Recognition and treatment of neuropsychiatric disturbances in Parkinson’s disease

Abstract

The non-motor symptoms of Parkinson's disease (PD) have been attracting increasing attention due to their ubiquitous nature and their often devastating effects on the quality of life. Behavioral problems in PD include dementia, depression, apathy, fatigue, anxiety, psychosis, akathisia, personality change, sleep disorders and impulse control disorders. Some of these are intrinsic to the neuropathology while others occur as an interplay between pathology, psychology and pharmacology. While few data exist for guiding therapy, enough is known to guide therapy in a rational manner.

Available and future treatments for atypical parkinsonism. A systematic review

“…The treatment of hallucinations can be especially difficult because of the sensitivity to neuroleptic drugs showed by around 39% of patients with PDD and because of the danger of worsening motor parkinsonian signs. Hallucinations do not constantly need therapy, and the very first action is certainly to eliminate iatrogenic causes and treat concomitant infections . Discontinuation of PD drugs starts with anticholinergics, followed by amantadine, dopamine agonists, monoamine oxidase B inhibitors, catechol‐O‐methyltransferase inhibitors, and lastly, L‐dopa.…”

“…Discontinuation of PD drugs starts with anticholinergics, followed by amantadine, dopamine agonists, monoamine oxidase B inhibitors, catechol‐O‐methyltransferase inhibitors, and lastly, L‐dopa. Neuroleptics may be suggested if hallucinations still persist . Clozapine has proved powerful in treating psychotic symptoms in PD; it is infrequently connected with neuroleptic sensitivity, and it has a benign motor profile .…”

Managing fatigue in patients with Parkinson's disease: a patient-focused perspective

“…6,[22][23][24][25] The severity of fatigue does not correlate with motor symptoms, and improving motor symptoms does not always reduce fatigue. 3,26,27 PD patients with fatigue have a significantly poorer health-related quality of life, although controlling for depression and anxiety reduces the effect. 10,13,20 Fatigue is part of the diagnostic criteria for depression and generalized anxiety disorder and separating these symptoms can be difficult.…”

“…Many patients with fatigue do not endorse apathy or a lack of motivation to perform activities, just the lack of energy. 3 It is this type of fatigue that is a frequent non-motor symptom of Parkinson's disease (PD) and other chronic illnesses. 1,[4][5][6] Fatigue has only been recently recognized as a common problem in PD.…”

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

“…In addition to having a significant impact on the patients' quality of life, 10 PDP significantly increases caregiver burden 11 and mortality. 12 PDP is also one of the strongest predictors of long-term care placement.…”