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Dernbach MR, Carpenter JE. Case Files of the Emory University Medical Toxicology Fellowship: A Patient Presents to the Outpatient Toxicology Clinic with Delusions of Being Poisoned. J Med Toxicol 2024; 20:233-244. [PMID: 38378951 PMCID: PMC10959915 DOI: 10.1007/s13181-024-00995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Matthew Robert Dernbach
- Department of Emergency Medicine, Emory University, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA.
- Georgia Poison Center, Atlanta, GA, USA.
| | - Joseph E Carpenter
- Department of Emergency Medicine, Emory University, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA
- Georgia Poison Center, Atlanta, GA, USA
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2
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Pagonabarraga J, Bejr-Kasem H, Martinez-Horta S, Kulisevsky J. Parkinson disease psychosis: from phenomenology to neurobiological mechanisms. Nat Rev Neurol 2024; 20:135-150. [PMID: 38225264 DOI: 10.1038/s41582-023-00918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/17/2024]
Abstract
Parkinson disease (PD) psychosis (PDP) is a spectrum of illusions, hallucinations and delusions that are associated with PD throughout its disease course. Psychotic phenomena can manifest from the earliest stages of PD and might follow a continuum from minor hallucinations to structured hallucinations and delusions. Initially, PDP was considered to be a complication associated with dopaminergic drug use. However, subsequent research has provided evidence that PDP arises from the progression of brain alterations caused by PD itself, coupled with the use of dopaminergic drugs. The combined dysfunction of attentional control systems, sensory processing, limbic structures, the default mode network and thalamocortical connections provides a conceptual framework to explain how new incoming stimuli are incorrectly categorized, and how aberrant hierarchical predictive processing can produce false percepts that intrude into the stream of consciousness. The past decade has seen the publication of new data on the phenomenology and neurobiological basis of PDP from the initial stages of the disease, as well as the neurotransmitter systems involved in PDP initiation and progression. In this Review, we discuss the latest clinical, neuroimaging and neurochemical evidence that could aid early identification of psychotic phenomena in PD and inform the discovery of new therapeutic targets and strategies.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - Helena Bejr-Kasem
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Saul Martinez-Horta
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Mangone G, Tosin MHS, Goetz CG, Stebbins GT, Mestre TA. Unveiling Assessment Gaps in Parkinson's Disease Psychosis: A Scoping Review. Mov Disord 2024; 39:560-570. [PMID: 38291860 DOI: 10.1002/mds.29710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Parkinson's disease psychosis (PDP) is a multidimensional construct that is challenging to measure. Accurate assessment of PDP requires comprehensive and reliable clinical outcome assessment (COA) measures. OBJECTIVE To identify PDP measurement gaps in available COAs currently used in clinical and research settings. METHODS We conducted a scoping review using Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. We implemented a three-step search strategy in international databases with keywords related to Parkinson's disease (PD), psychosis, and COA. We analyzed studies using COA to assess PDP, classifying their items according to domains and subdomains. RESULTS From 5673 identified studies, we included 628 containing 432 PDP core items from 32 COAs. Among the 32 COAs, 19 were PD-specific, containing 266 items, constructed as clinician-reported outcomes (ClinRO) (148 items), patient-reported outcomes (PRO) (112 items), and observer-reported outcomes (ObsRO) (six items). Across all PD-specific COAs, regardless of structure, 89.4% of the items from 27 COAs focused primarily on assessing PDP symptoms' severity, and only 9.7% of items probed the impact of PDP on a person's daily functioning. CONCLUSIONS Symptom-based domains are currently prioritized for measuring the severity of PDP, with limited coverage of the functional impact of PDP on patients' lives. Whereas the International Parkinson and Movement Disorder Society has traditionally developed a "Unified" COA that culls items from prior COAs to form a new one, a new COA will largely need newly developed items if the functional impact of PDP is prioritized. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Graziella Mangone
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurology, Centre d'Investigation Clinique Neurosciences, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Parkinson's Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Michelle H S Tosin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Tiago A Mestre
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Paris, France
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4
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Partinen E, Ylikoski A, Sieminski M, Partinen M. Impact of REM Sleep Behavior and Sleep Talking on Mortality in Parkinson's Disease. Cureus 2024; 16:e52565. [PMID: 38249652 PMCID: PMC10800163 DOI: 10.7759/cureus.52565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Background REM sleep behavior disorder (RBD) is a prodromal marker for Parkinson's disease (PD) and other alpha-synucleinopathies. Sleep talking (ST) is an isolated symptom and is frequent in PD and RBD. Here, we investigate the associations of ST and RBD with the mortality of PD patients. Patients and methods A total of 1,500 PD patients were randomly selected from the registry of the Finnish Parkinson's Association. Of the 855 that participated at baseline, 645 gave permission for follow-up studies. We gathered a completely filled sleep questionnaire and mortality information from 384 subjects. The Nelson-Aalen test and Cox hazard ratios (HR) were used for mortality analyses. Results The mean follow-up time was 4.3 years (0.3-7.0). PD patients with RBD or frequent ST had more non-motor symptoms. Depression, hallucinations, constipation, and excessive daytime sleepiness were more prevalent among subjects with RBD. Subjects with RBD and frequent ST (talking in their sleep ≥ once per week) had increased mortality (HR: 1.90, 95% CI: 1.18-3.06). RBD without frequent ST was not associated with mortality (HR: 0.77, 95% CI: 0.4-1.5). Frequent ST was associated with increased mortality when adjusted for age, PD duration, depression, gender, RBD, BMI, and hallucinations (HR: 2.22, 95% CI: 1.10-4.51). Additionally, age, duration of PD, arterial hypertension, and lower BMI were associated with increased mortality. Male gender, dopaminergic medication, depression, and hallucinations were not significantly associated with mortality. Conclusions RBD with frequent ST and ST alone appear to be risk factors for mortality in PD. Frequent ST may be a sign representing wider neurodegeneration. RBD subjects and frequent sleep talkers demonstrated more non-motor symptoms compared to PD without RBD or ST. Our findings have clinical implications. It remains to be seen if frequent ST indicates a poorer prognosis. Prospective studies are needed to find whether frequent ST is also a risk factor for developing PD.
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Affiliation(s)
- Eemil Partinen
- Department of Neurology, University of Helsinki, Helsinki, FIN
- Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, FIN
| | - Ari Ylikoski
- Department of Neurology, Social Insurance Institution of Finland (KELA), Helsinki, FIN
| | | | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, FIN
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, FIN
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Foley JA, Chen C, Paget A, Cipolotti L. A Bayesian predictive processing account of Othello syndrome in Parkinson's disease. Cogn Neuropsychiatry 2023; 28:269-284. [PMID: 37366042 DOI: 10.1080/13546805.2023.2229080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 03/24/2023] [Indexed: 06/28/2023]
Abstract
Introduction: Although delusions in Parkinson's disease (PD) are rare, when they occur they frequently take the form of "Othello syndrome": the irrational belief that a spouse or partner is being unfaithful. Hitherto dismissed as either a by-product of dopamine therapy or cognitive impairment, there are still no convincing theoretical accounts to explain why only some patients fall prey to this delusion, or why it persists despite clear disconfirmatory evidence.Methods: We discuss the limitations of existing explanations of this delusion, namely hyperdopaminergia-induced anomalous perceptual experiences and cognitive impairment, before describing how Bayesian predictive processing accounts can provide a more comprehensive explanation by foregrounding the importance of prior experience and its impact upon computation of probability. We illustrate this new conceptualisation with three case vignettes.Results: We suggest that in those with prior experience of romantic betrayal, hyperdominergic-induced aberrant prediction errors enable anomalous perceptual experiences to accrue greater prominence, which is then maintained through Bayes-optimal inferencing to confirm cognitive distortions, eliciting and shaping this dangerous delusion.Conclusions: We propose the first comprehensive mechanistic account of Othello syndrome in PD and discuss implications for clinical interventions.
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Affiliation(s)
- Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Cliff Chen
- Department of Clinical Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Andrew Paget
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
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Collerton D, Barnes J, Diederich NJ, Dudley R, Ffytche D, Friston K, Goetz CG, Goldman JG, Jardri R, Kulisevsky J, Lewis SJG, Nara S, O'Callaghan C, Onofrj M, Pagonabarraga J, Parr T, Shine JM, Stebbins G, Taylor JP, Tsuda I, Weil RS. Understanding visual hallucinations: a new synthesis. Neurosci Biobehav Rev 2023; 150:105208. [PMID: 37141962 DOI: 10.1016/j.neubiorev.2023.105208] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023]
Abstract
Despite decades of research, we do not definitively know how people sometimes see things that are not there. Eight models of complex visual hallucinations have been published since 2000, including Deafferentation, Reality Monitoring, Perception and Attention Deficit, Activation, Input, and Modulation, Hodological, Attentional Networks, Active inference, and Thalamocortical Dysrhythmia Default Mode Network Decoupling. Each was derived from different understandings of brain organisation. To reduce this variability, representatives from each research group agreed an integrated Visual Hallucination Framework that is consistent with current theories of veridical and hallucinatory vision. The Framework delineates cognitive systems relevant to hallucinations. It allows a systematic, consistent, investigation of relationships between the phenomenology of visual hallucinations and changes in underpinning cognitive structures. The episodic nature of hallucinations highlights separate factors associated with the onset, persistence, and end of specific hallucinations suggesting a complex relationship between state and trait markers of hallucination risk. In addition to a harmonised interpretation of existing evidence, the Framework highlights new avenues of research, and potentially, new approaches to treating distressing hallucinations.
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Affiliation(s)
- Daniel Collerton
- School of Psychology, Faculty of Medical Sciences, Third Floor, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL UK.
| | - James Barnes
- Fatima College of Health Sciences, Department of Psychology, Al Mafraq, Abu Dhabi, UAE.
| | - Nico J Diederich
- Department of Neurology, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210 Luxembourg-City, Luxembourg.
| | - Rob Dudley
- Department of Psychology, University of York, York, YO10 5DD, UK.
| | - Dominic Ffytche
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, de Crespigny Park, London, SE5 8AF, UK.
| | - Karl Friston
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR.
| | - Christopher G Goetz
- Rush University Medical Center, Suite 755, 1725 W Harrison St, Chicago IL 60612 USA.
| | - Jennifer G Goldman
- Departments of Physical Medicine and Rehabilitation and Neurology; Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders; Feinberg School of Medicine Northwestern University, 355 E. Erie Street, Chicago, IL 60611 USA.
| | - Renaud Jardri
- Lille University, INSERM U-1172, Centre Lille Neuroscience & Cognition, CURE platform, Fontan Hospital, CHU Lille, France.
| | - Jaime Kulisevsky
- Movement Disorders Unit, Sant Pau Hospital, Hospital Sant Pau. C/ Mas Casanovas 90. Barcelona (08041) and Universitat Autònoma de Barcelona; CIBERNED (Network Centre for Neurodegenerative Diseases), Spain.
