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Chang YT, Huang CW, Chang HI, Hsu SW, Lee CC, Huang SH, Wang PN, Chang CC. Neuropsychiatric Symptoms and Caregiver Stress in Parkinson's Disease with Cognitive Impairment, Alzheimer's Disease, and Frontotemporal Dementia. JOURNAL OF PARKINSON'S DISEASE 2023; 13:243-254. [PMID: 36776077 PMCID: PMC10041428 DOI: 10.3233/jpd-223550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND A better understanding of factors associated with caregiver burden might facilitate the construction of coping strategies to improve their clinical outcomes and the comprehensive care model for dementia. OBJECTIVE To investigate the cognitive and neuropsychiatric domains that contribute to caregiver burden in three types of neurodegenerative disorders: Parkinson's disease (PD), Alzheimer's disease (AD), and frontotemporal disease (FTD). METHODS Eight hundred and fourteen patients and their caregivers were invited to participate; among them, 235 had PD with cognitive impairment; 429 had AD, and 150 had FTD. The evaluation protocol included the Neuropsychiatric Inventory (NPI), the Mini-Mental State Examination, the Chinese Version Verbal Learning Test, the modified Trail Making Test B, semantic fluency, and a geriatric depression score. Statistical comparisons of the cognitive tests, NPI total scores, and caregiver burden among the three diagnosed types of dementia, matched for a Clinical Dementia Rating (CDR) of 0.5 or 1, were performed, and multivariate linear regression models were used to evaluate the parameter significance. RESULTS Caregivers for patients with PD and FTD showed significant burden increments when the CDR scores changes from 0.5 to 1. For CDR = 0.5, the PD group had significantly lower caregiver burdens than the AD group, but the NPI total scores were significantly higher. Factors related to caregiver burden were the presence of delusion among all diagnosis groups, while the impact of NPI total scores related to caregiver burden was the highest in FTD, followed by AD and PD. CONCLUSIONS At the mild to moderate stages, our results suggested different degrees of significance in terms of the cognitive test scores or NPI subdomains for predicting caregiver stress among the three types of dementia.
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Affiliation(s)
- Yu-Tzu Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Wei Huang
- Cognition and Aging Center, Department of General Neurology, Institutes for translational research in biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-I Chang
- Cognition and Aging Center, Department of General Neurology, Institutes for translational research in biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Wei Hsu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Chang Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Hua Huang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Ning Wang
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, School of Medicine, National Yang-Ming Chia Tung University, Taipei, Taiwan
| | - Chiung-Chih Chang
- Cognition and Aging Center, Department of General Neurology, Institutes for translational research in biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Wieringa G, Dale M, Eccles FJR. Adjusting to living with Parkinson's disease; a meta-ethnography of qualitative research. Disabil Rehabil 2022; 44:6949-6968. [PMID: 34592863 DOI: 10.1080/09638288.2021.1981467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Parkinson's disease (PD) is a condition which causes significant difficulties in physical, cognitive and psychological domains. It is a progressive condition which people have to live with for a long time; consequently, there is a need to understand what contributes to individual adjustment. This review aimed to answer the question "how do individuals adjust to PD?" METHOD A systematic search of three databases (MEDLINE, CINAHL and PsycINFO) was carried out of papers documenting the adjustment process when living with PD and the findings were synthesised using a meta-ethnographic approach. RESULTS After exclusion based on eligibility criteria, 21 articles were included and were assessed for quality prior to analysing the data. Three main themes are proposed relating to the process of adjustment: "maintaining a coherent sense of self", "feeling in control" and "holding a positive mindset". Although many of the studies described challenges of living with PD, the results are dominated by the determination of individuals to self-manage their condition and maintain positive wellbeing. CONCLUSION The results highlight the need to empower patients to self-manage their illness, mitigating the effects of Parkinson's disease and supporting future wellbeing.IMPLICATIONS FOR REHABILITATIONIndividual identity disruption impacts on the self-value and sense of self coherence in individuals living with Parkinson's disease.Healthcare professionals should appreciate the complexity of the adjustment process which is related to the ability to maintain a coherent sense of self, to feel in control and to hold a positive mindset.Healthcare professionals should ensure information and knowledge related to self-management is tailored to an individual's understanding and experience of the disease.
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Affiliation(s)
- Gina Wieringa
- Faculty of Health and Medicine, Division of Health Research, Furness College, Lancaster University, Lancaster, UK
| | - Maria Dale
- Leicestershire Partnership NHS Trust, Mill Lodge, Leicestershire, UK
| | - Fiona J R Eccles
- Faculty of Health and Medicine, Division of Health Research, Furness College, Lancaster University, Lancaster, UK
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Dhingra A, Janjua AU, Hack L, Waserstein G, Palanci J, Hermida AP. Exploring Nonmotor Neuropsychiatric Manifestations of Parkinson Disease in a Comprehensive Care Setting. J Geriatr Psychiatry Neurol 2021; 34:181-195. [PMID: 32242493 DOI: 10.1177/0891988720915525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a debilitating neurological condition that includes both motor symptoms and nonmotor symptoms (NMS). Psychiatric complaints comprise NMS and are collectively referred to as neuropsychiatric manifestations. Common findings include atypical depressive symptoms, anxiety, psychosis, impulse control disorder, deterioration of cognition, and sleep disturbances. Quality of life (QoL) of patients suffering from NMS is greatly impacted and many times can be more debilitating than motor symptoms of PD. We expand on knowledge gained from treatment models within a comprehensive care model that incorporates multidisciplinary specialists working alongside psychiatrists to treat PD. Insight into background, clinical presentations, and treatment options for patients suffering from neuropsychiatric manifestations of PD are discussed. Identifying symptoms early can help improve QoL, provide early symptom relief, and can assist tailoring treatment plans that limit neuropsychiatric manifestations.
