Psychiatric complications in Parkinson’s disease

  • E. Ch. Wolters
Conference paper


Parkinson’s disease (PD) is caused by an abnormal degeneration of the dopamine (DA) producing cells in the substantia nigra (SN) and ventral tegmentum area (VTA) in combination with a varying decay of the noradrenergic (locus coeruleus), cholinergic forebrain (nucleus basalis of Meynert) and serotoninergic (dorsal raphe nuclei) systems, leading to a multitude of motor and non-motor behavioral disturbances, known as parkinsonism. Normally, main dopamine depletion is restricted to the SN region with manifest (non)motor behavioral abnormalities caused by the inability to spontaneously switch between intern-cued cortical behavioral programmes. Clinical symptoms comprise motoric abnormalities, though subtle cognitive disturbances as well as psychological dysfunction with loss of mental flexibility and reactive


Lewy Body Dementia With Lewy Body Dorsal Raphe Nucleus Psychiatric Complication Mental Dysfunction 
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  1. Aarsland D, Larsen JP, Karlsen K, Lim NG, Tandberg E (1999a) Mental symptoms in Parkinson’s disease are important contributors to caregiver distress. Int J Geriatr Psychiatry 14: 866–874PubMedCrossRefGoogle Scholar
  2. Aarsland D, Larsen JP, Cummings JL Laake K (1999b) Prevalence and clinical correlates of psychotic symptoms in Parkinson disease. Arch Neurol 56: 595–601PubMedCrossRefGoogle Scholar
  3. Alexander GE, DeLong MR, Strick P (1986) Parallel organization of functionally segre-gated circuits linking basal ganglia and cortex. Annu Rev Neurosci 9: 357–381PubMedCrossRefGoogle Scholar
  4. Brown R, Jahanshahi M (1995) Depression in Parkinson’s disease: A psychological viewpoint. In: Weiner WS, Lang AE (eds) Behavioural neurology of movement disorders. Raven Press, New York, 61–84Google Scholar
  5. Brown RG, MacCarthy B (1990) Psychiatric morbidity in patients with Parkinson’s disease. Psychol Med 20: 77–87PubMedCrossRefGoogle Scholar
  6. Brown RG, Marsden CD (1984) How common is dementia in Parkinson’s disease. Lancet II: 1262–1265PubMedCrossRefGoogle Scholar
  7. Brown LL, Schneider JS, Lidsky TI (1997) Sensory and cognitive functions of the basal ganglia. Curr Opin Neurobiol 7: 157–163PubMedCrossRefGoogle Scholar
  8. Cools AR, Berger HJC, Buytenhuis EL, Horstink MWIM, Van Spaendonck KPM (1994) Manifestations of switching disorders in animal and man with dopamine deficits in A10 and/or A9 circuitries. In: Wolters ECh, Scheltens Ph (eds) Mental dysfunction in Parkinson’s disease. ICG Publications, Dordrecht, 49–67Google Scholar
  9. Cools R, Swainson R, Owen AM, Robbins TW (1999) Cognitive dysfunction in non-demented Parkinson’s disease. In: Wolters ECh, Scheltens Ph, Berendse H (eds) Mental dysfunction in Parkinson’s disease. APP, Utrecht, 11: 142–164Google Scholar
  10. Cooper JA, Sagar HJ, Jordan N, Harvey NS, Sullivan EV (1991) Cognitive impairment in early, untreated Parkinson’s disease and it’s relationship to motor disability. Brain 114: 2095–2122PubMedCrossRefGoogle Scholar
  11. Cummings JL (1991) Behavioral complications of drug treatment of Parkinson’s disease. J Am Geriatr Soc 39: 708–716PubMedGoogle Scholar
  12. Cummings JL (1992) Depression and Parkinson’s disease: A review. Am J Psychiatry 149: 443–454PubMedGoogle Scholar
  13. Cummings JL (1993) Frontal-subcortical circuits and human behavior. Arch Neurol 50: 873–880PubMedCrossRefGoogle Scholar
