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Neuropsychiatric aspects of parkinson’s disease

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Abstract

Previous studies of the neuropsychiatric aspects of Parkinson’s disease were frequently methodologically inadequate. Small sample sizes, selection bias, lack of diagnostic criteria of Parkinson’s disease, different definitions and assessment of neuropsychiatric symptoms, and lack of control groups seriously questioned the validity of and ability to generalize the results from many studies. During the past decade, however, several of these methodological issues have been addressed. Recent studies have found that mild cognitive impairment is very common, and dementia, depression, and psychotic symptoms develop in a large proportion of patients. Neuropsychiatric symptoms are important determinants of mortality and disease progression, as well as of the patients quality of life and course of disease, caregiver distress, and nursing home admission. Few adequately designed treatment trials have been published, but available evidence suggests that depression and hallucinations may be effectively treated using new antidepressants and atypical antipsychotic agents without worsening of parkinsonism.

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References and Recommended Reading

  1. Litvan I, MacIntyre A, Goetz CG, et al.: Accurcay of the clinical diagnoses of Lewy body disease, Parkinson’s disease, and dementia with Lewy bodies. Arch Neurol 1998, 55:969–978. An interesting paper comparing the clinical diagnoses with autopsy findings in subjects with PD, dementia with Lewy bodies, and controls. The paper provides important background information regarding the studies of neuropsychiatric symptoms in PD.

    Article  PubMed  CAS  Google Scholar 

  2. Cummings JL, Mega M, Gray K, et al.: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994, 44:2308–2314.

    PubMed  CAS  Google Scholar 

  3. Aarsland D, Larsen JP, Lim NG, et al.: The spectrum of neuropsychiatric disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry, in press.

  4. Marder K, Tang MX, Cote L, et al.: The frequency and associated risk factors for dementia in patients with Parkinson’s disease. Arch Neurol 1995, 52:695–701.

    PubMed  CAS  Google Scholar 

  5. Tison F, Dartigues JF, Auriacombe S, et al.: Dementia in Parkinson’s disease: a population-based study in ambulatory and institutionalized individuals. Neurology 1995, 45:705–707.

    PubMed  CAS  Google Scholar 

  6. Aarsland D, Larsen JP, Tandberg E: Frequency of dementia in Parkinson’s disease. Arch Neurol 1996, 53; 538–542.

    PubMed  CAS  Google Scholar 

  7. Luis ED, Marder K, Cote L, et al.: Mortality from Parkinson’s disease. Arch Neurol 1997, 54:260–264.

    Google Scholar 

  8. Stern Y, Marder K, Tang MX, et al.: Antecedent clinical features associated with dementia in Parkinson’s disease. Neurology 1993, 43:1690–1692.

    PubMed  CAS  Google Scholar 

  9. Caparros-Lefebvre D, Pecheux NN, Petit V, et al.: Which factors predict cognitive decline in Parkinson’s disease? J Neurol Neurosurg Psychiatry 1995, 58:51–55.

    PubMed  CAS  Google Scholar 

  10. Jacobs DM, Marder K, Cote LJ, et al.: Neuropsychological characteristics of preclinical dementia in Parkinson’s disease. Neurol 1995, 45:1691–1696.

    CAS  Google Scholar 

  11. Bayles KA, Tomoeda CK, Wood JA, et al.: Change in cognitive function in idiopathic Parkinson’s disease. Arch Neurol 1996, 53:1140–1146.

    PubMed  CAS  Google Scholar 

  12. Dubois B, Pillon B: Cognitive deficits in Parkinson’s disease. J Neurol 1997, 244:2–8.

    Article  PubMed  CAS  Google Scholar 

  13. Goldman WP, Baty JD, Buckles VD, et al.: Cognitive and motor functioning in Parkinson’s disease: subjects with and without questionable dementia. Arch Neurol 1998, 55:674–680.

    Article  PubMed  CAS  Google Scholar 

  14. Brown P, Marsden CD: What do the basal ganglia do? Lancet 1999, 351:1801–1804.

    Article  Google Scholar 

  15. Mayberg HS, Solomon D: Depression in Parkinson’s disease: a biological and organic viewpoint. In In Advances in Neurology, vol. 65. Edited by Weiner WJ, Lang AE. New York: Raven, 1995:49–60.