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Affiliation(s)
- Amitha Dhingra
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Hack
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriella Waserstein
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
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Juneja A, Anand K, Chandra M, Deshpande S, Dhamija R, Kathuria P, Mahajan R. Neuropsychiatric Symptoms and Caregiver Burden in Parkinson's Disease. Ann Indian Acad Neurol 2021; 23:656-660. [PMID: 33623267 PMCID: PMC7887493 DOI: 10.4103/aian.aian_91_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: Parkinson’s disease (PD) is a neurodegenerative disorder. It has a significant impact on the quality of life of patients and their caregivers. The present study aims to study the phenomena of neuropsychiatric symptoms and their association with caregiver burden in PD. Methods: The study was conducted in 100 patients of Parkinson’s disease and their primary caregivers. The patients of PD were diagnosed on the basis of UK Brain Bank criteria; severity/staging of Parkinson’s disease was done by Movement Disorder Society - Unified Parkinson’s disease rating scale (MDS-UPDRS-III). Patients who fulfilled inclusion and exclusion criteria were recruited for the study. The neuropsychiatric evaluation was based on Neuropsychiatric Inventory-Questionnaire (NPI-Q). Caregiver burden was assessed with the Zarit Caregiver Burden Inventory (ZCBI). Results: Mean age of PD patients was 61.48 ± 6.71 years, majority of them were males (68%). Mean total NPI score of patients was 44.46 ± 5.38. Mean age of caregivers was 52.26 ± 6.80 years, majority of them were females (72%) and spouse (76%) in relation to the patient. Caregiver burden was significantly related to age of the patient, duration of illness, severity of illness, and total NPI score. Conclusion: Neuropsychiatric symptoms significantly contribute to the caregiver burden in Parkinson’s disease.
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Affiliation(s)
| | - Kuljeet Anand
- Department of Neurology, Dr. RML Hospital, Delhi, India
| | - Mina Chandra
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | | | - Rajinder Dhamija
- Department of Neurology, LHMC and Sucheta Kriplani Hospital, Delhi, India
| | - Parul Kathuria
- Department of Psychiatry, Dr. RML Hospital, Delhi, India
| | - Rahul Mahajan
- Department of Neurology, Dr. RML Hospital, Delhi, India
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Williams NR, Bentzley BS, Sahlem GL, Pannu J, Korte JE, Revuelta G, Short EB, George MS. Unilateral ultra-brief pulse electroconvulsive therapy for depression in Parkinson's disease. Acta Neurol Scand 2017; 135:407-411. [PMID: 27241213 DOI: 10.1111/ane.12614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Electroconvulsive therapy (ECT) has demonstrated efficacy in treating core symptoms of Parkinson's disease (PD); however, widespread use of ECT in PD has been limited due to concern over cognitive burden. We investigated the use of a newer ECT technology known to have fewer cognitive side effects (right unilateral [RUL] ultra-brief pulse [UBP]) for the treatment of medically refractory psychiatric dysfunction in PD. MATERIALS AND METHODS This open-label pilot study included 6 patients who were assessed in the motoric, cognitive, and neuropsychiatric domains prior to and after RUL UBP ECT. Primary endpoints were changes in total score on the HAM-D-17 and GDS-30 rating scales. RESULTS Patients were found to improve in motoric and psychiatric domains following RUL UBP ECT without cognitive side effects, both immediately following ECT and at 1-month follow-up. CONCLUSIONS This study demonstrates that RUL UBP ECT is safe, feasible, and potentially efficacious in treating multiple domains of PD, including motor and mood, without clear cognitive side effects.
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Affiliation(s)
- N. R. Williams
- Department of Psychiatry & Behavioral Sciences; Stanford University; Stanford CA USA
| | - B. S. Bentzley
- Department of Psychiatry & Behavioral Sciences; Stanford University; Stanford CA USA
| | - G. L. Sahlem
- Department of Psychiatry; Medical University of South Carolina; Charleston SC USA
| | - J. Pannu
- Department of Psychiatry & Behavioral Sciences; Stanford University; Stanford CA USA
| | - J. E. Korte
- Department of Public Health Sciences; Medical University of South Carolina; Charleston SC USA
| | - G. Revuelta
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
| | - E. B. Short
- Department of Psychiatry; Medical University of South Carolina; Charleston SC USA
| | - M. S. George
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
- Department of Psychiatry; Medical University of South Carolina; Charleston SC USA
- Ralph H. Johnson VA Medical Center; Charleston SC USA
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Khan MA, Quadri SA, Tohid H. A comprehensive overview of the neuropsychiatry of Parkinson's disease: A review. Bull Menninger Clin 2017; 81:53-105. [DOI: 10.1521/bumc.2017.81.1.53] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Syed A. Quadri
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hassaan Tohid
- Center for Mind & Brain, University of California, Davis
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Haussmann R, Bauer M, Donix M. [Evidence-based treatment of psychosis associated with Parkinson's disease]. DER NERVENARZT 2017; 87:543-51. [PMID: 26643499 DOI: 10.1007/s00115-015-4438-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Psychotic symptoms in Parkinson's disease are frequent phenomena and are often associated with an immense burden for caregivers, increased risk of nursing home placement and mortality. Treatment of psychotic disorders associated with Parkinson's disease often poses a therapeutic dilemma and necessitates a differentiated risk-benefit assessment as both the reduction of antiparkinsonian drugs and use of antipsychotic drugs can result in deterioration of motor functions. This article gives an overview of relevant clinical aspects and highlights the pharmacological evidence-based treatment options.
