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Treatment of behavioural disturbances in Parkinson’s disease

  • Conference paper
Dementia in Parkinsonism

Part of the book series: Journal of Neural Transmission. Supplementa ((NEURAL SUPPL,volume 51))

Summary

Behavioural disorders in Parkinson’s disease can grossly be subdivided in primary disturbances and those which are related to drug treatment.

Depression and anxiety are a common feature in parkinsonian patients. Both occur independently of drug treatment. In general, most current antide­pressive and anxiolytic drugs could be administered in Parkinson’s disease with the same precautions as in the normal population. However, in single case reports modern serotonin reuptake blockers in Parkinson’s disease have been accused to worsen parkinsonian motor condition. Combinations of serotonin reuptake inhibitors with MAO-inhibitors like selegiline should be used with caution.

In the case of cognitive decline firstly an underlying depression should be disclosed or if existent be treated. Depression seems to be the single most important factor associated with the severity of dementia and early antidepressant treatment seems to decrease cognitive decline in depressed parkinsonian patients. Anticholinergic medications should be discontinued since they may cause mental side effects.

Sleep disorders in Parkinson’s disease are mainly caused by nocturnal akinesia, which causes sleep fragmentation or altered dreaming and nightmares, which might be a side-effect of dopaminergic treatment. In the first case the administration of a controlled release preparation of levodopa at bedtime may be indicated. If the sleep disorder is considered to be due to dopaminergic medication, a reduction of long-term acting agents like modern dopamine agonists and controlled-release levodopa should be considered.

In severe psychotic states related to drug treatment antiparkinsonian therapy must be carefully analysed and, if possible, reduced. If motor condition worsens and/or psychiatric symptoms do not improve, initiation with “atypical” neuroleptics like clozapine is indicated. The pharmacological and clinical properties of new antipsychotic drugs that can be used in Parkinson’s disease are revised.

Supported by a Feodor-Lynen Fellowship from the Alexander von Humboldt-Stiftung, Bonn, Federal Republic of Germany

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Authors and Affiliations

  1. Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic i Provincial de Barcelona, Institut Pi Sunyer, University of Barcelona, Spain

    F. Valldeoriola, F. A. Nobbe & E. Tolosa

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  1. F. Valldeoriola
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  2. F. A. Nobbe
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  3. E. Tolosa
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Editors and Affiliations

  1. Parkinson’s Disease Society Brain Research Centre (Brain Bank), Institute of Neurology, London, UK

    S. E. Daniel  & A. J. Lees  & 

  2. Neurological Tissue Bank, Hospital Clinic, University of Barcelona, Spain

    F. F. Cruz-Sánchez

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Valldeoriola, F., Nobbe, F.A., Tolosa, E. (1997). Treatment of behavioural disturbances in Parkinson’s disease. In: Daniel, S.E., Cruz-Sánchez, F.F., Lees, A.J. (eds) Dementia in Parkinsonism. Journal of Neural Transmission. Supplementa, vol 51. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6846-2_15

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