Neuropsychiatric Symptoms of Parkinson's Disease

The Neuropsychiatry of Parkinson’s Disease: Advances and Challenges

• Neuropsychiatric signs and symptoms are common throughout the course of Parkinson's disease, and can be as clinically relevant as motor symptoms.

• These symptoms fall into broad categories of affect, perception and thinking, and motivation, and can be similar to or distinct from their counterparts in the general population.

• Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics.

• Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice.

• Mounting evidence supports a range of pharmacological and nonpharmacological interventions, but relatively few efficacious treatment options exist.

• Depression and anxiety are the most frequently occurring neuropsychiatric signs and symptoms, with depression prevalence rising more rapidly than anxiety in early disease.

• Psychosis and impulse control disorders are often associated with advanced Parkinson's disease, with the timing of impulse control disorders varying depending on dopaminergic medication prescribing practices.

• Apathy in Parkinson's disease has been much less studied than other neuropsychiatric presentations, with the reported prevalence ranging between studies.

• Correlates and risk factors of neuropsychiatric signs and symptoms can facilitate targeted screening, increasing the likelihood of early detection, management, and potential prevention.

• Several neuropsychiatric signs and symptoms observed in Parkinson's disease have bidirectional risk associations, suggesting that brainstem pathophysiological changes may be responsible for neuropsychiatric presentations in the prodromal phase.

• Psychosocial factors can also have an important role in the presentation of neuropsychiatric symptoms.

• Longitudinal studies suggest that psychosis in Parkinson's disease is most strongly associated with cognitive impairment, age, and disease duration.Neuropsychiatric symptoms in Parkinson's disease: recognition and treatment

• Neuropsychiatric symptoms are common in Parkinson's disease and include depression, anxiety, apathy, psychosis, and impulse control disorders.

• These symptoms have a significant impact on quality of life, disability, and caregiver burden.

• Risk factors for these symptoms include age, sex, disease severity, and medication use.

• Screening for these symptoms should be done regularly using validated instruments such as the International Parkinson and Movement Disorder Society Non-Motor Rating Scale and the Neuropsychiatric Inventory.

• Additional assessment can be done with disorder-specific rating scales and self-report forms.

• Non-pharmacological interventions such as psychotherapy and exercise have shown promise in treating depression.

• Pharmacological interventions such as antidepressants and selective serotonin reuptake inhibitors have also been effective in treating depression.

• Front-line psychopharmacology for anxiety in Parkinson's disease is typically a selective serotonin reuptake inhibitor.

• Good management principles for Parkinson's disease psychosis include ruling out delirium, decreasing dopaminergic therapy, and minimizing anticholinergic medication use.

• Pimavanserin, a serotonin 2A receptor inverse agonist and antagonist, is the frontline treatment for Parkinson's disease psychosis and has demonstrated efficacy for dementia-related psychosis.

• Clozapine is efficacious but rarely used, and quetiapine has little robust evidence to support its use.

• Interdisciplinary collaboration between psychiatrists, psychologists, and neurologists is needed for adequate treatment of these symptoms.Neuropsychiatry in Parkinson's disease: advances and challenges

• Neuropsychiatric symptoms in Parkinson's disease have a cumulative frequency greater than 50% and are associated with excess disability, worse quality of life, and greater burden for caregivers.

• The aetiology of neuropsychiatric symptoms in Parkinson's disease is a complex interaction of biological, psychological, and social factors.

• Parkinsonian treatments have varied effects on neuropsychiatric symptoms and optimal management is limited by the existence of few treatment options that are both efficacious and well-tolerated.

• Impulse control disorders in Parkinson's disease are associated with altered dopamine receptor function and downstream dysfunction in extrastriatal regions.

• Apathy in Parkinson's disease involves not only dopamine agonist pathways but also non-dopamine agonist pathways such as serotonin, norepinephrine, acetylcholine, and adenosine.

• Depression in Parkinson's disease could be related to dysfunction in subcortical nuclei and the prefrontal cortex, striatal-thalamic-prefrontal cortex circuits, brainstem monoamine and indolamine systems, and cerebral small vessel disease.

• Anxiety in Parkinson's disease is associated with alterations in the fear circuit and the limbic cortico-striato-thalamocortical circuit, and impairments in the dopamine system.

• Psychosis in Parkinson's disease is associated with dopaminergic therapy, cholinergic deficits, and a serotonin-dopamine imbalance.

