Treatment of Cognitive, Psychiatric, and Affective Disorders Associated with Parkinson's Disease

Abstract

Neuropsychiatric symptoms are common in Parkinson's disease (PD) and add significantly to the burden of disease. These symptoms are most commonly part of the disease spectrum owing to pathological changes within relevant brain regions. Neuropsychiatric problems include disorders of cognition, ranging from mild cognitive impairment to dementia, psychotic symptoms, including, most commonly, well-formed visual hallucinations and paranoid delusions, and mood disorders, such as depression and anxiety. The other common cause of neuropsychiatric problem is secondary to use of dopaminergic drugs. Some PD patients may develop behavioral disorders, including impulse control disorders (ICDs) and addictive symptoms. Psychosis can be due to a mixture of underlying pathology, with triggering or worsening of symptoms with changes to PD medications. Currently, management of these disorders primarily uses therapies developed for general psychiatry and cognitive neurology, rather than specifically for PD. However, significant adverse effects, such as worsening of the motor symptoms of PD, can limit use of some drug therapies. Identification of drug-induced symptoms, such as ICDs, enables withdrawal of the offending drug as the principal management strategy. Research is ongoing in an effort to develop more specific therapies for PD-related neuropsychiatric symptoms.

Temporal Dissociation of Striatum and Prefrontal Cortex Uncouples Anhedonia and Defense Behaviors Relevant to Depression in 6-OHDA-Lesioned Rats

“…However, this mild dopaminergic damage triggered mood-related behavioral alterations, such as anhedonia, defense behaviors, and impaired social interaction, as also observed in previous studies [24][25][26]; thus, this 6-OHDA-based model is an experimental model well-suited to evaluate behaviors related to symptoms occurring in the PD prodrome [3,27,28], without affecting motor functions that could confound the interpretation of emotional parameters associated to defense behaviors relevant to depression and anhedonia. Furthermore, we now confirmed that fluoxetine and the atypical antidepressant drug bupropion prevented the appearance of these behavioral alterations, further validating the pertinence of these alterations to the PD-related depressive status [29,30]. This is particularly relevant since PD patients exhibit a wide range of non-motor symptoms such as anhedonia, depression, and anxiety that affect their quality of life and represent a major unmet therapeutic need [2,3,6].…”

Parkinson’s Disease Psychosis: Therapy Tips and the Importance of Communication Between Neurologists and Psychiatrists

“…The approach of psychosis in PD is similar to that of a patient in delirium [32]. The first step is to identify any possible trigger(s).…”

Depression in patients with Parkinson's disease with dementia

“…Depression is a very common in dementia as part of PD. Therefore, its early identification is of the essence in order to begin early medicament therapy, which will in the long-run improve the quality of life both of the patient and the caregiver (11,16,21).…”