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Affiliation(s)
- R Haussmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - M Bauer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Donix
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Williams NR, Sahlem G, Pannu J, Takacs I, Short B, Revuelta G, George MS. Neuroversion: using electroconvulsive therapy as a bridge to deep brain stimulation implantation. Neurocase 2017; 23:26-30. [PMID: 28376692 DOI: 10.1080/13554794.2016.1276605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Parkinson's disease (PD) is a movement disorder with significant neuropsychiatric comorbidities. Electroconvulsive therapy (ECT) is effective in treating these neuropsychiatric symptoms; however, clinicians are reluctant to use ECT in patients with deep brain stimulation (DBS) implantations for fear of damaging the device, as well as potential cognitive side effects. Right unilateral ultra-brief pulse (RUL UBP) ECT has a more favorable cognitive side-effect profile yet has never been reported in PD patients with DBS implants. We present a case series of three patients with a history of PD that all presented with psychiatric decompensation immediately prior to planned DBS surgery. All three patients had DBS electrode(s) in place at the time and an acute course of ECT was utilized in a novel method to "bridge" these individuals to neurosurgery. The patients all experienced symptom resolution (psychosis and/or depression and/or anxiety) without apparent cognitive side effects. This case series not only illustrates that right unilateral ultra-brief pulse can be utilized in patients with DBS electrodes but also illustrates that this intervention can be utilized as a neuromodulatory "bridge", where nonoperative surgical candidates with unstable psychiatric symptoms can be converted to operative candidates in a manner similar to electrical cardioversion.
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Affiliation(s)
- Nolan R Williams
- a Department of Psychiatry , Stanford University , Stanford , CA , USA
| | - Greg Sahlem
- b Department of Psychiatry , Medical University of South Carolina , Charleston , SC , USA
| | - Jaspreet Pannu
- a Department of Psychiatry , Stanford University , Stanford , CA , USA
| | - Istvan Takacs
- d Department of Neurosurgery , Medical University of South Carolina , Charleston , SC , USA
| | - Baron Short
- b Department of Psychiatry , Medical University of South Carolina , Charleston , SC , USA
| | - Gonzalo Revuelta
- c Department of Neurology , Medical University of South Carolina , Charleston , SC , USA
| | - Mark S George
- b Department of Psychiatry , Medical University of South Carolina , Charleston , SC , USA.,c Department of Neurology , Medical University of South Carolina , Charleston , SC , USA
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9
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Abstract
Psychosis in Parkinson's disease (PD) is one of the greatest determinants of nursing home placement and caregiver stress. Traditionally associated with medications with dopaminergic effect, it has now been linked to other medications and other stressors e.g. systemic illnesses. The development of hallucinations in a PD patient can herald the onset of dementia and usually predicts increased mortality risk. Medication reduction in PD psychosis usually reduces the symptoms; however, this comes at the cost of worsening motor function. If gradually decreasing the patient's medications does not resolve the psychosis, the treatment of choice is an atypical antipychotic. Though only clozapine has level A recommendation for this indication, other atypicals like quetiapine continue to get used for this purpose on account of the logistics involved with clozapine use. Cholinesterase inhibitors are also increasingly being used for PD psychosis on account of the association with dementia. The treatment of PD psychosis is an unmet need in PD management and search for suitable agents constitutes an active area of research in PD.
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Affiliation(s)
- Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA. .,Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA. .,Department of Medicine, College of Medicine University of Lagos, P.M.B. 12003, Idi-araba, Lagos, Nigeria.
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Calderón-Fajardo H, Cervantes-Arriaga A, Llorens-Arenas R, Ramírez-Bermudez J, Ruiz-Chow Á, Rodríguez-Violante M. Electroconvulsive therapy in Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:856-60. [PMID: 26331387 DOI: 10.1590/0004-282x20150131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/15/2015] [Indexed: 12/31/2022]
Abstract
Purpose To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease.Methods A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed.Results A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both.Conclusion Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson's disease.
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Affiliation(s)
- Humberto Calderón-Fajardo
- Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Mexico City, ME
| | - Amin Cervantes-Arriaga
- Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Mexico City, ME
| | - Rodrigo Llorens-Arenas
- Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Mexico City, ME
| | - Jesús Ramírez-Bermudez
- Departmento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Mexico City, ME
| | - Ángel Ruiz-Chow
- Departmento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Mexico City, ME
| | - Mayela Rodríguez-Violante
- Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Mexico City, ME
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Oh YS, Lee JE, Lee PH, Kim JS. Neuropsychiatric symptoms in Parkinson's disease dementia are associated with increased caregiver burden. J Mov Disord 2015; 8:26-32. [PMID: 25614783 PMCID: PMC4298716 DOI: 10.14802/jmd.14019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/04/2014] [Accepted: 09/18/2014] [Indexed: 12/31/2022] Open
Abstract
Objective Neuropsychiatric symptoms are common in Parkinson’s disease dementia (PDD). Frequent and severe neuropsychiatric symptoms create high levels of distress for patients and caregivers, decreasing their quality of life. The aim of this study was to investigate neuropsychiatric symptoms that may contribute to increased caregiver burden in PDD patients. Methods Forty-eight PDD patients were assessed using the 12-item Neuropsychiatric Inventory (NPI) to determine the frequency and severity of mental and behavioral problems. The Burden Interview and Caregiver Burden Inventory were used to evaluate caregiver burden. Results All but one patient showed one or more neuropsychiatric symptoms. The three most frequent neuropsychiatric symptoms were apathy (70.8%) and anxiety (70.8%), followed by depression (68.7%). More severe neuropsychiatric symptoms were significantly correlated with increased caregiver burden. The domains of delusion, hallucination, agitation and aggression, anxiety, irritability and lability, and aberrant motor behavior were associated with caregiver stress. After controlling for age and other potential confounding variables, total NPI score was significantly associated with caregiver burden. Conclusions The results of this study confirm that neuropsychiatric symptoms are frequent and severe in patients with PDD and are associated with increased caregiver distress. A detailed evaluation and management of neuropsychiatric symptoms in PDD patients appears necessary to improve patient quality of life and reduce caregiver burden.