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Shigetoshi Nara
- Dept. Electrical & Electronic Engineering, Okayama University, Tsushima-naka, 3-1-1, Okayama 700-8530, Japan.
| | - Claire O'Callaghan
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Marco Onofrj
- Clinica Neurologica, Department of Neuroscience, Imaging and Clinical Science, University "G.d'Annunzio" of Chieti-Pescara, via Polacchi 39,66100, Chieti, Italy.
| | - Javier Pagonabarraga
- Movement Disorders Unit, Sant Pau Hospital, Hospital Sant Pau. C/ Mas Casanovas 90. Barcelona (08041) and Universitat Autònoma de Barcelona; CIBERNED (Network Centre for Neurodegenerative Diseases), Spain.
| | - Thomas Parr
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR.
| | - James M Shine
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Glenn Stebbins
- Rush University Medical Center, Suite 755, 1725 W Harrison St, Chicago IL 60612 USA.
| | - John-Paul Taylor
- Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle University NE4 5PL, UK.
| | - Ichiro Tsuda
- Chubu University Academy of Emerging Sciences and Center for Mathematical Science and Artificial Intelligence, Chubu University, Kasugai, Aichi 487-8501, Japan.
| | - Rimona S Weil
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR; Dementia Research Centre; Movement Disorders Centre, University College London, London, WC1N 3BG UK.
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7
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Non-visual hallucinations in Parkinson's disease: a systematic review. J Neurol 2023; 270:2857-2889. [PMID: 36702960 DOI: 10.1007/s00415-022-11545-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Non-visual hallucinations in Parkinson's disease (PD) can be prevalent and distressing. Most existing research has however, focused on visual hallucinations as well as related risk factors. The current study thus conducted a systematic review to collate existing evidence on non-visual hallucinations in PD, focusing on their prevalence, phenomenology, and clinical-cognitive correlates. METHODS Ninety-one relevant studies were included from a systematic search across PsycINFO APA, PubMed, and Web of Science, for peer-reviewed publications in the English language, from 1970 to the present. These comprised a mix of case (30 studies; n = 56) and group design (62 studies; n = 7346) studies, divided into three somewhat overlapping collections to address our three research foci. RESULTS Prevalence estimates for hallucinations were: auditory 1.5-72.0%, olfactory 1.6-21.0%, somatic-tactile 0.4-22.5%, gustatory 1.0-15.0%, and sensed presence 0.9-73.3%. Phenomenological inquiries revealed descriptions of vivid, consuming events replete with elaborate detail, adversely affecting PD patients in different ways. Overt experiences of multisensory hallucinations were also highly variable (0.4-80%) but exceedingly common, reported by almost half of the 45 included prevalence studies. There was some evidence for modality-specific hallucination predictors, but this was largely tentative, pending robust replication. CONCLUSIONS Marked prevalence figures coupled with phenomenological descriptions implicating distress denote that non-visual and multisensory hallucinations in PD are of clinical significance. More direct research and clinical attention need to be devoted to the study and management of such hallucinatory experiences.
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Mok VWL, Chan LG, Goh JCB, Tan LCS. Psychosis in Parkinson's disease in a Southeast Asian cohort: prevalence and clinical correlates. Singapore Med J 2022; 63:702-708. [PMID: 34911181 PMCID: PMC9875879 DOI: 10.11622/smedj.2021182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction Psychosis is a prominent neuropsychiatric symptom of Parkinson's disease (PD) and is associated with negative outcomes, such as poorer quality of life and greater rate of functional impairment. Early identification of patients with PD at risk of developing psychosis facilitates appropriate management to improve outcomes. However, this phenomenon has not been examined locally. This study aimed to examine the prevalence of PD-associated psychosis in the local setting, identify any associated risk factors, as well as characterise the cognitive trajectory of patients with PD with psychosis. Methods A retrospective cohort of 336 patients with PD, who presented to the National Neuroscience Institute, Singapore, in 2006 and 2007 and attended follow-up visits through to 2013 was analysed. The data analysed included scores from clinician assessments of cognitive function, disease severity and presence of psychotic symptoms, conducted when clinically appropriate during patients' medical visits. Survival analysis and logistic and linear regression analysis were performed. Results Psychosis was diagnosed in 63 patients with PD, indicating a prevalence of 18.8% for PD-associated psychosis. Incidence of psychosis in PD was calculated to be 40 per 1,000 person-years. No significant association was found between demographic variables and the odds of developing psychosis in PD. Regression analyses found that the presence of psychosis significantly predicted greater cognitive decline and disease severity. Conclusion Psychosis has a significant presence among the PD population in Singapore, possibly serving as an indicator of more rapid cognitive decline and progression of PD severity.
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Affiliation(s)
| | - Lai Gwen Chan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Louis Chew Seng Tan
- Research; Department of Neurology, National Neuroscience Institute, Singapore
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9
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Komagamine T, Suzuki K, Kokubun N, Komagamine J, Kawasaki A, Funakoshi K, Hirata K. Sleep-related hallucinations in patients with Parkinson's disease. PLoS One 2022; 17:e0276736. [PMID: 36282859 PMCID: PMC9595548 DOI: 10.1371/journal.pone.0276736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
Given that sleep-wake cycle dysfunction can cause hallucinations in Parkinson's disease patients, sleep-related hallucinations may be a different subtype from hallucinations that occur only during full wakefulness. However, few studies that distinguish the onset situations of hallucinations related to sleep from those that occur in full wakefulness have been conducted to investigate hallucinations in Parkinson's disease patients. Therefore, we conducted a multicenter observational study to investigate the prevalence of and factors associated with sleep-related hallucinations in patients with Parkinson's disease. Information on hallucinations was collected by using a questionnaire and face-to-face interviews. Of 100 consecutive patients with Parkinson's disease, 29 (29%) reported sleep-related hallucinations, and 16 (16%) reported hallucinations only in the full wakefulness. A longer duration of Parkinson's disease treatment (OR 1.35, 95% CI 1.07 to 1.72), higher Beck Depression Inventory-II scores (OR 1.07; 95% CI 1.01 to 1.14), and higher rapid eye movement sleep behavior disorder scores (OR 5.60; 95% CI 1.54 to 20.38) were independent factors associated with the presence of sleep-related hallucinations in a multivariable analysis. Sleep-related hallucinations, but not daytime hallucinations, were associated with probable rapid eye movement sleep behavior disorder. Phenomenological discrimination between sleep-related hallucinations and daytime hallucinations is important for elucidating the full pathology in Parkinson's disease and the mechanisms underlying hallucinations.
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Affiliation(s)
- Tomoko Komagamine
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Norito Kokubun
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Junpei Komagamine
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
| | - Akiko Kawasaki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Kei Funakoshi
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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10
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Mehraram R, Peraza LR, Murphy NRE, Cromarty RA, Graziadio S, O'Brien JT, Killen A, Colloby SJ, Firbank M, Su L, Collerton D, Taylor JP, Kaiser M. Functional and structural brain network correlates of visual hallucinations in Lewy body dementia. Brain 2022; 145:2190-2205. [PMID: 35262667 PMCID: PMC9246710 DOI: 10.1093/brain/awac094] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 12/02/2022] Open
Abstract
Visual hallucinations are a common feature of Lewy body dementia. Previous studies have shown that visual hallucinations are highly specific in differentiating Lewy body dementia from Alzheimer’s disease dementia and Alzheimer–Lewy body mixed pathology cases. Computational models propose that impairment of visual and attentional networks is aetiologically key to the manifestation of visual hallucinations symptomatology. However, there is still a lack of experimental evidence on functional and structural brain network abnormalities associated with visual hallucinations in Lewy body dementia. We used EEG source localization and network based statistics to assess differential topographical patterns in Lewy body dementia between 25 participants with visual hallucinations and 17 participants without hallucinations. Diffusion tensor imaging was used to assess structural connectivity between thalamus, basal forebrain and cortical regions belonging to the functionally affected network component in the hallucinating group, as assessed with network based statistics. The number of white matter streamlines within the cortex and between subcortical and cortical regions was compared between hallucinating and not hallucinating groups and correlated with average EEG source connectivity of the affected subnetwork. Moreover, modular organization of the EEG source network was obtained, compared between groups and tested for correlation with structural connectivity. Network analysis showed that compared to non-hallucinating patients, those with hallucinations feature consistent weakened connectivity within the visual ventral network, and between this network and default mode and ventral attentional networks, but not between or within attentional networks. The occipital lobe was the most functionally disconnected region. Structural analysis yielded significantly affected white matter streamlines connecting the cortical regions to the nucleus basalis of Meynert and the thalamus in hallucinating compared to not hallucinating patients. The number of streamlines in the tract between the basal forebrain and the cortex correlated with cortical functional connectivity in non-hallucinating patients, while a correlation emerged for the white matter streamlines connecting the functionally affected cortical regions in the hallucinating group. This study proposes, for the first time, differential functional networks between hallucinating and not hallucinating Lewy body dementia patients, and provides empirical evidence for existing models of visual hallucinations. Specifically, the outcome of the present study shows that the hallucinating condition is associated with functional network segregation in Lewy body dementia and supports the involvement of the cholinergic system as proposed in the current literature.
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Affiliation(s)
- Ramtin Mehraram
- Experimental Oto-rhino-laryngology (ExpORL) Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium.,NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nicholas R E Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.,The Menninger Clinic, Houston, TX, 77035, USA.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sara Graziadio
- NIHR Newcastle in vitro Diagnostics Cooperative, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alison Killen
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sean J Colloby
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Li Su
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK.,Department of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Daniel Collerton
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Abstract
Cognitive impairment affects up to 80% of patients with Parkinson's disease (PD) and is associated with poor quality of life. PD cognitive dysfunction includes poor working memory, impairments in executive function and difficulty in set-shifting. The pathophysiology underlying cognitive impairment in PD is still poorly understood, but there is evidence to support involvements of the cholinergic, dopaminergic, and noradrenergic systems. Only rivastigmine, an acetyl- and butyrylcholinesterase inhibitor, is efficacious for the treatment of PD dementia, which limits management of cognitive impairment in PD. Whereas the role of the serotonergic system in PD cognition is less understood, through its interactions with other neurotransmitters systems, namely, the cholinergic system, it may be implicated in cognitive processes. In this chapter, we provide an overview of the pharmacological, clinical and pathological evidence that implicates the serotonergic system in mediating cognition in PD.