    Google Scholar 

  16. Bejjani BP, Damier P, Arnulf I, et al.: Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 1999, 340:1476–1480. A very interesting case of a patient who, during the course of high-frequency electrical stimulation in the central region of the left substantia nigra, reported unequivocal symptoms and signs of depression. Depression was not elicited by stimulation of the right side. The authors hypothesize that the stimulation have affected the nigral gamma-aminobutyric acid-emplying (GABAergic) neurons innervating the ventral nuclei of the thalamus, which project to the prefrontal and orbitofrontal cortexes. This remarkable finding may stimulate new hypotheses and research of the etiology and treatment of depression in Parkinson’s disease.

    Article  PubMed  CAS  Google Scholar 

  17. Hantz P, Caracador-Davies T, Weatherall M, et al.: Depression in Parkinson’s disease. Am J Psychiatry 1994, 151:1010–1014.

    PubMed  CAS  Google Scholar 

  18. Tandberg E, Larsen JP, Aarsland D, et al.: The occurrence of depression in Parkinson’s disease: a community-based study. Arch Neurol 1996, 53:175–179.

    PubMed  CAS  Google Scholar 

  19. Karlsen K, Larsen JP, Tandberg E, et al.: Fatigue in patients with Parkinson’s disease. Mov Disord 1999, 14:237–241.

    Article  PubMed  CAS  Google Scholar 

  20. Tandberg E, Larsen JP, Aarsland D, et al.: Risk factors for depression in Parkinson’s disease. Arch Neurol 1997, 54:625–630.

    PubMed  CAS  Google Scholar 

  21. Gonera EG, van Hof M, Berger HJC, et al.: Symptoms and duration of the prodromal phase in Parkinson’s disease. Mov Disord 1997, 12:871–876.

    Article  PubMed  CAS  Google Scholar 

  22. Stenager EN, Wermuth L, Stenager E, Boldsen J: Suicide in patients with PD: an epidemiolgoic study. Acta Psychiatr Scand 1994, 90:70–72.

    PubMed  CAS  Google Scholar 

  23. Naimark D, Jackson E, Rockwell E, et al.: Psychotic symptoms in Parkinson’s disease patients with dementia. J Am Geriatr Soc 1996, 44:296–299.

    PubMed  CAS  Google Scholar 

  24. Sanchez-Ramos JR, Ortoll R, Paulson GW: Visual hallucinations associated with Parkinson’s disease. Arch Neurol 1996, 53:1265–1268.

    PubMed  CAS  Google Scholar 

  25. Graham JM, Grunewald RA, Sagar HJ: Hallucinations in idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 1997, 63:434–440.

    PubMed  CAS  Google Scholar 

  26. Aarsland D, Larsen JP, Cummings JL, et al.: Prevalence and clinical correlates of psychosis in Parkinson’s disease. Arch Neurol 1999, 56:595–601. This paper studied the frequency of psychotic symptoms in a large, epidemiologic sample using the thought disorder subscale of the UPDRS. This is the first population-based study of psychotic symptoms in PD.

    Article  PubMed  CAS  Google Scholar 

  27. Pappert EJ, Goetz CG, Niederman FG, et al.: Hallucinations, sleep fragmentation, and altered dream phenomena in Parkinson’s disease. Mov Disord 1999, 14:117–121.

    Article  PubMed  CAS  Google Scholar 

  28. Goetz CG, Vogel C, Tanner C, et al.: Early dopaminergic druginduced hallucinations in parkinsonian patients. Neurology 1998, 51:811–814. This paper compared baseline clinical features and 5-year follow-up data of patients diagnosed with PD with early and late-onset hallucinations. They found that early onset hallucinations signals diagnoses other than PD.

    PubMed  CAS  Google Scholar 

  29. Goetz CG, Pappert EJ, Blasucci LM, et al.: Intravenous levodopa in hallucinating Parkinson’s disease patients: highdose challenge does not precipitate hallucinations. Neurology 1998, 50:515–517.

    PubMed  CAS  Google Scholar 

  30. Fetoni V, Solivieri P, Monza D, et al.: Affective symptoms in multiple system atorphy and Parkinson’s disease: response to levodopa therapy. J Neurol Neurosurg Psychiatry 1999, 66:541–544.