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Affiliation(s)
- Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji E Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bountouni I, Zis P, Chaudhuri KR, Schrag A. Psychosis in Parkinson’s Disease. NEUROPSYCHIATRIC SYMPTOMS OF MOVEMENT DISORDERS 2015. [DOI: 10.1007/978-3-319-09537-0_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Advanced Parkinson's disease: Clinical characteristics and treatment. Part II. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2013.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Enfermedad de Parkinson avanzada. Características clínicas y tratamiento. Parte II. Neurologia 2013; 28:558-83. [DOI: 10.1016/j.nrl.2013.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/16/2013] [Accepted: 05/02/2013] [Indexed: 01/24/2023] Open
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Nadeau D, Giroux I, Dufour J, Simard M. Jeu pathologique chez les patients atteints de la maladie de Parkinson. SANTE MENTALE AU QUEBEC 2012; 37:189-202. [DOI: 10.7202/1012651ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le jeu pathologique consiste en une pratique inadaptée, persistante et répétée du jeu qui a des répercussions majeures sur les individus touchés, leur famille et la société (APA, 2003). Plusieurs facteurs de risque de nature biologique, psychologique et sociale ont été soulevés comme pouvant contribuer au jeu pathologique. Une nouvelle population à risque a récemment été découverte : les patients atteints de la Maladie de Parkinson. Le développement d’un jeu pathologique chez ces patients serait principalement relié à une médication associée au traitement de la Maladie de Parkinson, les agonistes dopaminergiques. Bien qu’une recrudescence d’études neurologiques qui s’intéressent à ce phénomène ait été notée, peu d’intervenants semblent être au courant de cette problématique et peu de recherches ont été réalisées afin d’étudier les aspects psychologiques de cette problématique.
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Affiliation(s)
- Dominic Nadeau
- Étudiant au doctorat en psychologie clinique à l’Université Laval (Québec)
| | - Isabelle Giroux
- Professeure à l’École de psychologie de l’Université Laval
- Directrice du Centre québécois d’excellence sur la prévention et le traitement du jeu (CQEPTJ) (Québec)
| | - Julie Dufour
- Psychologue au Centre de Réadaptation Ubald-Villeneuve (CRUV)
| | - Martine Simard
- Professeure à l’École de psychologie de l’Université Laval (Québec)
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Abstract
BACKGROUND : The use of antipsychotic medications is associated with an increased risk of death in older adults with dementia. The risk of death in patients with preexisting parkinsonism who receive antipsychotic drugs is not known. METHODS : Using a nested case-control design, we examined the risk of death within 30 days of newly starting antipsychotic medications among people with Parkinsonism aged 70 years and older in Ontario, Canada. Data were obtained from Ontario's healthcare administrative databases. RESULTS : Among 5,391 individuals with parkinsonism who died during the study period (2002-2008) and a matched comparison group of 25,937 who were still alive, individuals exposed to atypical antipsychotic drugs had a higher risk of death (unadjusted odds ratio [OR] = 2.8, 95% CI: 2.1-3.8, adjusted OR: 2.0, 95% CI: 1.4-2.7). Results were similar for quetiapine use compared with no antipsychotic use (unadjusted OR: 2.5, 95% CI: 1.6-4.0, adjusted OR = 1.8, 95% CI: 1.1-3.0). Typical antipsychotics were associated with an increased odds of death compared with atypical antipsychotics (unadjusted OR = 2.4, 95% CI 1.1-5.2, adjusted OR = 2.4, 95% CI: 1.1-5.7). CONCLUSIONS : Individuals with parkinsonism who are newly prescribed antipsychotic medications have a higher risk of death within 30 days than those who do not start these medications. Although it is not possible to establish causality, the results suggest an increased risk. It is important to be vigilant for accompanying serious medical conditions that may increase mortality in individuals requiring treatment with antipsychotics and to consider alternative approaches to treating psychosis, agitation, and aggression in this population.
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Weintraub D, Chen P, Ignacio RV, Mamikonyan E, Kales HC. Patterns and trends in antipsychotic prescribing for Parkinson disease psychosis. ACTA ACUST UNITED AC 2011; 68:899-904. [PMID: 21747029 DOI: 10.1001/archneurol.2011.139] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Antipsychotic (AP) use is common in Parkinson disease (PD), but APs can worsen parkinsonism, evidence for efficacy is limited, and use in patients with dementia increases mortality. OBJECTIVE To examine the frequency and characteristics, including changes over time, of AP use in a large cohort of patients with PD. DESIGN Using Veterans Affairs data from fiscal year (FY) 2008, rates and predictors of AP prescribing were determined for patients with PD and psychosis stratified by dementia status (N = 2597) and a comparison group of patients with dementia and psychosis without PD (N = 6907). Fiscal year 2008 and FY2002 data were compared to examine changes in AP prescribing over time. SETTING Department of Veterans Affairs outpatient facilities. PARTICIPANTS Outpatients with PD and psychosis and outpatients without PD with dementia and psychosis, all receiving care at Veterans Affairs facilities in FY2002 and FY2008. MAIN OUTCOME MEASURE Antipsychotic prescribing, including overall, class, and specific medications. RESULTS In FY2008, 50% of patients with PD having a diagnosis of psychosis were prescribed an AP. Among treated patients, the atypical AP quetiapine was most frequently prescribed (66%), but approximately 30% received high-potency APs. Clozapine was rarely prescribed (<2%). In multivariate models, diagnoses of PD and dementia were associated with AP use. Comparing FY2008 with FY2002, AP use in PD was unchanged, with decreases in risperidone and olanzapine use offset by an increase in quetiapine prescribing and the introduction of aripiprazole. CONCLUSIONS Half of the patients with PD and psychosis receive APs, not uncommonly high-potency agents associated with worsening parkinsonism, and frequency of use has been unchanged since the "black box" warning for AP use in patients with dementia was issued. Recent trends are a shift to quetiapine use and the common use of aripiprazole. As psychosis and dementia are frequently comorbid in PD, safety risks associated with AP use in this population need to be assessed.