• There is preliminary evidence that monogenic forms of Parkinson's disease might vary in terms of neuropsychiatry, with patients with GBA mutations having more severe symptoms and rapid progression than patients with LRKK2 mutations.

• Clinical-genetic models and pupillary reward sensitivity measures have been explored as potential personalised treatment approaches for impulse control disorders in Parkinson's disease.

• Advances in neurobiology can lead to improved recognition of signs and symptoms and the development of new treatments for neuropsychiatric symptoms in Parkinson's disease.

• Developing and testing new treatments for neuropsychiatric symptoms in Parkinson's disease is challenging due to the difficulty in recruiting for clinical trials and the complexity of multimorbid presentations with non-motor and motor symptoms.Non-motor symptoms in Parkinson's disease: a comprehensive overview

• Non-motor symptoms of Parkinson's disease (PD) can occur before motor symptoms and have a significant impact on quality of life.

• Neuropsychiatric symptoms, such as depression, anxiety, and apathy, are common in PD and can occur at any stage of the disease.

• Impulse control disorders, such as gambling and hypersexuality, are often associated with dopamine agonist use and affect up to 14% of PD patients.

• Psychosis, including hallucinations and delusions, is a common non-motor symptom of PD and affects up to 60% of patients.

• Sleep disturbances, such as REM sleep behavior disorder, are common in PD and can precede motor symptoms by years.

• Fatigue is a common non-motor symptom of PD and affects up to 50% of patients.

• Non-motor symptoms can be more disabling than motor symptoms and can be challenging to treat.

• Non-motor symptoms can be predictive of cognitive decline and dementia in PD.

• Risk factors for non-motor symptoms in PD include older age, longer disease duration, and greater motor severity.

• Treatment options for non-motor symptoms include pharmacological and non-pharmacological interventions, such as cognitive-behavioral therapy and exercise.

• Screening for non-motor symptoms should be a routine part of PD care, and interdisciplinary management is recommended.

• Further research is needed to better understand the underlying mechanisms of non-motor symptoms in PD and to develop more effective treatments.

The Neuropsychiatry of Parkinson’s Disease: Advances and Challenges

• Neuropsychiatric signs and symptoms are common throughout the course of Parkinson's disease, and can be as clinically relevant as motor symptoms.

• These symptoms fall into broad categories of affect, perception and thinking, and motivation, and can be similar to or distinct from their counterparts in the general population.

• Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics.

• Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice.

• Mounting evidence supports a range of pharmacological and nonpharmacological interventions, but relatively few efficacious treatment options exist.

• Depression and anxiety are the most frequently occurring neuropsychiatric signs and symptoms, with depression prevalence rising more rapidly than anxiety in early disease.

• Psychosis and impulse control disorders are often associated with advanced Parkinson's disease, with the timing of impulse control disorders varying depending on dopaminergic medication prescribing practices.

• Apathy in Parkinson's disease has been much less studied than other neuropsychiatric presentations, with the reported prevalence ranging between studies.

• Correlates and risk factors of neuropsychiatric signs and symptoms can facilitate targeted screening, increasing the likelihood of early detection, management, and potential prevention.

• Several neuropsychiatric signs and symptoms observed in Parkinson's disease have bidirectional risk associations, suggesting that brainstem pathophysiological changes may be responsible for neuropsychiatric presentations in the prodromal phase.

• Psychosocial factors can also have an important role in the presentation of neuropsychiatric symptoms.

• Longitudinal studies suggest that psychosis in Parkinson's disease is most strongly associated with cognitive impairment, age, and disease duration.Neuropsychiatric symptoms in Parkinson's disease: recognition and treatment

• Neuropsychiatric symptoms are common in Parkinson's disease and include depression, anxiety, apathy, psychosis, and impulse control disorders.

• These symptoms have a significant impact on quality of life, disability, and caregiver burden.

• Risk factors for these symptoms include age, sex, disease severity, and medication use.

• Screening for these symptoms should be done regularly using validated instruments such as the International Parkinson and Movement Disorder Society Non-Motor Rating Scale and the Neuropsychiatric Inventory.

• Additional assessment can be done with disorder-specific rating scales and self-report forms.

• Non-pharmacological interventions such as psychotherapy and exercise have shown promise in treating depression.

• Pharmacological interventions such as antidepressants and selective serotonin reuptake inhibitors have also been effective in treating depression.

• Front-line psychopharmacology for anxiety in Parkinson's disease is typically a selective serotonin reuptake inhibitor.