    PubMed  CAS  Google Scholar 

  31. Maricle RA, Nutt JG, Valentine RJ, et al.: Dose-response relationship of levodopa with mood and anxiety in fluctuating Parkinson’s disease: a double-blind, placebo-controlled study. Neurology 1995, 45:1757–1760.

    PubMed  CAS  Google Scholar 

  32. Growdon JH, Kieburtz K, McDermott MP, et al.: Levodopa improves motor function without impairing cognition in mild non-demented Parkinson’s disease patients. Neurology 1998, 50:1327–1331. This paper compared motor, cognitive, and psychiatric status before and 6 months after initiation of levodopa in 387 patients with PD. Small effects on tests of frontal lobe functions and mood were found.

    PubMed  CAS  Google Scholar 

  33. Tom T, Cummings JL: Depression in Parkinson’s disease: pharmacological characteristics and treatment. Drugs Aging 1998, 12:55–74.

    Article  PubMed  CAS  Google Scholar 

  34. Jansen Steur EN, Ballering LAP: Moclobemide and selegiline in the treatment of depression in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1997, 63:547–558.

    Google Scholar 

  35. Cooper JA, Sagar HJ, Doherty SM, et al.: Different effects of dopaminergic and anticholinergic therapies on cognitive and motor functions in Parkinson’s disease: a follow-up study of untreated patients. Brain 1992, 115:1701–1725.

    Article  PubMed  Google Scholar 

  36. Kieburtz K, McDermott M, Como P, et al.: The effect of deprenyl and tocopherol on cognitive performance in early untreated Parkinson’s disease. Neurology 1994, 44:1756–1759.

    PubMed  CAS  Google Scholar 

  37. Klaassen T, Verhey FRJ, Sneijders HJM, et al.: Treatment of depression in Parkinson’s disease: a meta-analysis. J Neuropsychiatry Clin Neurosci 1995, 7:281–286.

    PubMed  CAS  Google Scholar 

  38. Wermuth L, Sorensen PS, Timm S, et al.: Depression in idiopathic Parkinson’s disease treated with citalopram: a placebo-controlled trial. Nord J Psychiatry 1998, 52:163–169. This is the first randomized trial of antidepressants in PD. The results were somewhat disappointing, in that no difference between placebo and citalopram was found. The authors discuss possible methodologic explanations for this.

    Article  Google Scholar 

  39. Arsland D, Larsen JP, Lim NG, Bech P: Citalopram plus mianserin for depression in patients with Parkinson’s disease and depression: an open-label study. Nord J Psychiatry 1998, 52:115–116.

    Google Scholar 

  40. Brefel-Courben C, Thalamas C, Paul HPS, et al.: Alpha-2-adrenoceptor antagonists: a new approach in Parkison’s Disease. CNS Drugs 1998, 10:189–207.

    Article  Google Scholar 

  41. Richard IH, Kurlan R: A survey of antidepressant drug use in Parkinson’s disease. Parkinson Study Group. Neurology 1997, 49:1168–1170.

    PubMed  CAS  Google Scholar 

  42. Hauser RA, Zesiewitcz TA: Sertraline for depression in Parkinson’s disease. Mov Disord 1996, 12:756–759.

    Article  Google Scholar 

  43. Goetz CG, Tanner CM, Klawans HL: Bupropion in Parkinson’s disease. Neurology 1984, 34:1092–1094.

    PubMed  CAS  Google Scholar 

  44. Moellentine C, Rummans T, Ahlskog J, et al.: Effectiveness of ECT in patients with parkinsonism. J Neuropsychiatry Clin Neurosci 1998, 10:187–193.

    PubMed  CAS  Google Scholar 

  45. Andersen J, Aabro E, Gulmann N, et al.: Antidepressive treatment in Parkinson’s disease. Acta Neurol Scand 1980, 62:210–219.

    Article  PubMed  CAS  Google Scholar 

  46. Wittgens W, Donath O, Trenckmann U: Treatment of depressive symptoms in Parkinson’s disease with paroxetine. Mov Disord 1997, 12(suppl 1):128.

    Google Scholar 

  47. Laine K, Anttila M, Heinonen E, et al.: Lack of adverse interactions between concomitantly administered selegiline and citalopram. Clin Neuropharmacol 1997, 5:419–433.