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Affiliation(s)
- Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Todd D, Simpson J, Murray C. An interpretative phenomenological analysis of delusions in people with Parkinson's disease. Disabil Rehabil 2010; 32:1291-9. [PMID: 20088687 DOI: 10.3109/09638280903514705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this qualitative study was to explore what delusional experiences mean for people with Parkinson's disease (PD) and to examine how psychosocial factors contribute to the development and maintenance of delusional beliefs. METHOD Eight participants were interviewed, and interpretative phenomenological analysis was used to identity themes within their accounts. Participants were either recruited from a hospital-based outpatient movement disorder clinic or from a PD support group in the north-west of England. RESULTS Four themes emerged from the analysis: (1) 'I got very frightened': The emotional experience associated with delusions; (2) 'Why the hell's that happening?': Sense of uncertainty and of losing control; (3) 'I feel like I'm disintegrating': Loss of identity and sense of self; (4) 'I've just tried to make the best of things': Acceptance and adjustment to experience of delusions. These interconnected themes in participants' accounts of delusional beliefs were reflected in their descriptions of living with, and adjusting to, PD. CONCLUSIONS The results of this study add to the evidence base indicating the urgent examination of psychological alternatives to conventional, medication-based approaches to alleviating the distress caused by delusions in people with PD.
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Affiliation(s)
- David Todd
- Division of Health Research, Department of Clinical Psychology, Lancaster University, Lancaster LA1 4YT, UK.
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Abstract
OBJECTIVES Psychosis is common and often medically intractable in Parkinson disease (PD). Sometimes, its management is essential for the determination of the prognosis of PD. There have been several lines of studies demonstrating the effectiveness of electroconvulsive therapy (ECT) for depression in PD but very few for psychosis. The purpose of this retrospective study was to examine the effects of acute ECT on PD-associated psychosis. METHODS The subjects were 5 elderly PD patients (duration, 2-10 years); 4 of whom were diagnosed as "other substance (antiparkinsonian medications)-induced psychotic disorder, with hallucinations," and as 1 "psychotic disorder due to PD, with hallucinations," according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Two patients had comorbidity of major depressive disorder, single episode. The psychosis, being refractory to antipsychotics, was treated with a course of acute ECT. Psychiatric conditions were evaluated using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS), and the Global Assessment of Functioning (GAF) scale. Motor function was assessed using the Hoehn and Yahr staging. RESULTS The total BPRS and GAF scores after ECT improved significantly compared with those just before ECT. The Hoehn and Yahr staging also showed significant improvement. No marked adverse effects were seen. Duration of the improvement was between 5 and 30 weeks in followed-up patients. CONCLUSIONS Acute ECT was effective for medically refractory psychosis in patients with PD regardless of the comorbidity of depression. Our results suggest a possible indication of acute ECT for refractory psychosis in patients with PD.
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Meltzer HY, Mills R, Revell S, Williams H, Johnson A, Bahr D, Friedman JH. Pimavanserin, a serotonin(2A) receptor inverse agonist, for the treatment of parkinson's disease psychosis. Neuropsychopharmacology 2010; 35:881-92. [PMID: 19907417 PMCID: PMC3055369 DOI: 10.1038/npp.2009.176] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Psychotic symptoms occur in up to 40% of patients with Parkinson's disease (PD). Clozapine and quetiapine, two atypical antipsychotic drugs, at doses markedly lower than those effective in schizophrenia, which, nevertheless, still cause sedation, hypotension, and other side effects, are widely used to treat psychotic symptoms in patients with PD psychosis (PDP), although quetiapine has never been shown to be effective in a placebo-controlled study. The demonstrated efficacy of clozapine in PDP has been attributed to serotonin (5-HT(2A)) receptor blockade. We postulated that pimavanserin (ACP-103), a highly selective 5-HT(2A) inverse agonist, would attenuate psychosis in patients with PDP, but avoid motoric worsening and non-motoric side effects. In this double-blind, randomized multicenter 28-day study, the tolerability and efficacy of pimavanserin was compared with placebo in 60 patients with L-DOPA or dopamine (DA) agonist-induced PDP. Motor function was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II and III. Antipsychotic efficacy was evaluated using multiple measures from the Scale for the Assessment of Positive Symptoms (SAPS) and a UPDRS Part I psychosis-relevant item. Pimavanserin did not differentiate from placebo with regard to motor impairment, sedation, hypotension, or other side effects. The principal measures of efficacy of antipsychotic response to pimavanserin, the SAPS total domain score, only showed a trend. However, the pimavanserin-treated patients showed significantly greater improvement in some but not all measures of psychosis, including SAPS global measures of hallucinations and delusions, persecutory delusions, and the UPDRS measure of delusions and hallucinations. Pimavanserin showed significantly greater improvement in psychosis in patients with PDP at a dose which did not impair motor function, or cause sedation or hypotension Thus, pimavanserin may represent a novel treatment for PDP. Furthermore, these results support the hypothesis that attenuation of psychosis secondary to DA receptor stimulation in PDP may be achieved through selective 5-HT(2A) receptor antagonism.
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Affiliation(s)
- Herbert Y Meltzer
- Department of Psychiatry, Vanderbilt University School of Medicine, Psychiatric Hospital at Vanderbilt, Nashville,TN 37212, USA.
| | | | | | | | | | - Daun Bahr
- ACADIA Pharmaceuticals, San Diego, CA, USA
| | - Joseph H Friedman
- Department of Clinical Neurosciences, The Warren Alpert School of Medicine of Brown University, Parkinson's Disease and Movement Disorders Center, NeuroHealth, Warwick, RI, USA
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Psychiatric Issues in Parkinson's Disease. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/b978-1-4160-6641-5.00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abbas A, Roth BL. Pimavanserin tartrate: a 5-HT2A inverse agonist with potential for treating various neuropsychiatric disorders. Expert Opin Pharmacother 2009; 9:3251-9. [PMID: 19040345 DOI: 10.1517/14656560802532707] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pimavanserin tartrate is the first 5-HT(2A) inverse agonist to enter clinical trials as a treatment for L-dopa-induced psychosis in Parkinson's disease and for augmentation of low-dose risperidone treatment in schizophrenia. Pimavanserin is also being evaluated as a possible anti-insomnia drug. OBJECTIVE To discuss the potential of pimavanserin to fill multiple therapeutic needs. METHODS The problems with currently approved antipsychotics and sleep agents are explored to highlight how pimavanserin might address some longstanding issues in the treatment of psychosis and insomnia. RESULTS/CONCLUSIONS In Phase II clinical trials, pimavanserin seemed to be safe, well-tolerated and efficacious in treating L-dopa-induced psychosis without worsening motor symptoms. Pimavanserin also potentiated the therapeutic effects of low-dose risperidone, reduced haloperidol-induced akathisia, and increased slow-wave sleep in older individuals.