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12
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Fry A, Singh D, Manganas L, Gordon ML, Christodoulou C, Leung HC, Schwartz GJ. Parkinson's Disease With Visual Hallucinations Is Associated With Epileptiform Activity on EEG. Front Neurol 2022; 12:788632. [PMID: 35087470 PMCID: PMC8787040 DOI: 10.3389/fneur.2021.788632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Visual hallucinations (VHs) in Parkinson's disease (PD) are the cardinal symptoms which declare the onset of PD psychosis (PDP). The anthropomorphic and zoomorphic VHs of PD resemble those of Charles Bonnet syndrome and temporal lobe epilepsy. In both of these disorders electroencephalography (EEG) abnormalities have been described. We therefore sought to examine whether VHs in PD were associated with similar EEG abnormalities. Methods: This retrospective observational study searched the medical records of 300 PD patients and filtered for those containing clinical 20-min scalp EEGs. Remaining records were separated into two groups: patients with reported VHs and those without. The prevalence of epileptiform discharges in the EEGs of both groups was identified. Results: Epileptiform discharges were present in 5 of 13 (38.5%) PD patients with VHs; all localized to the temporal lobe. No epileptiform discharges were observed in the EEGs of the 31 PD patients without VHs. Conclusion: The significantly high incidence of temporal lobe epileptiform discharges in PD patients with VHs as compared to those without VHs lends to the possibility of an association visual cortex epileptogenic focus. Accordingly, for treatment-refractory patients, antiepileptic drugs might be considered, as in the case of Charles Bonnet syndrome, temporal lobe epilepsy and migraine with visual aura. Future prospective studies involving larger samples and multi-center cohorts are required to validate these observational findings.
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Affiliation(s)
- Adam Fry
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dharampreet Singh
- Department of Neurology, Renaissance School of Medicine at Stony Brook University, New York, NY, United States.,Department of Neurology, Joan C. Edwards School of Medicine at Marshall University, Huntington, WV, United States
| | - Louis Manganas
- Department of Neurology, Renaissance School of Medicine at Stony Brook University, New York, NY, United States
| | - Marc L Gordon
- The Litwin-Zucker Research Center, The Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States.,Departments of Neurology and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States
| | - Christopher Christodoulou
- Department of Neuropsychology, Renaissance School of Medicine at Stony Brook University, New York, NY, United States
| | - Hoi-Chung Leung
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Guy J Schwartz
- Department of Neurology, Renaissance School of Medicine at Stony Brook University, New York, NY, United States
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13
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Chendo I, Fabbri M, Godinho C, Moiron Simões R, Severiano Sousa C, Coelho M, Voon V, Ferreira JJ. High frequency of psychosis in late-stage Parkinsońs disease. Clin Park Relat Disord 2022; 5:100119. [PMID: 34988427 PMCID: PMC8710406 DOI: 10.1016/j.prdoa.2021.100119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 12/31/2022] Open
Abstract
55.4% of late-stage Parkinsońs disease (LSPD) patients have psychotic symptoms. 72.5% of LSPD patients present a comorbid psychiatric diagnosis. Clinical diagnostic interview increases detection of psychosis.
Background Psychosis is a frequent non-motor symptom in Parkinson’s disease (PD). Estimates of the frequency of Parkinsońs disease psychosis (PDP) vary widely. Knowledge about the frequency and phenomenology of psychosis in late-stage (LS) PD patients is limited. This study aimed to determine the frequency of psychosis in LSPD patients through clinical diagnostic interview (CDI) (gold standard), according to NINDS/NIMH diagnostic criteria for PDP. The secondary objectives were to characterize the phenomenology, to test selected instruments and assess their adequacy in comparison to CDI, and to assess the psychiatric comorbidities. Methods A cross-sectional study including LSPD patients (patients with ≥ 7 years from symptoms onset and Hoehn and Yahr scale score > 3 or a Schwab and England scale score < 50% in the ON condition) was conducted. Patients were subjected to psychiatric, neurological, and neuropsychological evaluations. Each patient was interviewed by a psychiatrist who performed a CDI. Results 92 LSPD patients were included. 55.4% experienced psychotic symptoms according to NINDS/NIMH diagnostic criteria for PDP. Hallucinations were present in 94.1% and delusions in 29.4% of the psychotic patients. Visual hallucinations were the most common (88.23%) psychotic symptom. 72.5% of LSPD patients with psychotic symptoms had at least one comorbid psychiatric diagnosis. Lower frequency of psychosis was found when the assessment was performed only through selected instruments rather than CDI. Conclusions A high frequency (55.4%) of psychotic symptoms and comorbid psychiatric (72.5%) diagnosis were found in LSPD patients. The use of CDI, in addition to structured scales may increase the sensitivity of detecting psychotic symptoms.
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Affiliation(s)
- Inês Chendo
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal.,Clínica Universitária de Psiquiatria e de Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Margherita Fabbri
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France
| | - Catarina Godinho
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC) do Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Almada, Portugal
| | - Rita Moiron Simões
- CNS - Campus Neurológico, Torres Vedras, Portugal.,Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Severiano Sousa
- Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Miguel Coelho
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Neurology Service, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Joaquim J Ferreira
- CNS - Campus Neurológico, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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14
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Dixon E, Anderson J, Lazar A. Understanding How Sensory Changes Experienced by Individuals with a Range of Age-Related Cognitive Changes Can Effect Technology Use. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2022; 15:10.1145/3511906. [PMID: 35919105 PMCID: PMC9340800 DOI: 10.1145/3511906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/01/2022] [Indexed: 10/18/2022]
Abstract
Clinical researchers have identified sensory changes people with age-related cognitive changes, such as dementia and mild cognitive impairment, experience that are different from typical age-related sensory changes. Technology designers and researchers do not yet have an understanding of how these unique sensory changes affect technology use. This work begins to bridge the gap between the clinical knowledge of sensory changes and technology research and design through interviews with people with mild to moderate dementia, mild cognitive impairment, subjective cognitive decline, and healthcare professionals. This extended version of our ASSETS conference paper includes people with a range of age-related cognitive changes describing changes in vision, hearing, speech, dexterity, proprioception, and smell. We discuss each of these sensory changes and ways to leverage optimal modes of sensory interaction for accessible technology use with existing and emerging technologies. Finally, we discuss how accessible sensory stimulation may change across the spectrum of age-related cognitive changes.
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Affiliation(s)
- Emma Dixon
- University of Maryland, College Park, Maryland, USA
| | | | - Amanda Lazar
- University of Maryland, College Park, Maryland, USA
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15
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Stang CD, Mullan AF, Camerucci E, Hajeb M, Turcano P, Martin P, Mielke MM, Josephs KA, Splett M, Abler V, Boeve BF, Bower JH, Savica R. Incidence, Prevalence, and Mortality of Psychosis Associated with Parkinson's Disease (1991-2010). JOURNAL OF PARKINSON'S DISEASE 2022; 12:1319-1327. [PMID: 35213389 PMCID: PMC9336204 DOI: 10.3233/jpd-213035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Parkinson's disease (PD)-associated psychosis is a well-known non-motor complication, occurring years after diagnosis of PD. Incidence data vary across different studies highlighting a need for long-term observation and clinical definition. OBJECTIVE To determine the incidence of psychosis in patients with PD and to investigate their survival in an incident cohort study from 1991-2010 in Olmsted County, MN. METHODS We used the Rochester Epidemiology Project to define an incident-cohort study of parkinsonism (1991-2010) in Olmsted County, MN. A movement-disorder specialist reviewed the electronic medical records and applied diagnosis criteria to PD. Psychosis was diagnosed using of NINDS/NIMH unified criteria. RESULTS We identified 669 cases of parkinsonism; 297 patients were clinically diagnosed with PD. 114/297 (38.4%) patients had evidence of psychosis (60% male); the median onset age of psychosis was 79.4 years. The incidence of Parkinson's disease psychosis (PDP) was 4.28/100 person-years. PDP patients had a 71% increased risk of death compared to PD patients. In PD patients without psychosis, men had 73.4% increased risk of death compared to women, whereas no significant sex difference was observed among PDP men vs. women. Of 114 patients diagnosed with psychosis, 59 were treated with antipsychotics. There was no significant difference in survival between treated and untreated patients. CONCLUSION PDP increased the odds of death compared to PD patients. Men with PD without psychosis had greater odds of death compared to women; however, in PD with psychosis the odds of death were comparable among sexes. Lastly, treatment with anti-psychotics did not significantly affect survival.
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Affiliation(s)
- Cole D. Stang
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA
| | - Aidan F. Mullan
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | | | - Mania Hajeb
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA
| | | | - Peter Martin
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | - Michelle M. Mielke
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | | | | | - Victor Abler
- ACADIA Pharmaceuticals Inc., San Diego, California, USA
| | | | - James H. Bower
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Mayo Clinic Department of Neurology, Rochester, Minnesota, USA,Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA,Corresponding Author: Rodolfo Savica, MD, PhD, Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, (507) 284-2120/
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16
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Hamedani AG. Vision loss and hallucinations: perspectives from neurology and ophthalmology. Curr Opin Neurol 2021; 34:84-88. [PMID: 33230034 DOI: 10.1097/wco.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to summarize the evidence for visual impairment as a risk factor for visual hallucinations in neurologic disease and recent advances in our understanding of the central visual pathways that mediate this association. RECENT FINDINGS Recent studies have described the prevalence Charles Bonnet syndrome and questioned its lack of association with cognitive impairment, used advanced neuroimaging to show that disinhibition of the occipital lobe is involved in the pathogenesis of visual hallucinations in Parkinson's disease, and demonstrated that visual impairment because of eye disease is a consistent risk factor for visual hallucinations across a number of different neurodegenerative disease populations. SUMMARY Through connections between the primary visual cortex and other brain structures, visual function is closely tied to visual hallucinations. Given that the vast majority of vision loss is caused by ophthalmic disease, much of which is preventable or treatable, the detection and treatment of vision loss in at-risk populations may reduce the burden and consequences of visual hallucinations in older adults.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Bernasconi F, Blondiaux E, Potheegadoo J, Stripeikyte G, Pagonabarraga J, Bejr-Kasem H, Bassolino M, Akselrod M, Martinez-Horta S, Sampedro F, Hara M, Horvath J, Franza M, Konik S, Bereau M, Ghika JA, Burkhard PR, Van De Ville D, Faivre N, Rognini G, Krack P, Kulisevsky J, Blanke O. Robot-induced hallucinations in Parkinson's disease depend on altered sensorimotor processing in fronto-temporal network. Sci Transl Med 2021; 13:13/591/eabc8362. [PMID: 33910980 DOI: 10.1126/scitranslmed.abc8362] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/18/2020] [Accepted: 01/23/2021] [Indexed: 01/23/2023]
Abstract
Hallucinations in Parkinson's disease (PD) are disturbing and frequent non-motor symptoms and constitute a major risk factor for psychosis and dementia. We report a robotics-based approach applying conflicting sensorimotor stimulation, enabling the induction of presence hallucinations (PHs) and the characterization of a subgroup of patients with PD with enhanced sensitivity for conflicting sensorimotor stimulation and robot-induced PH. We next identify the fronto-temporal network of PH by combining MR-compatible robotics (and sensorimotor stimulation in healthy participants) and lesion network mapping (neurological patients without PD). This PH-network was selectively disrupted in an additional and independent cohort of patients with PD, predicted the presence of symptomatic PH, and associated with cognitive decline. These robotics-neuroimaging findings extend existing sensorimotor hallucination models to PD and reveal the pathological cortical sensorimotor processes of PH in PD, potentially indicating a more severe form of PD that has been associated with psychosis and cognitive decline.
