Abstract

Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disease characterized by bradykinesia, tremor and/ or rigidity, often with gait disturbance and postural instability.

In addition to these typical features, patients with PD may experience further problems related to the disease itself or to the medications used to treat it. These comorbid problems include neuropsychiatric conditions (including psychosis, hallucinations, excessive daytime sleepiness, anxiety, depression, fatigue and dementia) as well as problems associated with autonomic nervous system function such as bowel and bladder function. PD can also present in emergency situations with a ‘neuroleptic malignant like picture’ and acute psychosis. It is not uncommon to see motor fluctuations due to drug interactions and ‘withdrawal’ symptoms following dose reduction of dopamine agonists.

In patients with PD, disturbances of mental state constitute some of the most difficult treatment challenges of advanced disease, often limiting effective treatment of motor symptoms and leading to increased disability and poor quality of life. While some of these symptoms may be alleviated by antiparkinsonian medication, especially if they are ‘off-period’ related, treatment-related phenomena are usually exacerbated by increasing the number or dosage of antiparkinsonian drugs. Elimination of exacerbating factors and simplification of drug regimens are the first and most important steps in improvement of such symptoms.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Wood BH, Bilclough JA, Bowron A, et al.Incidence and prediction of falls in Parkinson’s disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry 2002; 72(6): 721–725.
2. Michałowska M, Fiszer U, Krygowska-Wajs A, et al. Falls in Parkinson’s disease: causes and impact on patients’ quality of life. Funct Neurol 2005; 20(4):163–168.
3. Pickering RM, Grimbergen YAM, Rigney U, et al. Ametaanalysis of six prospective studiesof falling in Parkinson’s disease. Mov Disord 2007; 22(13):1892–1900.
4. Global Parkinson’s Disease Survey Steering Committee. Factors impacting on quality of life in Parkinson’s disease: results from an international survey. Mov Disord 2002; 17: 60–67
5. Ahlskog JE, Muenter MD. Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord 2001; 16(3): 448–458.
6. Factor SA, Molho ES. Emergency department presentations of patients with Parkinson’s disease. Am J Emerg Med 2000; 18(2):209–215.
7. Weiner WJ, Goetz CG, Nausieda PA, et al. Respiratory dyskinesias: extrapyramidal dysfunction and dyspnea. Ann Intern Med 1978; 88:327–31.
8. Pahwa R, Factor SA, Lyons KE, et al. Practice parameter: treatment of Parkinson disease motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66: 983–95.
9. Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985 Oct; 142(10):1137–45.
10. Takubo H, Harada T, Hashimoto T, et al. A collaborative study on the malignant syndrome in Parkinson’s disease and related disorders. Parkinsonism Relat Disord 2003; S31-41.
11. Factor SA. Fatal Parkinsonism-hyperpyrexia syndrome in a Parkinson’s disease patient while actively treated with deep brain stimulation. Mov Disord 2007; 22(1): 148–149.
12. Movement Disorders Task Force (2002) Treatment of depression in idiopathic Parkinson’s disease. Mov Disord 17: 112–119.
13. Mills KC. Serotonin syndrome: a clinical update. Crit Care Clin 1997; 13(4): 763–783.
14. Mason PJ, Morris VA, Balcezak TJ. Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine 2000; 79: 201–9.
15. Aarsland D, Larsen JP, Tandberg E, et al. Predictors of nursing home placement in Parkinson’s disease: a population-based, prospective study. J Am Geriatr Soc 2000; 48(8): 938–942.
16. Mosimann UP, Rowan EN, Partington CE, et al. Characteristics of visual hallucinations in Parkinson disease dementia and dementia with Lewy bodies. Am J Geriatr Psychiatry 2006; 14(2):153–160.
17. Miyasaki JM, Shannon K, Voon V, et al. Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence based review). Report of the Quality Standards Subcommittee of the American Academy
    of Neurology. Neurology 2006; 66(7): 996–1002.
18. Anette Schrag. Psychiatric aspects of Parkinson’s disease, An Update. J Neurol 2004; 251: 795–804.
19. 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.
20. Giovannoni G, O’Sullivan JD, Turner K, Lees AJ (2000) Hedonistic homeostatic dysregulation in patients with Parkinson’s disease on dopamine replacement therapies. J Neurol Neurosurg Psychiatry 68: 423–428.
21. Rabinak CA, Nirenberg MJ. Dopamine agonist withdrawal syndrome in Parkinson’s disease. Arch Neurol 2010; 67(1): 58–63.
22. Giladi N, Treves TA, Paleacu D, et al. Risk factors for dementia, depression and psychosis in long-standing Parkinson’s disease. J Neural Transm 2000; 107: 59–71.
23. Frankel JP, Lees AJ, Kempster PA, et al. Subcutaneous apomorphine in the treatment of Parkinson’s disease. J Neurol Neurosurg Psychiatry 1990; 53: 96–101.
24. Leo RJ. Movement disorders associated with the serotonin selective reuptake inhibitors. J Clin Psychiatry 1996; 57(10): 449.
25. Hughes AJ, Daniel SE, Kilford L, et al. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease. A clinico-pathological study of 100 cases. JNNP 1992; 55: 181–184.