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Affiliation(s)
- Atheir Abbas
- Case Western Reserve University School of Medicine, Biochemistry, Cleveland, OH 44106, USA.
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23
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Abstract
Parkinson's disease (PD) is a neurodegenerative disorder which is often reduced to a mere dysfunction of motor performance. Non-motor symptoms, however, are frequent impairments in PD and result in a major impact on the patients and their caregivers. The major neuropsychiatric comorbidities depression, anxiety, and psychotic symptoms are briefly discussed. Additionally, a brief outlook on deep brain stimulation and its effect on psychiatric symptoms is provided. Several studies did show that neuropsychiatric symptoms are underdiagnosed and consecutively treated inadequately. All in all more attention should be directed to the detection and treatment of psychiatric symptoms in PD patients in routine clinical settings.
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Syndrome de dysrégulation dopaminergique dans la maladie de Parkinson. Rev Neurol (Paris) 2008; 164:310-21. [DOI: 10.1016/j.neurol.2008.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 11/19/2007] [Accepted: 01/10/2008] [Indexed: 12/31/2022]
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Onofrj M, Thomas A, Bonanni L. New approaches to understanding hallucinations in Parkinson's disease: phenomenology and possible origins. Expert Rev Neurother 2008; 7:1731-50. [PMID: 18052766 DOI: 10.1586/14737175.7.12.1731] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors review current literature on hallucinations in Parkinson's disease (PD). Recent neuropathological studies showed that hallucinations occur in synucleinopathies and are a significant predictor of Lewy Body depositions. Therefore, hallucinations are a hallmark of PD and of dementia with Lewy Bodies. Visual hallucinations are mostly complex and kinematic; preserved or disturbed insight on the nature of hallucinations is a major prognostic factor, although eventually all hallucinators will present with reduced insight. Current theories on the origin of hallucinations point to visual dysfunction, dream overflow and cognitive impairment, yet objection can be raised on each one of the putative models of hallucinations. Understanding of the origin of hallucinations is required in order to develop treatments: all treatment evaluations were focused in general on psychosis, and only clozapine obtained positive evidence-based ratings on efficacy. However, it is likely that cholinesterase inhibitors, antipsychotics and anti-5-hydroxytryptamine(3) agents and drugs acting on sleep regulation will have different and perhaps opposite effects on different types of hallucinations, whether they are accompanied by disturbed insight, sleep disorders or other psychotic features. Further studies will try to separate phenomenology and responses to treatment and will investigate the relevance of concomitant sleep disorders and abnormality of frontoparietal networks involved in the attention process.
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Affiliation(s)
- Marco Onofrj
- University G. D'Annunzio, Department of Neurophysiopathology, Chieti-Pescara, 65124, Pescara, Italy.
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26
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Abstract
Psychotic symptoms in Parkinson's disease (PD) are relatively common and, in addition to creating a disturbance in patients' daily lives, have consistently been shown to be associated with poor outcome. Our understanding of the pathophysiology of psychosis in PD has expanded dramatically over the past 15 years, from an initial interpretation of symptoms as dopaminergic drug adverse effects to the current view of a complex interplay of extrinsic and disease-related factors.PD psychosis has unique clinical features, namely that it arises within a context of a clear sensorium and retained insight, there is relative prominence of visual hallucinations and progression occurs over time. PD psychosis tends to emerge later in the disease course, and disease duration represents one risk factor for its development. The use of anti-PD medications (particularly dopamine receptor agonists) has been the most widely identified risk factor for PD psychosis. Other risk factors discussed in the literature include older age, disease severity, sleep disturbance, cognitive impairment, dementia and/or depression.Recent efforts have aimed to explore the complex pathophysiology of PD psychosis, which is now known to involve an interaction between extrinsic, drug-related and intrinsic, disease-related components. The most important extrinsic factor is use of dopaminergic medication, which plays a prominent role in PD psychosis. Intrinsic factors include visual processing deficits (e.g. lower visual acuity, colour and contrast recognition deficits, ocular pathology and functional brain abnormalities identified amongst hallucinating PD patients); sleep dysregulation (e.g. sleep fragmentation and altered dream phenomena); neurochemical (dopamine, serotonin, acetylcholine, etc.) and structural abnormalities involving site-specific Lewy body deposition; and genetics (e.g. apolipoprotein E epsilon4 allele and tau H1H1 genotype). Preliminary reports have also shown a potential relationship between deep brain stimulation surgery and PD psychosis.When reduction in anti-PD medications to the lowest tolerated dose does not improve psychosis, further intervention may be warranted. Several atypical antipsychotic agents (i.e. clozapine, olanzapine) have been shown to be efficacious in reducing psychotic symptoms in PD; however, use of clozapine requires cumbersome monitoring and olanzapine leads to motor worsening. Studies of ziprasidone and aripiprazole are limited to open-label trials and case reports and are highly variable; however, it appears that while each may be effective in some patients, both are associated with adverse effects. While quetiapine has not been determined efficacious in two randomized controlled trials, it is a common first-line treatment for PD psychosis because of its tolerability, ease of use and demonstrated utility in numerous open-label reports. Cholinesterase inhibitors currently represent the most promising pharmacological alternative to antipsychotics. Tacrine is rarely tried because of hepatic toxicity, and controlled trials with donepezil have not shown significant reductions in psychotic symptoms, due perhaps to methodological limitations. However, results from an open-label study and a double-blind, placebo-controlled trial involving 188 hallucinating PD patients support the efficacy of rivastigmine. With regard to non-pharmacological interventions, case reports suggest that electroconvulsive therapy has the potential to reduce psychotic symptoms and may be considered in cases involving concurrent depression and/or medication-refractory psychosis. Limited case reports also suggest that specific antidepressants (i.e. clomipramine and citalopram) may improve psychosis in depressed patients. Finally, studies in the schizophrenia literature indicate that psychological approaches are effective in psychosis management but, to date, this strategy has been supported only qualitatively in PD, and further studies are warranted.
