New Thoughts on Thought Disorders in Parkinson's Disease: Review of Current Research Strategies and Challenges

Goldman, Jennifer G.

doi:10.4061/2011/675630

Cited by 14 publications

(8 citation statements)

References 109 publications

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“…Though once attributed primarily to dopaminergic medication side effects, PD psychosis is more likely related to a complicated interplay between intrinsic pathophysiological changes and extrinsic variables [16] (Table 1). Intrinsic processes include neurochemical changes affecting dopamine, serotonin and acetylcholine; aberrant cortical and brainstem activation patterns; sleep disturbances; primary visual impairment; and abnormal attentional, cognitive, and visuospatial functioning.…”

Section: Psychosis In Pdmentioning

confidence: 99%

Treatment of Psychosis and Dementia in Parkinson’s Disease

Goldman

Holden

2014

Curr Treat Options Neurol

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109

103

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Opinion Statement Parkinson’s disease (PD) has been increasingly recognized as having a multitude of non-motor symptoms including psychosis, cognitive impairment and dementia, mood disturbances, fatigue, apathy, and sleep disorders. Psychosis and dementia, in particular, greatly affect quality of life for both patients and caregivers and are associated with poor outcomes. Safe and effective treatment options for psychosis and dementia in PD are much needed. Antipsychotics with dopamine-blocking properties can worsen parkinsonian motor features and have been associated with increased morbidity and mortality in elderly, dementia patients. For treating PD psychosis, a first step would be eliminating confounding variables, such as delirium, infections or toxic-metabolic imbalances, followed by simplifying parkinsonian medications as tolerated. If additional treatment is warranted after such interventions, clozapine or quetiapine can be implemented at the low dose levels typically needed by PD patients. Although quetiapine is easy-to-use in clinical settings, does not require blood count monitoring like clozapine, and is anecdotally beneficial, it remains “investigational” in evidence-based medicine reviews. Though not currently available, the novel 5-HT2a inverse agonist, pimavanserin has shown promise in the treatment of PD psychosis. Current treatments for PD dementia are mostly derived from those utilized in Alzheimer’s disease, focusing mainly on cholinesterase inhibitors and memantine, a NMDA receptor antagonist. Rivastigmine, the only approved medication for PD dementia, is a reasonable first choice. Other cholinesterase inhibitors and memantine have not yet achieved recommendation status in evidence-based medicine reviews but are well tolerated in studies of PD dementia patients. At present, there are no approved treatments for mild cognitive impairment in PD, but rasagiline, a selective MAO-B inhibitor, and atomoxetine, a serotonin norepinephrine reuptake inhibitor, have been recently studied. Non-pharmacological interventions, including cognitive therapy, physical activity, music and art therapy and non-invasive brain stimulation techniques, may be promising options for PD cognitive impairment but await rigorous study.

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Section: Psychosis In Pdmentioning

confidence: 99%

Treatment of Psychosis and Dementia in Parkinson’s Disease

Goldman

Holden

2014

Curr Treat Options Neurol

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109

103

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“…However, there are complex interactions between dopamine, serotonin, acetylcholine and noradrenaline systems, and mechanisms involving other neurotransmitter systems have also been implicated in the psychosis associated with PD treatment. For example, dopamine administration may lead to hyperstimulation of 5HT‐2a receptors that affects glutamatergic‐modulated activity of dopamine neurones in the ventral tegmental area; this may lead to excitation of the limbic system and inhibition of the prefrontal cortex . Moreover, medications acting on other neurotransmitter systems such as anticholinergic medications may also cause psychotic symptoms, to which older patients are particularly prone.…”

Section: Neuropsychiatric Side‐effectsmentioning

confidence: 99%

Neuropsychiatric effects of Parkinson's disease treatment

Aarons¹,

Peisah

Wijeratne

2012

Australas J Ageing

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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.

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“…The usefulness of these treatments to deal with BPSD has not been demonstrated, and serious side effects and mortality risk have been repeatedly documented (Sink et al, 2005;Kales et al, 2007;Vilalta-Franch et al, 2008), yet APs are extensively used, off-label, in patients with dementia (Radley et al, 2006;Jeste et al, 2008;Tjia et al, 2010). Although APs have been broadly shown to worsen the motor symptoms of PSd (Goldman, 2011), such as Parkinson's disease with dementia (PDD) or DLB, more than 50% of the cases in our study were prescribed a neuroleptic. For a long time, psychotic symptoms in these subtypes of dementia were suspected to be side effects of dopaminergic medications.…”

Section: Discussionmentioning

confidence: 99%