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Affiliation(s)
- Fosco Bernasconi
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Eva Blondiaux
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Jevita Potheegadoo
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Giedre Stripeikyte
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, 08041 Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain.,Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Helena Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, 08041 Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain.,Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Michela Bassolino
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Michel Akselrod
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland.,MySpace Lab, Lausanne University UNIL and University Hospital of Lausanne, CHUV, 1011 Lausanne, Switzerland
| | - Saul Martinez-Horta
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, 08041 Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain.,Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, 08041 Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain.,Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Masayuki Hara
- Graduate School of Science and Engineering, Saitama University, 338-8570 Saitama, Japan
| | - Judit Horvath
- Department of Neurology, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Matteo Franza
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Stéphanie Konik
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland.,MySpace Lab, Lausanne University UNIL and University Hospital of Lausanne, CHUV, 1011 Lausanne, Switzerland
| | - Matthieu Bereau
- Department of Neurology, Geneva University Hospitals, 1205 Geneva, Switzerland.,Department of Neurology, Besançon University Hospital, 25056 Besançon, France
| | | | - Pierre R Burkhard
- Department of Neurology, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Dimitri Van De Ville
- Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland.,Department of Radiology and Medical Informatics, University of Geneva, 1206 Geneva, Switzerland
| | - Nathan Faivre
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland.,Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000 Grenoble, France
| | - Giulio Rognini
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital and University of Bern, 3010 Bern, Switzerland
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Sant Pau Hospital, 08041 Barcelona, Spain. .,Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain.,Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland. .,Department of Neurology, Geneva University Hospitals, 1205 Geneva, Switzerland
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18
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Terravecchia C, Mostile G, Rascunà C, Arabia G, Barone P, Marconi R, Morgante L, Quattrone A, Nicoletti A, Zappia M. Does an association between cigarette smoking and Parkinson's Disease-related psychosis exist? Insights from a large non-demented cohort. J Neurol Sci 2021; 427:117509. [PMID: 34082149 DOI: 10.1016/j.jns.2021.117509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Parkinson's Disease-related Psychosis (PDP) encompasses a spectrum of symptoms ranging from "minor" hallucinations to formed hallucinations and delusions. Notably, cognitive impairment has been recognized as the strongest risk factor for PDP. Several evidences suggest a possible role of cigarette smoking in both cognition and psychotic syndromes. OBJECTIVES To evaluate the possible independent association between cigarette smoking and PDP in a large cohort of non-demented PD patients. METHODS A cohort of non-demented PD patients was selected from the FRAGAMP study population. All participants underwent a standardised structured questionnaire to assess demographic, clinical and environmental exposure data. Clinical features were assessed using UPDRS, HY stage, AIMS, MMSE and Hamilton Rating Scale for Depression. Presence of psychotic symptoms was assessed using UPDRS-I.2 score. Diagnosis of PDP was made according to NINDS/NIMH criteria. RESULTS Four hundred eighty-five non-demented PD patients were enrolled [292 men (60.2%); mean age ± SD 65.6 ± 9.8]. Among them, 28 (5.8%) had PDP. Multivariate analysis, adjusting by HY stage, MMSE and LED, shown an independent association between PDP and "nightmares-abnormal movements during sleep" and current smoking [adjOR 7.39 (95%CI 1.45-37.69; P-value 0.016)]. CONCLUSIONS Our findings provide interesting insights about the possible role of current smoking in facilitating the occurrence of psychotic symptoms in PD.
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Affiliation(s)
- Claudio Terravecchia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Giovanni Mostile
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy; Oasi Research Institute-IRCCS, Troina, Italy
| | - Cristina Rascunà
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Gennarina Arabia
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Paolo Barone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | | | | | - Andrea Quattrone
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy.
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19
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Murphy N, Killen A, Gupta RK, Graziadio S, Rochester L, Firbank M, Baker MR, Allan C, Collerton D, Taylor JP, Urwyler P. Exploring Bottom-Up Visual Processing and Visual Hallucinations in Parkinson's Disease With Dementia. Front Neurol 2021; 11:579113. [PMID: 33584490 PMCID: PMC7876258 DOI: 10.3389/fneur.2020.579113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/31/2020] [Indexed: 01/28/2023] Open
Abstract
Visual hallucinations (VH) are a common symptom of Parkinson's disease with dementia (PDD), affecting up to 65% of cases. Integrative models of their etiology posit that a decline in executive control of the visuo-perceptual system is a primary mechanism of VH generation. The role of bottom-up processing in the manifestation of VH in this condition is still not clear although visual evoked potential (VEP) differences have been associated with VH at an earlier stage of PD. Here we compared the amplitude and latency pattern reversal VEPs in healthy controls (n = 21) and PDD patients (n = 34) with a range of VH severities. PDD patients showed increased N2 latency relative to controls, but no significant differences in VEP measures were found for patients reporting complex VH (CVH) (n = 17) compared to those without VH. Our VEP findings support previous reports of declining visual system physiology in PDD and some evidence of visual system differences between patients with and without VH. However, we did not replicate previous findings of a major relationship s between the integrity of the visual pathway and VH.
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Affiliation(s)
- Nicholas Murphy
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Alison Killen
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rajnish Kumar Gupta
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sara Graziadio
- National Institute for Health Research Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Firbank
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R. Baker
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Allan
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Daniel Collerton
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Prabitha Urwyler
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- University Neurorehabilitation Unit, Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
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20
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Pimavanserin Treatment for Parkinson's Disease Psychosis in Clinical Practice. PARKINSONS DISEASE 2021; 2021:2603641. [PMID: 33489083 PMCID: PMC7801085 DOI: 10.1155/2021/2603641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/04/2023]
Abstract
Background Parkinson's disease psychosis (PDP) is a common, nonmotor symptom of Parkinson's disease (PD), which may affect up to 60% of patients and is associated with impaired quality of life, increased healthcare costs, and nursing home placement, among other adverse outcomes. Characteristic symptoms of PDP include illusions; visual, auditory, tactile, and olfactory hallucinations; and delusions. PDP symptoms typically progress over its course from being mild, infrequent, and often untroubling to complex, sometimes constant, and potentially highly disturbing. PDP has traditionally been treated with atypical antipsychotics (e.g., clozapine and quetiapine) although these are not approved for this indication and clozapine requires frequent white blood cell count monitoring due to the risk of agranulocytosis. Pimavanserin is a newer atypical antipsychotic with highly selective binding to serotonergic receptors, no evidence for worsening motor symptoms in PD, and no need for white blood cell count monitoring. It is currently the only approved medication indicated for PDP treatment. However, because it was approved relatively recently (2016), clinical experience with pimavanserin is limited. Case Presentations. A wide variety of representative clinical scenarios are presented, each with distinct variables and complications. Issues addressed include distinguishing PDP from similar symptoms caused by other disorders such as dementia, coordinating pimavanserin with other PD medications and with deep brain stimulation, adapting pimavanserin dosing for optimal benefit and tolerability, and recognizing variability of PDP symptoms due to patients' changing life circumstances. Conclusions These scenarios provide multiple insights regarding PDP management and the role of pimavanserin. Effective treatment of PDP may reduce disturbing symptoms of psychosis, thus improving patient function and quality of life. In addition, effective pharmacotherapy for PDP may also facilitate the use of other medications needed to treat neurological symptoms of PD (e.g., tremor, bradykinesia, and dyskinesia), although they may also have adverse effects that contribute to symptoms of PDP.
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21
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Schizotypy in Parkinson's disease predicts dopamine-associated psychosis. Sci Rep 2021; 11:759. [PMID: 33437004 PMCID: PMC7804198 DOI: 10.1038/s41598-020-80765-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022] Open
Abstract
Psychosis is the most common neuropsychiatric side-effect of dopaminergic therapy in Parkinson’s disease (PD). It is still unknown which factors determine individual proneness to psychotic symptoms. Schizotypy is a multifaceted personality trait related to psychosis-proneness and dopaminergic neurotransmission in healthy subjects. We investigated whether (1) PD patients exhibit lower schizotypy than controls and (2) dopamine-related neuropsychiatric side-effects can be predicted by higher schizotypy. In this cross-sectional study, we used the Oxford-Liverpool Inventory of Feelings and Experiences in 56 PD patients (12 women, mean ± sd age: 61 ± 11 years) receiving their usual dopaminergic medication and 32 age-matched healthy controls (n = 32; 18 women, mean ± sd age: 57 ± 6 years). We further compared schizotypy scores of patients with (n = 18, 32.1%) and without previously experienced psychosis. We found that patients exhibited lower schizotypy than controls. Further, patients with a history of psychosis exhibited higher schizotypy than patients without these symptoms. Using an information theoretic measure and a machine learning approach, we show that schizotypy yields the greatest predictive value for dopamine-associated hallucinations compared to other patient characteristics and disease related factors. Our results indicate an overlap between neural networks associated with schizotypy and the pathophysiology of PD and a relationship between schizotypy and psychotic side-effects of dopaminergic medication.
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22
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Pennington C, Duncan G, Ritchie C. Altered awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review. Int J Geriatr Psychiatry 2021; 36:15-30. [PMID: 32869379 DOI: 10.1002/gps.5415] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Altered awareness of cognitive and neuropsychiatric symptoms is a common feature of neurodegeneration, which can significantly impact on quality of life, medication concordance and personal safety. Elucidating how awareness is affected by common alpha-synucleinopathies therefore has significant clinical relevance. We performed a systematic review of the literature on awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies. METHODS Searches of PubMed and Web of Science were carried out, using keywords and MeSH subheadings, limited to papers in English dealing with humans. The terms "Parkinson's" or "Lewy body" were used to denote the disease of interest, combined with either "agnosia", "anosognosia", "insight", "metacognition", or "neuropsychology" to denote the neuropsychological area of interest. RESULTS 21 publications investigating awareness of cognitive symptoms, and 18 publications on awareness of neuropsychiatric symptoms were identified. The large majority focused on Parkinson's disease rather than Dementia with Lewy Bodies. Cognitively intact people with Parkinson's disease may over-report cognitive symptoms, whilst those with cognitive impairment under-report symptoms. Awareness of neuropsychiatric symptoms is likely to decline over time, particularly in those with progressive cognitive impairment. CONCLUSIONS Altered awareness of cognitive and neuropsychiatric symptoms is common in Parkinson's disease. Symptom awareness varies significantly between individuals, and appears to be influenced by mood and global cognitive functioning, with executive functioning specifically implicated. There are gaps in our understanding of how dopaminergic medications influence symptom awareness, and a need for longitudinal studies of how awareness changes over time in Parkinson's disease and Dementia with Lewy Bodies.
