Neuropsychiatric effects of Parkinson's disease treatment

Abstract

Advances in the treatment of Parkinson's disease have led to significant improvement in many of the disabling motor symptoms of the disease, but often at the cost of neuropsychiatric side-effects. These include psychosis, dopamine dysregulation syndrome, impulse control disorders, mood disorders and Parkinson's disease drug withdrawal syndromes. Such side-effects can be as disabling and have as much impact on activities of daily living, quality of life, relationships and caregiver burden as motor symptoms. Awareness of these potential side-effects is important both in terms of obtaining informed consent, and to aid early identification and intervention, as patients may not spontaneously report side-effects because of lack of insight, or deny them out of shame or embarrassment. The challenge of treatment can be a trade off between the emergence of such side-effects and the amelioration of parkinsonism, best mastered with an informed dialogue between clinician and patient.

Impact of Frontal Lobe Function and Behavioral Changes on Health-Related Quality of Life in Patients with Parkinson's Disease: A Cross-Sectional Study from Southwest China

“…In addition, we also observed that higher percentage of treatment with dopamine agonist was associated with increasing severity of frontal behavioral changes in PD patients. This is consistent with previous evidences that dopamine agonist treatments in PD are associated with increased risk of behavioral changes and neuropsychiatric symptoms [25,26] , especially impulse control disorders [27] .…”

Parkinson's disease cluster: the wind of change

“…None of these therapies have, so far, shown to be getting any closer to preventing disease progression and are, therefore, essentially symptomatic or palliative. Despite the efficacy of dopaminergic therapies in improving motor function and overall quality of life, they fail to prevent disease progression, and are associated with important complications [8][9][10]. This is consistent with the notion that the upstream molecular processes responsible for the cascade of pathological events are not yet being targeted by therapies currently available or under clinical development.…”

Phenomenology and gender characteristics of hobbyism and punding in Parkinson’s disease: A self-report study

“…Impulse control disorders as well as mere symptoms of ICBs may have a potentially negative impact on patients' quality of life, finances, and social functioning and induce an increased caregiver burden [10]. Thus it is of utmost clinical importance to quickly identify patients at risk for developing ICBs.…”

“…Furthermore, it appears that despite the negative consequences of ICBs, patients seldom present symptoms to healthcare professionals, which may be related to patients underestimating or denying the presence and severity of ICBs [10,25,26] e.g. due to lack of insight [27] or unwillingness to reveal behavioral symptoms [28].…”