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Affiliation(s)
- Laura B Zahodne
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
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27
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Mehler-Wex C, Riederer P, Gerlach M. Dopaminergic dysbalance in distinct basal ganglia neurocircuits: implications for the pathophysiology of Parkinson's disease, schizophrenia and attention deficit hyperactivity disorder. Neurotox Res 2007; 10:167-79. [PMID: 17197367 DOI: 10.1007/bf03033354] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The basal ganglia form a forebrain system that collects signals from a large part of the neocortex, redistributes these cortical inputs both with respect to one another and with respect to inputs from the limbic system, and then focuses the inputs of this redistributed, integrated signals into particular regions of the frontal lobes and brainstem involved in aspects of motor planning and motor memory. Movement disorders associated with basal ganglia dysfunction comprise a spectrum of abnormalities that range from the hypokinetic disorder (from which Parkinson's disease, PD, is the best-known-example) at one extreme to the hyperkinetic disorder (exemplified by Huntington's disease and hemiballism) at the other. In addition to disorders of movement, major mental disorders including schizophrenic-like states and attention deficit hyperactivity disorder (ADHD) have been linked to abnormalities in the basal ganglia and their allied nuclei. In this paper we discuss recent evidence indicating that a dopamine-induced dysbalance of basal ganglia neurocircuitries may be an important pathophysiological component in PD, schizophrenia and ADHD. According to our model, the deprivation of dopaminergic nigro-striatal input, as in PD, reduces the positive feedback via the direct system, and increases the negative feedback via the indirect system. The critical consequences are an overactivity of the basal ganglia output sites with the resulting inhibition of thalamo-cortical drive. In schizophrenia the serious cognitive deficits might be partly a result of a hyperactivity of the inhibitory dopamine D(2) transmission system. Through this dysinhibition, the thalamus exhibits hyperactivity that overstimulates the cortex resulting in dysfunctions of perception, attention, stimulus distinction, information processing and affective regulation (inducing hallucinations and delusions) and motor disabilities. Recent studies have strongly suggested that a disturbance of the dopaminergic system is also involved in the pathophysiology of ADHD. The most convincing evidence comes from the demonstration of the efficacy of psychostimulants such as the dopamine transporter (DAT) blocker methylphenidate in the symptomatic treatment of ADHD. Genetic studies have shown an association between ADHD and genes involved in dopaminergic neurotransmission (for example the dopamine receptor genes DRD4 and DRD5, and the DAT gene DAT1). DAT knockout mice display a phenotype with increased locomotor activity, which is normalized by psychostimulant treatment. Finally, imaging studies demonstrated an increased density of DAT in the striatum of ADHD patients. Which system is disturbed and whether this system is hyper- or hypoactive is not unambiguously known yet.
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Affiliation(s)
- C Mehler-Wex
- Department of Child and Adolescent Psychiatry and Psychotherapy, Julius-Maximilians-University, Wuerzburg, Germany
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Aarsland D, Brønnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, Cummings JL. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 2007; 78:36-42. [PMID: 16820421 PMCID: PMC2117797 DOI: 10.1136/jnnp.2005.083113] [Citation(s) in RCA: 289] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the profile of neuropsychiatric symptoms in patients with dementia associated with Parkinson's disease (PDD). METHODS 537 patients with PDD drawn from an international multicentre clinical trial of rivastigmine were assessed using the 10-item Neuropsychiatric Inventory (NPI). A cluster analysis was used to investigate the inter-relationship of NPI items. Associations between the clusters and demographic and clinical variables were analysed. RESULTS 89% of the patients presented at least one symptom on the NPI, 77% had two or more symptoms and 64% had at least one symptom with a score > or = 4. The most common symptoms were depression (58%), apathy (54%), anxiety (49%) and hallucinations (44%). Patients with more severe dementia and advanced Parkinson's disease had more neuropsychiatric symptoms. Nearly 60% of the care givers reported at least one NPI symptom to be of at least moderate severe distress. Five NPI clusters were identified: one group with few and mild symptoms (52%); a mood cluster (11%, high scores on depression, anxiety and apathy); apathy (24%; high apathy and low scores on other items); agitation (5%, high score on agitation and high total NPI score); and a psychosis cluster (8%; high scores on delusions and hallucinations). The psychosis and agitation clusters had the lowest Mini-Mental State Examination score and the highest Unified Parkinson's Disease Rating Scale and care giver distress scores. CONCLUSION Neuropsychiatric symptoms are common in patients with PDD. The profile of these symptoms differs from that in other types of dementia. Subgroups with different neuropsychiatric profiles were identified. These subgroups may be associated with distinct neurobiological changes, which should be explored in future studies.
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Affiliation(s)
- D Aarsland
- Centre for Clinical Neuroscience Research, Stavanger University Hospital, Stavanger, Norway.