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Affiliation(s)
- Catherine Pennington
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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23
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Visser F, Apostolov VI, Vlaar AMM, Twisk JWR, Weinstein HC, Berendse HW. Visual hallucinations in Parkinson's disease are associated with thinning of the inner retina. Sci Rep 2020; 10:21110. [PMID: 33273513 PMCID: PMC7712774 DOI: 10.1038/s41598-020-77833-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022] Open
Abstract
Visual hallucinations (VH) are common in patients with Parkinson's disease (PD), yet the underlying pathophysiological mechanisms are still unclear. We aimed to explore the association of the presence of VH with inner retinal thinning and, secondarily, with visual acuity. To this end, we included 40 PD patients in this exploratory study, of whom 14 had VH, and 22 age- and sex-matched healthy controls. All participants were interviewed for the presence of VH by a neurologist specialized in movement disorders and underwent a thorough ophthalmologic examination, including measurement of the best-corrected visual acuity (BCVA) and optical coherence tomography to obtain macular scans of the combined ganglion cell layer and inner plexiform layer (GCL-IPL). Patients with VH had a thinner GCL-IPL than patients without VH, which persisted after correction for age, disease stage, levodopa equivalent daily dose (LED) and cognitive function. Furthermore, BCVA was lower in the PD group with VH than in the PD group without VH, although only a trend remained after correction for age, disease stage, LED and cognitive function. Taken together, in patients with PD, visual hallucinations appear to be associated with a thinning of the inner retinal layers and, possibly, with reduced visual acuity. Further research using a longitudinal design is necessary to confirm these findings and to establish the causality of these relationships.
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Affiliation(s)
- F Visser
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - V I Apostolov
- Department of Ophthalmology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - A M M Vlaar
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - J W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
| | - H C Weinstein
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - H W Berendse
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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24
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Kurita A, Koshikawa H, Akiba T, Seki K, Ishikawa H, Suzuki M. Visual Hallucinations and Impaired Conscious Visual Perception in Parkinson Disease. J Geriatr Psychiatry Neurol 2020; 33:377-385. [PMID: 31808354 DOI: 10.1177/0891988719892318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Visual hallucinations (VHs) are common in patients with Parkinson disease (PD), especially those with dementia, whereas auditory hallucinations are quite rare. Recent studies have revealed the involvement of several regions along the visual information-processing system that contribute to the pathophysiological mechanism of VHs: the eyes and retina, retinofugal projection, lateral geniculate nucleus, striate cortex, ventral pathways in the temporal cortices, and frontal and parietal cortices. In addition, the concurrent involvement of other systems in the brainstem and basal forebrain further modify VHs in PD. In this review, we discuss the pathophysiological association between the regional involvement of these areas and VHs.
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Affiliation(s)
- Akira Kurita
- Department of Neurology, 26403Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Hiroaki Koshikawa
- Department of Neurology, 26403Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Takeshi Akiba
- Department of Neurology, 26403Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Kanako Seki
- Department of Neurology, 26403Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Hiroaki Ishikawa
- Department of Neurology, 26403Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Megumi Suzuki
- Department of Neurology, 26403Teikyo University Chiba Medical Center, Ichihara, Japan
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25
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Indrieri A, Pizzarelli R, Franco B, De Leonibus E. Dopamine, Alpha-Synuclein, and Mitochondrial Dysfunctions in Parkinsonian Eyes. Front Neurosci 2020; 14:567129. [PMID: 33192254 PMCID: PMC7604532 DOI: 10.3389/fnins.2020.567129] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
Parkinson’s disease (PD) is characterized by motor dysfunctions including bradykinesia, tremor at rest and motor instability. These symptoms are associated with the progressive degeneration of dopaminergic neurons originating in the substantia nigra pars compacta and projecting to the corpus striatum, and by accumulation of cytoplasmic inclusions mainly consisting of aggregated alpha-synuclein, called Lewy bodies. PD is a complex, multifactorial disorder and its pathogenesis involves multiple pathways and mechanisms such as α-synuclein proteostasis, mitochondrial function, oxidative stress, calcium homeostasis, axonal transport, and neuroinflammation. Motor symptoms manifest when there is already an extensive dopamine denervation. There is therefore an urgent need for early biomarkers to apply disease-modifying therapeutic strategies. Visual defects and retinal abnormalities, including decreased visual acuity, abnormal spatial contrast sensitivity, color vision defects, or deficits in more complex visual tasks are present in the majority of PD patients. They are being considered for early diagnosis together with retinal imaging techniques are being considered as non-invasive biomarkers for PD. Dopaminergic cells can be found in the retina in a subpopulation of amacrine cells; however, the molecular mechanisms leading to visual deficits observed in PD patients are still largely unknown. This review provides a comprehensive analysis of the retinal abnormalities observed in PD patients and animal models and of the molecular mechanisms underlying neurodegeneration in parkinsonian eyes. We will review the role of α-synuclein aggregates in the retina pathology and/or in the onset of visual symptoms in PD suggesting that α-synuclein aggregates are harmful for the retina as well as for the brain. Moreover, we will summarize experimental evidence suggesting that the optic nerve pathology observed in PD resembles that seen in mitochondrial optic neuropathies highlighting the possible involvement of mitochondrial abnormalities in the development of PD visual defects. We finally propose that the eye may be considered as a complementary experimental model to identify possible novel disease’ pathways or to test novel therapeutic approaches for PD.
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Affiliation(s)
- Alessia Indrieri
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy.,Institute for Genetic and Biomedical Research, National Research Council, Milan, Italy
| | - Rocco Pizzarelli
- Center for Life Nanoscience, Istituto Italiano di Tecnologia, Rome, Italy
| | - Brunella Franco
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy.,Medical Genetics, Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Elvira De Leonibus
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy.,Institute of Biochemistry and Cellular Biology, National Research Council, Rome, Italy
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26
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Hamedani AG, Abraham DS, Maguire MG, Willis AW. Visual Impairment Is More Common in Parkinson's Disease and Is a Risk Factor for Poor Health Outcomes. Mov Disord 2020; 35:1542-1549. [PMID: 32662528 PMCID: PMC8183672 DOI: 10.1002/mds.28182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Visual impairment is associated with hip fracture, depression, anxiety, and dementia in the general population, and many causes of visual impairment are preventable or treatable with early detection. However, the prevalence, outcomes, and healthcare utilization patterns associated with visual impairment have not been examined in Parkinson's disease (PD). METHODS We performed a cross-sectional analysis of all Medicare beneficiaries with complete data in 2014 and longitudinal analysis of beneficiaries with PD from 2010 to 2014. We used diagnosis and procedure codes to identify PD, visual impairment, eye exams, hip fracture, and neuropsychiatric disorders. We compared the prevalence of visual impairment using logistic regression and used Cox proportional hazards regression to examine visual impairment and incident hip fracture, depression, anxiety, dementia, and death. We also examined the frequency of eye exams in PD using repeated-measures logistic regression. RESULTS Among 26,209,997 Medicare beneficiaries in 2014, visual impairment was significantly more prevalent in PD (1.7%) than non-PD (0.71%) (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.56-1.65). In a longitudinal cohort of 542,224 Medicare beneficiaries with PD, less than 60% had a yearly eye exam. Visual impairment associated with increased hazard of depression (hazard ratio [HR], 1.23; 95% CI, 1.14-1.32), anxiety (HR, 1.34; 95% CI, 1.24-1.43), dementia (HR, 1.28; 95% CI, 1.21-1.36), and death (HR, 1.49; 95% CI, 1.44-1.55). CONCLUSION Visual impairment is more common in PD than the general population and is associated with negative PD-related outcomes. Understanding the mechanisms for these relationships is important for guiding future interventions to improve health outcomes in PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ali G. Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle S. Abraham
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen G. Maguire
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Allison W. Willis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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27
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Hamedani AG, Thibault DP, Shea JA, Willis AW. Self-reported vision and hallucinations in older adults: results from two longitudinal US health surveys. Age Ageing 2020; 49:843-849. [PMID: 32253434 DOI: 10.1093/ageing/afaa043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/14/2020] [Accepted: 02/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vision loss may be a risk factor for hallucinations, but this has not been studied at the population level. METHODS To determine the association between self-reported vision loss and hallucinations in a large community-based sample of older adults, we performed a cross-sectional and longitudinal analysis of two large, nationally representative US health surveys: the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Visual impairment and hallucinations were self- or proxy-reported. Multivariate single and mixed effects logistic regression models were built to examine whether visual impairment and history of cataract surgery were associated with hallucinations. RESULTS In NHATS (n = 1520), hallucinations were more prevalent in those who reported difficulty reading newspaper print (OR 1.77, 95% confidence interval (CI): 1.32-2.39) or recognising someone across the street (OR 2.48, 95% CI: 1.86-3.31) after adjusting for confounders. In HRS (n = 3682), a similar association was observed for overall (OR 1.32, 95% CI: 1.08-1.60), distance (OR 1.61, 95% CI: 1.32-1.96) and near eyesight difficulties (OR 1.52, 95% CI: 1.25-1.85). In neither sample was there a significant association between cataract surgery and hallucinations after adjusting for covariates. CONCLUSIONS Visual dysfunction is associated with increased odds of hallucinations in the older US adult population. This suggests that the prevention and treatment of vision loss may potentially reduce the prevalence of hallucinations in older adults.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dylan P Thibault
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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28
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Reckner E, Cipolotti L, Foley JA. Presence phenomena in parkinsonian disorders: Phenomenology and neuropsychological correlates. Int J Geriatr Psychiatry 2020; 35:785-793. [PMID: 32250497 DOI: 10.1002/gps.5303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The feeling of a presence that occurs in the absence of objectively identifiable stimuli is common in parkinsonian disorders. Although previously considered benign and insignificant, recent evidence suggests that presence phenomena may act as the gateway to more severe hallucinations and dementia. Despite this, we still know relatively little about these phenomena. OBJECTIVE To examine parkinsonian disorder patients' subjective experience of presence phenomena, and retrospectively analyse their cognitive correlates, in order to elucidate the emergence of information processing deficits in parkinsonian disorders. METHODS/DESIGN 25 patients who endorsed presence phenomena were asked to complete a semi-structured interview about their experiences. The cognitive profiles of these patients were then compared to those of age- and education-matched patients who denied presence phenomena. RESULTS Patients described the presence as mostly that of an unknown human with neutral valence. Patients who described it as unpleasant were noted to also demonstrate elevated anxiety. Patients who identified the presence as a known person, described it as touching them, or interacted with the presence emotionally or physically demonstrated reduced insight. Patients with presence phenomena demonstrated more frequent impairments in visual processing, executive function and speed of processing. CONCLUSIONS Presence phenomena occur in the company of advancing cognitive impairment and involvement of the posterior cortical functions. Initially encountered as a neutral spatial skeleton, the experience is then shaped by the patient's affective state and level of insight.
