controls.…”

Can adenosine A2A receptor antagonists be used to treat cognitive impairment, depression or excessive sleepiness in Parkinson's disease?

“…Depression and anxiety are common features of PD that are both responses to the illness and integral components of the disease process [3,11,[44][45][46]. It is difficult to extricate those components that reflect daily events, such as frustration with completing activities of daily living and the cycles of symptomatic drug effect and the approach of 'OFF' periods, and events that reflect the widespread pathology of PD altering those parts of the circuitry that control mood and psychological state in general [47].…”

Exploring Treatment for Depression in Parkinson’s Patients: A Cross-Sectional Analysis

“…Depression is a highly prevalent comorbidity of PD, with prevalence estimates ranging from 22% to 91% [2][3][4] and estimates of concomitant anti-parkinsonian and antidepressant use in older adults ranging from 25% to 58% of patients [5,6], with selective serotonin reuptake inhibitors emerging as the most frequently used antidepressant [5,6]. Moreover, depression is a key predictor of health-related quality of life, with increasing severity corresponding to decreased quality of life [7,8]. While depression principally impacts mental and emotional aspects of quality of life [9], it may also exacerbate motor symptoms [10] and alter patient self-perception of motor function [11].…”