  14. Cummings JL (1994) Psychosis in basal ganglia disorders. In: Wolters ECh, Scheltens Ph (eds) Mental dysfunction in Parkinson’s disease. ICG Publications, Dordrecht, 257–268Google Scholar
  15. Dakof GA, Mendelsohn GA (1989) Patterns of adaptation to Parkinson’s disease. Health Psychol 8: 355–372PubMedCrossRefGoogle Scholar
  16. Damasio AR (1997) Neuropsychology. Towards a neuropathology of emotion and mood. Nature 386: 769–770PubMedCrossRefGoogle Scholar
  17. Dravid AR (1983) Deficits in cholinergic enzymes and muscarinic receptors in the hippo-campus and striatum of senescent rats: effect of chronic hydergine treatment. Arch Int Pharmacodyn Ther 264: 195–202PubMedGoogle Scholar
  18. Dubois B, Pillon B (1997) Cognitive deficits in Parkinson’s disease. J Neurol 244: 2–8PubMedCrossRefGoogle Scholar
  19. Gabrieli JDE, Singh J, Stebbins GT, Goetz CG (1996) Reduced working memory span in Parkinson’s disease: evidence for the role of a frontostriatal system in working and strategic memory. Neuropsychology 10: 322–332CrossRefGoogle Scholar
  20. Girotti F, Soliveri P, Carella F et al (1988) Dementia and cognitive impairment in Parkinson’s disease. J Neurol Neurosurg Psychiatry 51: 1498–1502PubMedCrossRefGoogle Scholar
  21. Goetz CG, Tanner CM, Klawans HL (1982) Pharmacology of hallucinations induced by long-term drug treatment. Am J Psychiatry 139: 494–497PubMedGoogle Scholar
  22. Goetz CG, Pappert EJ, Blasucci EJ, Blasucci LM et al (1998a) Intravenous levodopa in hallucinating Parkinson’s disease patients: high-dose challenge does not precipitate hallucinations. Neurology 50: 515–517PubMedCrossRefGoogle Scholar
  23. Goetz CG, Vogel C, Tanner CM, Stebbins GT (1998b) Early dopaminergic drug-induced hallucinations in parkinsonian patients. Neurology 51: 811–814PubMedCrossRefGoogle Scholar
  24. Graybiel AM (1997) The basal ganglia and cognitive pattern generators. Schizophr Bull 23: 459–469PubMedCrossRefGoogle Scholar
  25. Hoogendijk WJG, Sommer IEC, Tissingh G, Deeg DJH, Wolters ECh (1998) Depression in Parkinson’s disease: the impact of symptom overlap on prevalence. Psychosomatics 39: 416–421PubMedCrossRefGoogle Scholar
  26. Jellinger KA (1999) Neuropathological correlates of mental dysfunction in Parkinson’s disease: an update. In: Wolters ECh, Scheltens Ph, Berendse H (eds) Mental dysfunction in Parkinson’s disease 2. Current opinions in neurodegenerative diseases. APP, Utrecht, 11: 82–105Google Scholar
  27. Klein C, Kömpf D, Pulkowski U, Moser A, Vieregge P (1997) A study of visual hallucinations in patients with Parkinson’s disease. J Neurol 244: 371–377PubMedCrossRefGoogle Scholar
  28. Kostic VS, Filipovic SR, Lecic D, Momcilovic D, Sokic D, Sternic N (1994) Effect of age at onset on frequency of depression in Parkinson’s disease. J Neurol Neurosurg Psychiatry 57: 1265–1267PubMedCrossRefGoogle Scholar
  29. Kuzis G, Sabe L, Tiberti C, Leiguarda R, Starkstein SE (1997) Cognitive functions of major depression and Parkinson’s disease. Arch Neurol 54: 982–986PubMedCrossRefGoogle Scholar
  30. Langer KG (1994) Depression and disabling illness. Severity and patterns of self-reported symptoms in three groups. J Geriatr Psychiatry Neurol 7: 121–128PubMedGoogle Scholar
  31. Lewy FH (1923) Die Lehre vom Tonus and die der Bewegung. Springer, Berlin Lieberman AN (1997) Point of view: Dementia in Parkinson’s disease. Parkinsonism Relat Disord 3: 151–158Google Scholar
