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Parkinson Disease

  • Andrea E. Cavanna
Chapter

Abstract

Parkinson disease is a neurodegenerative condition characterised by the motor features of rest tremor, bradykinesia, and rigidity. The neuropathological process of Parkinson disease consists in the progressive loss of dopaminergic neurons at the level of the basal ganglia (substantia nigra). Over the last few years, the focus of clinical research has shifted from the motor symptoms to the non-motor features of Parkinson disease, especially changes in mental state and behaviour. Behavioural symptoms are common and have been shown to affect patients’ health-related quality of life to a greater extent than motor disability. The intrinsic neuropsychiatric manifestations are mainly related to hypodopaminergic states and encompass depression, anxiety, and apathy. The iatrogenic neuropsychiatric manifestations are mainly related to hyperdopaminergic states and include psychosis, dopamine dysregulation syndrome, and impulse control disorders. Impulse control disorders can occur in about 30% of patients with Parkinson disease treated with dopamine replacement therapy, particularly dopamine receptor agonists. Modulation of dopamine replacement therapy is the first-line treatment approach for iatrogenic behavioural problems, followed by targeted psychotherapy and, where appropriate, pharmacotherapy with atypical antipsychotics.

Keywords

Basal ganglia Dopamine Non-motor features Parkinson disease Movement disorder 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Andrea E. Cavanna
    • 1
  1. 1.Dept of NeuropsychiatryUniversity of BirminghamBirminghamUnited Kingdom

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