    Article  Google Scholar 

  48. Richard IH, Maughn A, Kurlan R: Do serotonin reuptake inhibitor antidepressants worsen Parkinson’s disease? A retrospective case series. Mov Disord 1999, 14:155–193.

    Article  PubMed  CAS  Google Scholar 

  49. The Parkinson Study Group: Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson’s disease. N Engl J Med 1999, 340:757–763. The first randomized trial of antipsychotic treatment in PD. Clozapine was found to improve psychosis compared to placebo, without worsening parkinsonism. This is a very important study, providing the clinician with evidence of a new option to relieve the commonly occurring psychotic symptoms in PD.

    Article  Google Scholar 

  50. Trosch RM, Friedman JH, Lannon MC: Clozapine use in Parkinson’s disease: a retrospective analysis of a large multicentered clinical experience. Mov Disord 1998, 13:377–382.

    Article  PubMed  CAS  Google Scholar 

  51. Hutchinson M, Fazzini E: Cholinesterase inhibition in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1996, 61:324–326.

    PubMed  CAS  Google Scholar 

  52. Marder K, Tang M-X, Alfaro B, et al.: Postmenopausal estrogen use and Parkinson’s disease with and without dementia. Neurology 1998, 50:1141–1143. The first study to explore the possible protective effect of estrogen use and dementia in PD. Estrogen use was protective both within the setting of PD (OR 0.22, 95% CI 0.05-1.0) and compared with controls without PD (OR 0.24, 95% CI 0.07-0.78).

    PubMed  CAS  Google Scholar 

  53. Luis ED, Tang MX, Cote L, et al.: Progression of Parkinsonian signs in Parkinson’s disease. Arch Neurol 1999, 56:334–337. One of the few studies in which subjects with PD are followed over time. Dementia was one of three baseline factors which predicted a more rapid progression of parkinsonian signs in this large, community-based cohort.

    Article  Google Scholar 

  54. Starkstein SE, Mayberg HS, Leiguarda R, et al.: A prospective longitudinal study of depression, cognitive decline, and physical impairment in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1992, 55:377–382.

    PubMed  CAS  Google Scholar 

  55. Karlsen KH, Larsen JP, Tandberg E, Maeland JG: Quality of life measurements in patients with Parkinson’s disease: a community-based study. Eur J Neurol 1998, 5:443–450.

    Article  PubMed  Google Scholar 

  56. Karlsen KH, Tandberg E, Aarsland D, Larsen JP: Health-related quality of life in Parkinson’s disease: a prospective longitudinal study. In press.

  57. Karlsen KH, Larsen JP, Tandberg E, et al.: The influence of clinical and demographic variables on quality of life in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999, 66:431–435. One of the first studies investigating the determinants of quality of life in patients with PD. Depression was found to be one of the most important factors.

    Article  PubMed  CAS  Google Scholar 

  58. O’Reilly F, Finnan F, Allwright S, et al.: The effects of caring for a spouse with Parkinson’s disease on social, psychological and physical well-being. Br J Gen Pract 1996, 46:507–512.

    PubMed  CAS  Google Scholar 

  59. Carter JH, Stewart BJ, Archbold PG, et al.: Living with a person who has Parkinson’s disease: the spouse’s perspective by stage of disease. Mov Disord 1998, 13:20–28.

    Article  PubMed  CAS  Google Scholar 

  60. Miller E, Berrios GE, Politynska BE: Caring for someone with Parkinson’s disease: factors that contribute to distress. Int J Geriatr Psychiatry 1996, 11:2630.

    Article  Google Scholar 

  61. Aarsland D, Larsen JP, Karlsen K, et al.: Mental symptoms in Parkinson’s disease are important contributors to caregiver distress. Int J Geriatr Psychiatry, in press. One of the first studies assessing the association between caregiver distress and a wide range of clinical features of 139 patients with PD. Cognitive and psychiatric symptoms were more closely associated with caregiver distress than motor symptoms.

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Aarsland, D., Karlsen, K. Neuropsychiatric aspects of parkinson’s disease. Curr Psychiatry Rep 1, 61–68 (1999). https://doi.org/10.1007/s11920-999-0011-3

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