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Affiliation(s)
- Erin Reckner
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
| | - Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,UCL Institute of Neurology, Queen Square, London, UK
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29
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Abstract
Parkinson disease has historically been conceptualized as a movement disorder. In recent decades, nonmotor and neuropsychiatric symptoms have become increasingly recognized as being of paramount importance for patients with Parkinson disease. Neuropsychiatric phenomena dominate the course of the other major Lewy body disease, dementia with Lewy bodies. In this review, we survey the clinical relevance of nonmotor and neuropsychiatric symptoms to the heterogeneous presentations of Lewy body disease and their significance to ongoing research in this area. We consider how the nature of Lewy body neuropathology may help explicate the basis of nonmotor and neuropsychiatric symptoms in these two disorders.
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Affiliation(s)
- Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, 1830 E Monument St, Baltimore, MD 21205, USA; Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 300, Baltimore, MD 21287, USA
| | - Gregory M Pontone
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, Phipps 300, Baltimore, MD 21287, USA; Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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30
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Dlay JK, Duncan GW, Khoo TK, Williams-Gray CH, Breen DP, Barker RA, Burn DJ, Lawson RA, Yarnall AJ. Progression of Neuropsychiatric Symptoms over Time in an Incident Parkinson's Disease Cohort (ICICLE-PD). Brain Sci 2020; 10:E78. [PMID: 32024222 PMCID: PMC7071603 DOI: 10.3390/brainsci10020078] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/25/2020] [Accepted: 01/31/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cross-sectional studies have identified that the prevalence of neuropsychiatric symptoms (NPS) in Parkinson's disease (PD) ranges from 70-89%. However, there are few longitudinal studies determining the impact of NPS on quality of life (QoL) in PD patients and their caregivers. We seek to determine the progression of NPS in early PD. METHODS Newly diagnosed idiopathic PD cases (n = 212) and age-matched controls (n = 99) were recruited into a longitudinal study. NPS were assessed using the Neuropsychiatric Inventory with Caregiver Distress scale (NPI-D). Further neuropsychological and clinical assessments were completed by participants, with reassessment at 18 and 36 months. Linear mixed-effects modelling determined factors associated with NPI-D and QoL over 36 months. RESULTS Depression, anxiety, apathy and hallucinations were more frequent in PD than controls at all time points (p < 0.05). Higher motor severity at baseline was associated with worsening NPI-D scores over time (β = 0.1, p < 0.05), but not cognition. A higher NPI total score was associated with poorer QoL at any time point (β = 0.3, p < 0.001), but not changed in QoL scores. CONCLUSION NPS are significantly associated with poorer QoL, even in early PD. Screening for NPS from diagnosis may allow efficient delivery of better support and treatment to patients and their families.
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Affiliation(s)
- J. K. Dlay
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
| | - G. W. Duncan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - T. K. Khoo
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia;
- School of Medicine, University of Wollongong, New South Wales 2522, Australia
| | - C. H. Williams-Gray
- John van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, UK; (C.H.W.-G.); (R.A.B.)
| | - D. P. Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH16 4UX, UK
| | - R. A. Barker
- John van Geest Centre for Brain Repair, University of Cambridge, Cambridge CB2 0PY, UK; (C.H.W.-G.); (R.A.B.)
| | - D. J. Burn
- Faculty of Medical Sciences, Newcastle University & Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4HH, UK;
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - R. A. Lawson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
| | - A. J. Yarnall
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (J.K.D.); (G.W.D.); (R.A.L.)
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
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31
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Abstract
BACKGROUND The development of delirium in patients with idiopathic Parkinson's disease (IPD) is a feared complication, which is often associated with sustained worsening of motor symptoms and psychopathological sequelae. Little is known regarding the prevalence and incidence rates, course and prognosis. Clinical studies from which recommendations for evidence-based management of delirium in IPD can be derived are lacking. OBJECTIVE To summarize the state of the art regarding epidemiological and clinical features of delirium in IPD. Discussion of prevention strategies and non-pharmacological and pharmacological treatment options. METHODS A literature search was carried out in PubMed. RESULTS The IPD is an independent risk factor for the development of delirium. Patients with IPD show poorer clinical outcome frequently with cognitive worsening and motor complications following development of delirium. CONCLUSION So far no validated rating scales for recognition and course evaluation of delirium in IPD are available. Preventive strategies and non-pharmacological measures should be consistently implemented to improve management. There are insufficient data concerning pharmacotherapy with quetiapine and clozapine, whereas other neuroleptics are contraindicated for delirium in IPD due to antidopaminergic side effects.
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Affiliation(s)
- C Franke
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - G Ebersbach
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Straße nach Fichtenwalde 16, 14547, Beelitz-Heilstätten, Deutschland
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32
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Xu X, Han Q, lin J, Wang L, Wu F, Shang H. Grey matter abnormalities in Parkinson’s disease: a voxel‐wise meta‐analysis. Eur J Neurol 2019; 27:653-659. [PMID: 31770481 DOI: 10.1111/ene.14132] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/19/2019] [Indexed: 02/05/2023]
Affiliation(s)
- X. Xu
- Neurology Department West China Hospital Sichuan University Chengdu China
| | - Q. Han
- Neurology Department West China Hospital Sichuan University Chengdu China
| | - J. lin
- Neurology Department West China Hospital Sichuan University Chengdu China
| | - L. Wang
- Neurology Department West China Hospital Sichuan University Chengdu China
| | - F. Wu
- Neurology Department West China Hospital Sichuan University Chengdu China
| | - H. Shang
- Neurology Department West China Hospital Sichuan University Chengdu China
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Clegg BJ, Duncan GW, Khoo TK, Barker RA, Burn DJ, Yarnall AJ, Lawson RA. Categorising Visual Hallucinations in Early Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:447-453. [PMID: 30040741 DOI: 10.3233/jpd-181338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Visual hallucinations (VHs) are common in Parkinson's disease (PD), with prevalence ranging from 27-50% in cross-sectional cohorts of patients with well-established disease. However, minor hallucinations may occur earlier in the disease process than has been previously reported. OBJECTIVE We sought to categorise VHs in a cohort of newly diagnosed PD patients and establish their relationship to other clinical features. METHODS Newly diagnosed PD participants (n = 154) were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in PD (ICICLE-PD) study. Participants completed the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS III), Montreal Cognitive Assessment (MoCA) and Parkinson's Disease Questionnaire (PDQ-39) to assess motor severity, cognition and quality of life (QoL), respectively. VHs were classified using the North East Visual Hallucinations Inventory. Hierarchical regression was used to build predictive models of motor severity, QoL and cognition. RESULTS 22% (n = 34) of participants experienced recurrent VHs with minor VHs being most frequently reported (64.7% of hallucinators). Complex VHs were present in 32.4% of hallucinating participants. Linear regression showed VHs predicted poorer PDQ-39 and MoCA scores (β= 0.201, p = 0.006 and β= - 0.167, p = 0.01, respectively) but not motor severity (p > 0.05). CONCLUSIONS Over a fifth of people with newly diagnosed PD reported recurrent VHs; minor hallucinations were the most common, although a small proportion reported complex VHs. Recurrent VHs were found to be a significant independent predictor of cognitive function and QoL but not motor severity. Our findings highlight the importance of screening for VHs at diagnosis.
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Affiliation(s)
| | - Gordon W Duncan
- Institute of Neuroscience, Newcastle University, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Tien K Khoo
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Australia.,School of Medicine, University of Wollongong, New South Wales, Australia
| | - Roger A Barker
- John Van Geest Centre for Brain Repair, University of Cambridge, UK
| | - David J Burn
- Faculty of Medical Science, Newcastle University, UK
| | - Alison J Yarnall
- Institute of Neuroscience, Newcastle University, UK.,Newcastle University Institute for Ageing, Newcastle University, UK
| | - Rachael A Lawson
- Institute of Neuroscience, Newcastle University, UK.,Newcastle University Institute for Ageing, Newcastle University, UK
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Eversfield CL, Orton LD. Auditory and visual hallucination prevalence in Parkinson's disease and dementia with Lewy bodies: a systematic review and meta-analysis. Psychol Med 2019; 49:2342-2353. [PMID: 30474581 PMCID: PMC6763539 DOI: 10.1017/s0033291718003161] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 09/21/2018] [Accepted: 10/04/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Non-motor features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB), such as auditory hallucinations (AH), contribute to disease burden but are not well understood. METHODS Systematic review and random-effects meta-analyses of studies reporting AH associated with PD or DLB. Prevalence of visual hallucinations (VH) in identified studies meeting eligibility criteria were included in meta-analyses, facilitating comparison with AH. Synthesis of qualitative descriptions of AH was performed. PubMed, Web of Science and Scopus databases were searched for primary journal articles, written in English, published from 1970 to 2017. Studies reporting AH prevalence in PD or DLB were screened using PRISMA methods. RESULTS Searches identified 4542 unique studies for consideration, of which, 26 met inclusion criteria. AH pooled prevalence in PD was estimated to be 8.9% [95% confidence interval (CI) 5.3-14.5], while in DLB was estimated to be 30.8% (±23.4 to 39.3). Verbal hallucinations, perceived as originating outside the head, were the most common form of AH. Non-verbal AH were also common while musical AH were rare. VH were more prevalent, with an estimated pooled prevalence in PD of 28.2% (±19.1 to 39.5), while in DLB they were estimated to be 61.8% (±49.1 to 73.0). Meta-regression determined that the use of validated methodologies to identify hallucinations produced higher prevalence estimates. CONCLUSIONS AH and VH present in a substantial proportion of PD and DLB cases, with VH reported more frequently in both conditions. Both AH and VH are more prevalent in DLB than PD. There is a need for standardised use of validated methods to detect and monitor hallucinations.