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29
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Abstract
Parkinson's disease affects up to 1 million people in the US, most of them elderly. Motor and non-motor symptoms can be significantly disabling to the point of necessitating institutionalisation. Age-related changes in drug absorption, distribution, metabolism and excretion complicate the treatment of elderly patients with Parkinson's disease. General management principles include initiation of medication at low doses with gradual titration based on clinical effects, avoidance of certain classes of drugs (e.g. anticholinergics), and attention to polypharmacy and its risk for potentially toxic drug interactions. Levodopa remains the most efficacious anti-Parkinson's disease medication and should be the cornerstone of therapy in the elderly Parkinson's disease patient. Use of dopamine receptor agonists, amantadine and anticholinergic drugs in the elderly is limited by high risk for psychotoxicity. Catechol-O-methyltransferase inhibitors may be used to augment levodopa in the setting of 'wearing off' (i.e. motor fluctuations). Monoamine oxidase type B (MAO-B) inhibitors can be used across the spectrum of disease severity, but selegiline (deprenyl), the prototype in this class, is characterised by low and erratic bioavailability of the parent drug and conversion to amphetamine metabolites that may increase the risk of adverse events. A new orally disintegrating tablet formulation overcomes some of these limitations. Rasagiline is a new, selective, second-generation MAO-B inhibitor that is chemically and metabolically distinct from selegiline. The favourable safety profile of rasagiline in the elderly and its once-daily formulation may maximise drug adherence and improve outcomes.
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Affiliation(s)
- Jack J Chen
- Movement Disorders Center, Schools of Medicine and Pharmacy, Loma Linda University, Loma Linda, California 92350, USA.
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Lin JJ, Yueh KC, Lin SZ, Harn HJ, Liu JT. Genetic polymorphism of the angiotensin converting enzyme and L-dopa-induced adverse effects in Parkinson's disease. J Neurol Sci 2006; 252:130-4. [PMID: 17196621 DOI: 10.1016/j.jns.2006.10.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 10/19/2006] [Accepted: 10/30/2006] [Indexed: 11/23/2022]
Abstract
There was increasing evidence suggesting that angiotensin I-converting enzyme may play an important role in the pathogenesis of PD. Our former study has shown that angiotensin I-converting enzyme gene (ACE) may confer a susceptibility for the risk of Parkinson's disease (PD). Meanwhile, recent studies have emphasized that genetic factors may involve in the occurrence of the adverse effects of chronic L-dopa therapy in PD patients. This study was designed to assess whether genetic polymorphism of the ACE could be a predictor of L-dopa-induced adverse effects in PD. There were 251 patients included in this study and their mean age at onset of disease was 63.3+/-11.4 years. The duration of disease and the treatment with L-dopa was 6.3+/-5.1 and 5.0+/-4.3 years, respectively. The frequency of the homozygote ACE-II genotype of the ACE in PD patients with L-dopa-induced psychosis was significantly higher than that in PD patients without the adverse effect (63.3% vs 43.0%; chi(2)=6.347, OR=1.435, 95%CI=1.105-1.864, p=0.012). However, the ACE polymorphism was not associated with the risk to develop dyskinesia or motor fluctuation induced by L-dopa. Furthermore, a logistic regression analysis confirmed that the ACE-II genotype was an independent risk factor for L-dopa-induced psychosis in PD patients (OR=2.542, p=0.012). In conclusion, results of the study showed that ACE-II genotype might confer a primary predictor for the occurrence of psychosis in L-dopa-treated PD.
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Affiliation(s)
- Juei-Jueng Lin
- Department of Neurology, Chushang Show-Chwan Hospital, Nantou, 557, Taiwan.
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Colosimo C, Fabbrini G, Berardelli A. Drug Insight: new drugs in development for Parkinson's disease. ACTA ACUST UNITED AC 2006; 2:600-10. [PMID: 17057747 DOI: 10.1038/ncpneuro0340] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 08/24/2006] [Indexed: 11/08/2022]
Abstract
For many years, levodopa has given most patients with Parkinson's disease excellent symptomatic benefit. This agent does not slow down the progression of the disease, however, and it can induce motor fluctuations and dyskinesias in the long term. The other available antiparkinsonian agents also have drawbacks, and as a consequence research into antiparkinsonian drugs is expected to take new and different directions in the coming years. The most promising approaches include the development of 'neuroprotective' drugs that are capable of blocking or at least slowing down the degenerative process that is responsible for cellular death; 'restorative' strategies intended to restore normal brain function; more-effective agents for replacing dopamine loss; and symptomatic and antidyskinetic drugs that act on neurotransmitters other than dopamine or target brain areas other than the striatum. In this Review, we discuss the numerous drugs in development that target the primary motor disorder in Parkinson's disease.
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Affiliation(s)
- Carlo Colosimo
- University Department of Neurosciences University of Rome, La Sapienza, Italy.
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Okamura T, Kudo K, Sata N, Sameshima T, Doi N, Kato N. Electroconvulsive therapy after coil embolization of cerebral aneurysm: a case report and literature review. J ECT 2006; 22:148-9. [PMID: 16801833 DOI: 10.1097/00124509-200606000-00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of an uneventful course after electroconvulsive therapy (ECT) of a patient who had undergone coil embolization for an intracranial aneurysm 37 days earlier. There have been no reports until now of ECT after coil embolization. According to histopathologic examinations, it takes approximately 2 weeks after coil embolization for the aneurysm to become fixed. The ECT can be a therapeutic option even in patients with a previous history of coil embolization, as long as it is performed under proper anesthetic management.
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Abstract
Psychosis is common in Parkinson's disease (PD), particularly in its later stages. The symptoms range from comparatively minor illusions, vivid dreams, and occasional, non-disturbing visual hallucinations to frank psychosis. The pathogenesis of psychosis in PD is not fully known. Management of psychosis in PD requires a multidisciplinary approach. Some of the newer atypical antipsychotics are effective against psychosis with no significant worsening of PD. Psychosis in PD is associated with poor quality of life for patients and the carers.
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Affiliation(s)
- B R Thanvi
- Department of Medicine for Older People, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK.
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