  32. McKeith IG (1998) Dementia with Lewy bodies: clinical and pathological diagnosis. Alzheimer Reports 1: 83–87Google Scholar
  33. McKeith IG (1999) Dementia with Lewy bodies. In: Wolters ECh, Scheltens Ph, Berendse H (eds), Mental dysfunction in Parkinson’s disease 2. APP, Utrecht 11: 194–208Google Scholar
  34. McKeith I, Fairbairn A, Perry R, Thompson P, Perry E (1992) Neuroleptic sensivity in patients with senile dementia of Lewy body type. Br Med J 305: 673–678CrossRefGoogle Scholar
  35. McKeith IG, Galasko D, Kosaka K et al (1996) Consensus guidelines for the clinical and pathological diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB International Workshop. Neurology 47: 1113–1124PubMedCrossRefGoogle Scholar
  36. Mjgnes H (1949) Paralysis agitans. A clinical and genetic study. Acta Psychiatr Scand S54Google Scholar
  37. Perry EK, Curtis M, Dick DJ et al (1985) Cholinergic correlates of cognitive impairment in Parkinson’s disease: comparisons with Alzheimer’s disease. J Neurol Neurosurg Psychiatr 48: 413–421PubMedCrossRefGoogle Scholar
  38. Piccirilli M, D’Alessandro P, Finali G, Piccinin G (1997) Early frontal impairment as a predictor of dementia in Parkinson’s disease [letter]. Neurology 48: 546–547PubMedCrossRefGoogle Scholar
  39. Ring HA, Bench CJ, Trimble MR, Brooks DJ, Frackowiak SJ, Dolan RJ (1994) Depres-sion in Parkinson’s disease: a positron emission study. Br J Psychiatry 165: 333–339PubMedCrossRefGoogle Scholar
  40. Seiler S, Perleth D, Gasser T, Ulm G, Oertel WH, Ellging H (1992) Partnership and depression in Parkinson’s disease. Behav Neurol 5: 75–78Google Scholar
  41. Shea C, Macknight C, Rockwood R (1998) Donepezil for treatment of dementia with Lewy bodies: a case series of nine patients. Int Psychogeriatrics 10: 229–239CrossRefGoogle Scholar
  42. Starkstein SE, Preziosi TJ, Bolduc PL, Robinson RG (1990) Depression in Parkinson’s disease. J Nery Ment Dis 178: 27–31CrossRefGoogle Scholar
  43. Stephens DA (1967) Psychotoxic effects of benzhexol hydrochloride (Artane). Br J Psychiatry 113: 213–218PubMedCrossRefGoogle Scholar
  44. Svensson TH, Mathe JM, Andersson JL, Nomikos GG, Hildebrand BE, Marcus M (1995) Mode of action of atypical neuroleptics in relation to the phencyclidine model of schizophrenia: role of 5-HT2 receptor and alpha 1-adrenoceptor antagonism. J Clin Psychopharmacol 15(S1): 11S–18SPubMedCrossRefGoogle Scholar
  45. Tandberg E, Larsen JP, Aarsland D, Cummings JL (1996) The occurrence of depression in Parkinson’s disease. Arch Neurol 53: 175–179PubMedCrossRefGoogle Scholar
  46. Taylor AE, Saint-Cyr JA, Lang AE (1986) Frontal lobe dysfunction in Parkinson’s disease: the cortical focus of neostriatal outflow. Brain 109: 845–883PubMedCrossRefGoogle Scholar
  47. Van Praag HM (1994) Serotonin and affective psychopathology in Parkinson’s disease. A psychobiological hypothesis with therapeutic consequences. In: Wolters ECh, Scheltens Ph (eds) Mental dysfunction in Parkinson’s disease. ICG Publications, Dordrecht, 335–348Google Scholar
  48. Wolters ECh, Francot CMJE (1998) Mental dysfunction in Parkinson’s disease. Parkinsonism Relat Disord 4: 107–112PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2000

Authors and Affiliations

  • E. Ch. Wolters
    • 1
  1. 1.Graduate School of Neurosciences, Department of Neurology, University of AmsterdamAmsterdam,Netherlands

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