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Affiliation(s)
- Charlotte Louise Eversfield
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK
| | - Llwyd David Orton
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK
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35
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Lyons KE, Pahwa R, Hermanowicz N, Davis T, Pagan F, Isaacson S. Changing the treatment paradigm for Parkinson’s disease psychosis with pimavanserin. Expert Rev Clin Pharmacol 2019; 12:681-691. [DOI: 10.1080/17512433.2019.1623669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly E. Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Neal Hermanowicz
- Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Thomas Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fernando Pagan
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
| | - Stuart Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
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Veys L, Vandenabeele M, Ortuño-Lizarán I, Baekelandt V, Cuenca N, Moons L, De Groef L. Retinal α-synuclein deposits in Parkinson's disease patients and animal models. Acta Neuropathol 2019; 137:379-395. [PMID: 30721408 DOI: 10.1007/s00401-018-01956-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/22/2018] [Accepted: 12/22/2018] [Indexed: 12/21/2022]
Abstract
Despite decades of research, accurate diagnosis of Parkinson's disease remains a challenge, and disease-modifying treatments are still lacking. Research into the early (presymptomatic) stages of Parkinson's disease and the discovery of novel biomarkers is of utmost importance to reduce this burden and to come to a more accurate diagnosis at the very onset of the disease. Many have speculated that non-motor symptoms could provide a breakthrough in the quest for early biomarkers of Parkinson's disease, including the visual disturbances and retinal abnormalities that are seen in the majority of Parkinson's disease patients. An expanding number of clinical studies have investigated the use of in vivo assessments of retinal structure, electrophysiological function, and vision-driven tasks as novel means for identifying patients at risk that need further neurological examination and for longitudinal follow-up of disease progression in Parkinson's disease patients. Often, the results of these studies have been interpreted in relation to α-synuclein deposits and dopamine deficiency in the retina, mirroring the defining pathological features of Parkinson's disease in the brain. To better understand the visual defects seen in Parkinson's disease patients and to propel the use of retinal changes as biomarkers for Parkinson's disease, however, more conclusive neuropathological evidence for the presence of retinal α-synuclein aggregates, and its relation to the cerebral α-synuclein burden, is urgently needed. This review provides a comprehensive and critical overview of the research conducted to unveil α-synuclein aggregates in the retina of Parkinson's disease patients and animal models, and thereby aims to aid the ongoing discussion about the potential use of the retinal changes and/or visual symptoms as biomarkers for Parkinson's disease.
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Deeb W, Nozile-Firth K, Okun MS. Parkinson's disease: Diagnosis and appreciation of comorbidities. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:257-277. [PMID: 31753136 DOI: 10.1016/b978-0-12-804766-8.00014-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Parkinson's disease (PD) is a complex neuropsychiatric disorder that manifests with a variety of motor and nonmotor symptoms. Its incidence increases with age. It is important for clinicians to be able to distinguish symptoms of aging and other comorbidities from those of PD. The diagnosis of PD has traditionally been rendered using strict criteria that mainly rely on the cardinal motor symptoms of rest tremor, rigidity, and bradykinesia. However, newer diagnostic criteria proposed by the Movement Disorders Society for diagnosis of PD collectively reflect a greater appreciation for the nonmotor symptoms. The treatment of PD remains symptomatic and the most noticeable improvements have been documented in the motor symptoms. Levodopa remains the gold standard for therapy, however there are now many other potential medical and surgical treatment strategies. Nonmotor symptoms have been shown to affect quality of life more than the motor symptoms. There is ongoing research into symptomatic and disease modifying treatments. Given the multisystem involvement in PD, an interdisciplinary patient-centered approach is recommended by most experts. This chapter addresses first the diagnostic approach and the many geriatric considerations. This is followed by a review of the nonmotor symptoms. Finally, a summary of current treatment strategies in PD is presented along with potential treatment complications.
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Affiliation(s)
- Wissam Deeb
- Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States.
| | - Kamilia Nozile-Firth
- Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Michael S Okun
- Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
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38
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Cozac VV. [Modern approaches to treatment of psychosis in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2018. [PMID: 28635863 DOI: 10.17116/jnevro2016116101103-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychotic disorders in Parkinson's disease (PDPD) are common and significantly influence the quality of life and disability level. The pathogenesis of PDPD is complex and not yet fully understood. Taking into consideration the features of the Parkinson's disease (usually older patients with a risk of cognitive decline), and the pharmacodynamics of the antiparkinsonian and traditional antipsychotic drugs, the management of PDPD is a challenging issue of clinical neurology and psychiatry. In this systematic review, scientific publications for the period 2014-2016 were analyzed within two bibliographic databases: MEDLINE/PubMed and eLIBRARY.RU. Additionally, the guidelines of the International Parkinson and Movement Disorders Society, American Academy of Neurology and European Academy of Neurology were included in the analysis. Clozapine is recommended to use in the treatment of PDPD, quetiapine is possible to use, pimavanserin will probably become a remedy of choice. Nonpharmacological approaches have positive effects on the general condition of the patients with PDPD, however the efficacy of such approaches to treat psychosis is unclear.
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Affiliation(s)
- V V Cozac
- Hospital of the University of Basel, Basel, Switzerland
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39
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Guo L, Normando EM, Shah PA, De Groef L, Cordeiro MF. Oculo-visual abnormalities in Parkinson's disease: Possible value as biomarkers. Mov Disord 2018; 33:1390-1406. [DOI: 10.1002/mds.27454] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Li Guo
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Eduardo M. Normando
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
| | - Parth Arvind Shah
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Lies De Groef
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Neural Circuit Development and Regeneration Research Group, Department of Biology; University of Leuven; Leuven Belgium
| | - M. Francesca Cordeiro
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
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40
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Lawson RA, McDonald C, Burn DJ. Defining delirium in idiopathic Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2018; 64:29-39. [PMID: 30279060 DOI: 10.1016/j.parkreldis.2018.09.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/28/2018] [Accepted: 09/21/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parkinson's disease patients may be at increased risk of delirium and developing adverse outcomes, such as cognitive decline and increased mortality. Delirium is an acute state of confusion that has overlapping symptoms with Parkinson's dementia, making it difficult to identify. This study aimed to determine the diagnostic criteria, prevalence, management strategies and outcomes of delirium in Parkinson's through a systematic review of the literature. METHODS Seven databases were used to identify all articles published before February 2017 comprising two key terms: "Parkinson's Disease" and "delirium". Data were extracted from studies meeting predefined inclusion criteria. RESULTS Twenty articles were identified. Delirium prevalence in Parkinson's ranged from 0.3 to 60% depending on setting; a diagnosis of Parkinson's was associated with an increased risk of developing delirium. Delirium was identified/diagnosed using seven different criteria. Delirium may be associated with an increased length of hospital stay and worsening motor symptoms. We did not identify any studies examining the management of delirium in Parkinson's. DISCUSSION This review highlights the paucity of well-designed, appropriately powered studies investigating delirium in Parkinson's. The results suggest that delirium is a significant issue in people with Parkinson's and that having delirium may be a risk factor for adverse outcomes, particularly in inpatient settings. Further prospective research is needed to accurately determine the prevalence of delirium in Parkinson's, its management strategies and outcomes, and to evaluate diagnostic criteria to differentiate between the overlapping symptoms of Parkinson's and delirium.
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Affiliation(s)
- Rachael A Lawson
- Institute of Neuroscience, Newcastle University, UK; Newcastle University Institute for Ageing, Newcastle University, UK.
| | - Claire McDonald
- Institute of Neuroscience, Newcastle University, UK; Gateshead Health NHS Foundation Trust, UK
| | - David J Burn
- Faculty of Medical Science, Newcastle University, UK
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41
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Charvin D, Di Paolo T, Bezard E, Gregoire L, Takano A, Duvey G, Pioli E, Halldin C, Medori R, Conquet F. An mGlu4-Positive Allosteric Modulator Alleviates Parkinsonism in Primates. Mov Disord 2018; 33:1619-1631. [PMID: 30216534 DOI: 10.1002/mds.27462] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/23/2018] [Accepted: 04/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Levodopa remains the gold-standard treatment for PD. However, it becomes less effective as the disease progresses and produces debilitating side effects, such as motor fluctuations and l-dopa-induced dyskinesia. Modulation of metabotropic glutamate receptor 4 represents a promising antiparkinsonian approach in combination with l-dopa, but it has not been demonstrated in primates. OBJECTIVE We studied whether a novel positive allosteric modulator of the metabotropic glutamate receptor 4, PXT002331 (foliglurax), could reduce parkinsonism in primate models. METHODS We assessed the therapeutic potential of PXT002331 in three models of MPTP-induced parkinsonism in macaques. These models represent three different stages of disease evolution: early stage and advanced stage with and without l-dopa-induced dyskinesia. RESULTS As an adjunct to l-dopa, PXT002331 induced a robust and dose-dependent reversal of parkinsonian motor symptoms in macaques, including bradykinesia, tremor, posture, and mobility. Moreover, PXT002331 strongly decreased dyskinesia severity, thus having therapeutic efficacy on both parkinsonian motor impairment and l-dopa-induced dyskinesia. PXT002331 brain penetration was also assessed using PET imaging in macaques, and pharmacodynamic analyses support target engagement in the therapeutic effects of PXT002331. CONCLUSIONS This work provides a demonstration that a positive allosteric modulator of metabotropic glutamate receptor 4 can alleviate the motor symptoms of PD and the motor complications induced by l-dopa in primates. PXT002331 is the first compound of its class to enter phase IIa clinical trials. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Delphine Charvin
- Prexton Therapeutics SA, 1228 Plan-les-Ouates, Geneva, Switzerland
| | - Therese Di Paolo
- Neuroscience Research Unit CHU de Québec, CHUL Pavillon and Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Erwan Bezard
- Motac Neuroscience Ltd, Manchester, United Kingdom
| | - Laurent Gregoire
- Neuroscience Research Unit CHU de Québec, CHUL Pavillon and Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Akihiro Takano
- Karolinska Institutet, Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Guillaume Duvey
- Prexton Therapeutics SA, 1228 Plan-les-Ouates, Geneva, Switzerland
| | - Elsa Pioli
- Motac Neuroscience Ltd, Manchester, United Kingdom
| | - Christer Halldin
- Karolinska Institutet, Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Rossella Medori
- Prexton Therapeutics SA, 1228 Plan-les-Ouates, Geneva, Switzerland
| | - François Conquet
- Prexton Therapeutics SA, 1228 Plan-les-Ouates, Geneva, Switzerland
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Warren N, O'Gorman C, Hume Z, Kisely S, Siskind D. Delusions in Parkinson's Disease: A Systematic Review of Published Cases. Neuropsychol Rev 2018; 28:310-316. [PMID: 30073446 DOI: 10.1007/s11065-018-9379-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/25/2018] [Indexed: 01/16/2023]
Abstract
Delusions in Parkinson's disease (PD) are thought to be associated with disease progression and cognitive impairment. However, this symptom description is not consistent in the literature and there is a suggestion that different subgroups of psychotic patients occur in PD, which we aimed to clarify. Case reports were identified through a systematic search of databases (PUBMED, EMBASE, PsychInfo). Cases with isolated delusions were compared to those with both delusions and hallucinations. We identified 184 cases of delusions in PD. Delusions were primarily paranoid in nature (83%) and isolated in 50%. Those with isolated delusions had an earlier onset of PD (46 years vs 55 years), higher rates of impulse control disorders (40.2 vs 10.3%), dopamine dysregulation (29.9 vs 11.3%) and lower rates of cognitive impairment (8.0 vs 26.8%). There is unexpected heterogeneity amongst cases of delusional psychosis, that cannot adequately be explained by existing models of PD psychosis.
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Affiliation(s)
- Nicola Warren
- School of Medicine, University of Queensland, Brisbane, Australia.
- Metro South Addiction and Mental Health Service, Brisbane, Australia.
| | - Cullen O'Gorman
- School of Medicine, University of Queensland, Brisbane, Australia
- Department of Neurology, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, Qld, 4102, Australia
| | - Zena Hume
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Dan Siskind
- School of Medicine, University of Queensland, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
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43
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Pardue MT, Allen RS. Neuroprotective strategies for retinal disease. Prog Retin Eye Res 2018; 65:50-76. [PMID: 29481975 PMCID: PMC6081194 DOI: 10.1016/j.preteyeres.2018.02.002] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
Diseases that affect the eye, including photoreceptor degeneration, diabetic retinopathy, and glaucoma, affect 11.8 million people in the US, resulting in vision loss and blindness. Loss of sight affects patient quality of life and puts an economic burden both on individuals and the greater healthcare system. Despite the urgent need for treatments, few effective options currently exist in the clinic. Here, we review research on promising neuroprotective strategies that promote neuronal survival with the potential to protect against vision loss and retinal cell death. Due to the large number of neuroprotective strategies, we restricted our review to approaches that we had direct experience with in the laboratory. We focus on drugs that target survival pathways, including bile acids like UDCA and TUDCA, steroid hormones like progesterone, therapies that target retinal dopamine, and neurotrophic factors. In addition, we review rehabilitative methods that increase endogenous repair mechanisms, including exercise and electrical stimulation therapies. For each approach, we provide background on the neuroprotective strategy, including history of use in other diseases; describe potential mechanisms of action; review the body of research performed in the retina thus far, both in animals and in humans; and discuss considerations when translating each treatment to the clinic and to the retina, including which therapies show the most promise for each retinal disease. Despite the high incidence of retinal diseases and the complexity of mechanisms involved, several promising neuroprotective treatments provide hope to prevent blindness. We discuss attractive candidates here with the goal of furthering retinal research in critical areas to rapidly translate neuroprotective strategies into the clinic.
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Affiliation(s)
- Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA, 30332, USA.
| | - Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
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44
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Turjanski N, Lloyd GG. Psychiatric side-effects of medications: recent developments. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.11.1.58] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Medications often induce neuropsychiatric side-effects. This article reviews psychiatric side-effects that are well known and describes those induced by recently developed medications. Therapeutic innovations have been prominent in the treatment of HIV infection, Parkinson's disease and epilepsy and therefore psychiatric side-effects caused by these agents are described in more detail.
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45
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Hinkle JT, Perepezko K, Bakker CC, Broen MPG, Chin K, Dawson TM, Johnson V, Mari Z, Marvel CL, Mills KA, Pantelyat A, Pletnikova O, Rosenthal LS, Shepard MD, Stevens DA, Troncoso JC, Wang J, Pontone GM. Onset and Remission of Psychosis in Parkinson's Disease: Pharmacologic and Motoric Markers. Mov Disord Clin Pract 2018; 5:31-38. [PMID: 29756003 PMCID: PMC5945218 DOI: 10.1002/mdc3.12550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/10/2017] [Accepted: 08/18/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Psychosis is among the most disabling complications of Parkinson's disease (PD). The chronicity of PD psychosis remains understudied and the relative importance of dopaminergic therapy versus the disease process itself in engendering psychosis remains unclear. OBJECTIVES To examine pharmacologic and motoric correlates of PD psychosis onset and remission in a longitudinally monitored PD cohort. METHODS We analyzed data from 165 participants enrolled in a longitudinal PD study through the Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins University. Evaluations included formal psychiatric assessment and were conducted at two-year intervals. Regression with generalized estimated equations (GEE) was used to produce unadjusted and adjusted estimates for time-varying longitudinal associations between psychosis and putative risk factors. RESULTS Sixty-two participants (37.6%) were diagnosed with psychosis during at least one evaluation. Of forty-nine participants with psychosis followed over multiple evaluations, 13 (26.5%) demonstrated remission despite significant Hoehn & Yahr stage increase (p=0.009); two of these cases later relapsed. Multivariable regression with GEE identified dementia diagnosis, akinesia-rigidity, anticholinergic usage, and levodopa-carbidopa dose to be significantly associated with psychosis, while disease duration was not. A sub-analysis of 30 incident psychosis cases suggested that dopamine agonist dose was lowered after psychosis onset with a compensatory increase in levodopa-carbidopa dosage. CONCLUSIONS Our findings suggest that in the context of standard therapy, PD-related psychotic disorder can remit at a frequency of approximately 27%. Additionally, akinetic-rigid motor impairment was more strongly associated with psychosis than disease duration, independent of cognitive impairment and medications.
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Affiliation(s)
- Jared T. Hinkle
- Medical Scientist Training ProgramJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Kate Perepezko
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Catherine C. Bakker
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Martijn P. G. Broen
- Department of NeurologyMaastricht University Medical CentreMaastrichtthe Netherlands
| | - Kathleen Chin
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Ted M. Dawson
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Neuroregeneration and Stem Cell ProgramsInstitute for Cell EngineeringJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Solomon H. Snyder Department of NeuroscienceJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Pharmacology and Molecular SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Vanessa Johnson
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Zoltan Mari
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Cherie L. Marvel
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Cognitive Neuroscience DivisionDepartment of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Kelly A. Mills
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Alexander Pantelyat
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Olga Pletnikova
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Clinical and Neuropathology CoreJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Liana S. Rosenthal
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Melissa D. Shepard
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Daniel A. Stevens
- Medical Scientist Training ProgramJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Juan C. Troncoso
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Clinical and Neuropathology CoreJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jiangxia Wang
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Gregory M. Pontone
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Morris K. Udall Parkinson's Disease Research CenterJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Schneider RB, Iourinets J, Richard IH. Parkinson's disease psychosis: presentation, diagnosis and management. Neurodegener Dis Manag 2017; 7:365-376. [DOI: 10.2217/nmt-2017-0028] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Parkinson's disease is a neurodegenerative disorder characterized by motor and nonmotor symptoms. Psychosis is a common feature of Parkinson's disease. Parkinson's disease psychosis (PDP) encompasses minor phenomena (illusions, passage hallucinations and presence hallucinations), visual and nonvisual hallucinations and delusions. PDP is associated with reduced function and quality of life. The initial management approach should focus on identification and treatment of any contributory medical factors, reduction or discontinuation of medications with potential to induce or worsen psychosis, nonpharmacological strategies and consideration of acetylcholinesterase inhibitor treatment in the setting of dementia. Pimavanserin, quetiapine and clozapine may all be considered for use in PDP. In this review, we discuss the presentation, diagnosis and management of PDP.
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Affiliation(s)
- Ruth B Schneider
- Department of Neurology, University of Rochester School of Medicine & Dentistry, 265 Crittenden Blvd, Box MIND, Rochester, NY 14642, USA
| | - Julia Iourinets
- Department of Neurology, University of Rochester School of Medicine & Dentistry, 919 Westfall Rd, Bldg C, Rochester, NY 14618, USA
| | - Irene H Richard
- Department of Neurology, University of Rochester School of Medicine & Dentistry, 919 Westfall Rd, Bldg C, Rochester, NY 14618, USA
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Foley JA, Warner TT, Cipolotti L. The neuropsychological profile of Othello syndrome in Parkinson's disease. Cortex 2017; 96:158-160. [DOI: 10.1016/j.cortex.2017.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/26/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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Sahli ZT, Tarazi FI. Pimavanserin: novel pharmacotherapy for Parkinson's disease psychosis. Expert Opin Drug Discov 2017; 13:103-110. [PMID: 29047301 DOI: 10.1080/17460441.2018.1394838] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Pimavanserin is the first FDA-approved atypical antipsychotic drug indicated for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis (PDP). Areas covered: This review focuses on the preclinical discovery of pimavanserin. It analyzes the pharmacological, behavioral and molecular mechanisms of pimavanserin and their contribution to the therapeutic advantages of the drug as reported in published preclinical and clinical studies, press releases and product labels. Expert opinion: Pimavanserin exhibits a unique pharmacological profile with nanomolar affinity at serotonin 5-HT2A and 5-HT2C receptors. Functionally, it acts as a potent inverse agonist at 5-HT2A receptors, with selectivity over 5-HT2C receptors and no appreciable activity at other neurotransmitter receptors. Behavioral studies found that pimavanserin reversed impaired behaviors in animal models predictive of antipsychotic activity, and with no impairment of motor functions. The drug exhibits long plasma half-life (57 hours), which support its once/day administration. A pivotal phase III clinical trial demonstrated significant improvement in PDP symptoms in patients receiving pimavanserin compared to placebo-treated patients. The drug also displayed relatively benign safety and tolerability profiles. Pimavanserin's mechanism of action might contribute to its unique psychopharmacological properties in the improved treatment of PDP, and perhaps psychosis in other diseases including schizophrenia and dementia-related psychosis.
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Affiliation(s)
- Zeyad T Sahli
- a Department of Psychiatry and Neuroscience Program , Harvard Medical School, McLean Hospital , Belmont , MA , USA
| | - Frank I Tarazi
- a Department of Psychiatry and Neuroscience Program , Harvard Medical School, McLean Hospital , Belmont , MA , USA
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Successful Use of Escitalopram for the Treatment of Visual Hallucinations in Patients With Parkinson Disease. Clin Neuropharmacol 2017; 40:246-250. [PMID: 29059136 DOI: 10.1097/wnf.0000000000000254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with Parkinson disease (PD) frequently experience visual hallucinations (VH). Visual hallucinations are most often viewed as an adverse effect of antiparkinsonian treatment. Possible treatments for this disturbance include a reduction of antiparkinsonian medications, adding atypical antipsychotics, or cholinesterase inhibitors. Some studies demonstrated that selective serotonin reuptake inhibitors may be an optional treatment for patients experiencing psychosis or agitation in dementia. Currently, there is no standard recommended treatment for VH in patients with PD. We present here our clinical experience with escitalopram (selective serotonin reuptake inhibitor) for treating this disturbance. METHODS Thirteen patients with PD (8 men and 5 women; age range 67-83 years) experiencing VH were openly treated with escitalopram 10 or 15 mg/d as add-on. Efficacy was assessed at baseline, then after 4 and 8 weeks of treatment using Clinical Global Impression-Severity and Clinical Global Impression-Improvement. RESULTS At the end of the 4th week of treatment, of 13 patients, 11 subjects demonstrated improvement, and in only 2 patients were there no changes in their condition. After an additional 4 weeks, 2 of the responders showed very significant improvement, 6 demonstrated much improvement, and 3 patients demonstrated minimal improvement. Only 1 patient showed no change in his condition. One additional patient stopped taking escitalopram after 5 weeks because of an absence of improvement in his state. CONCLUSIONS Escitalopram was well tolerated as treatment of VH in PD patients. This medication could be a promising optional therapy for this disturbance; however, further randomized controlled and bigger studies are necessary.
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Fields JA. Cognitive and Neuropsychiatric Features in Parkinson's and Lewy Body Dementias. Arch Clin Neuropsychol 2017; 32:786-801. [DOI: 10.1093/arclin/acx085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 01/11/2023] Open
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