• Good management principles for Parkinson's disease psychosis include ruling out delirium, decreasing dopaminergic therapy, and minimizing anticholinergic medication use.

• Pimavanserin, a serotonin 2A receptor inverse agonist and antagonist, is the frontline treatment for Parkinson's disease psychosis and has demonstrated efficacy for dementia-related psychosis.

• Clozapine is efficacious but rarely used, and quetiapine has little robust evidence to support its use.

• Interdisciplinary collaboration between psychiatrists, psychologists, and neurologists is needed for adequate treatment of these symptoms.Neuropsychiatry in Parkinson's disease: advances and challenges

• Neuropsychiatric symptoms in Parkinson's disease have a cumulative frequency greater than 50% and are associated with excess disability, worse quality of life, and greater burden for caregivers.

• The aetiology of neuropsychiatric symptoms in Parkinson's disease is a complex interaction of biological, psychological, and social factors.

• Parkinsonian treatments have varied effects on neuropsychiatric symptoms and optimal management is limited by the existence of few treatment options that are both efficacious and well-tolerated.

• Impulse control disorders in Parkinson's disease are associated with altered dopamine receptor function and downstream dysfunction in extrastriatal regions.

• Apathy in Parkinson's disease involves not only dopamine agonist pathways but also non-dopamine agonist pathways such as serotonin, norepinephrine, acetylcholine, and adenosine.

• Depression in Parkinson's disease could be related to dysfunction in subcortical nuclei and the prefrontal cortex, striatal-thalamic-prefrontal cortex circuits, brainstem monoamine and indolamine systems, and cerebral small vessel disease.

• Anxiety in Parkinson's disease is associated with alterations in the fear circuit and the limbic cortico-striato-thalamocortical circuit, and impairments in the dopamine system.

• Psychosis in Parkinson's disease is associated with dopaminergic therapy, cholinergic deficits, and a serotonin-dopamine imbalance.

• There is preliminary evidence that monogenic forms of Parkinson's disease might vary in terms of neuropsychiatry, with patients with GBA mutations having more severe symptoms and rapid progression than patients with LRKK2 mutations.

• Clinical-genetic models and pupillary reward sensitivity measures have been explored as potential personalised treatment approaches for impulse control disorders in Parkinson's disease.

• Advances in neurobiology can lead to improved recognition of signs and symptoms and the development of new treatments for neuropsychiatric symptoms in Parkinson's disease.

• Developing and testing new treatments for neuropsychiatric symptoms in Parkinson's disease is challenging due to the difficulty in recruiting for clinical trials and the complexity of multimorbid presentations with non-motor and motor symptoms.Non-motor symptoms in Parkinson's disease: a comprehensive overview

• Non-motor symptoms of Parkinson's disease (PD) can occur before motor symptoms and have a significant impact on quality of life.

• Neuropsychiatric symptoms, such as depression, anxiety, and apathy, are common in PD and can occur at any stage of the disease.

• Impulse control disorders, such as gambling and hypersexuality, are often associated with dopamine agonist use and affect up to 14% of PD patients.

• Psychosis, including hallucinations and delusions, is a common non-motor symptom of PD and affects up to 60% of patients.

• Sleep disturbances, such as REM sleep behavior disorder, are common in PD and can precede motor symptoms by years.

• Fatigue is a common non-motor symptom of PD and affects up to 50% of patients.

• Non-motor symptoms can be more disabling than motor symptoms and can be challenging to treat.

• Non-motor symptoms can be predictive of cognitive decline and dementia in PD.

• Risk factors for non-motor symptoms in PD include older age, longer disease duration, and greater motor severity.

• Treatment options for non-motor symptoms include pharmacological and non-pharmacological interventions, such as cognitive-behavioral therapy and exercise.

• Screening for non-motor symptoms should be a routine part of PD care, and interdisciplinary management is recommended.

• Further research is needed to better understand the underlying mechanisms of non-motor symptoms in PD and to develop more effective treatments.

The Neuropsychiatry of Parkinson’s Disease: Advances and Challenges

• Neuropsychiatric signs and symptoms are common throughout the course of Parkinson's disease, and can be as clinically relevant as motor symptoms.

• These symptoms fall into broad categories of affect, perception and thinking, and motivation, and can be similar to or distinct from their counterparts in the general population.

• Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics.

• Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice.

• Mounting evidence supports a range of pharmacological and nonpharmacological interventions, but relatively few efficacious treatment options exist.

• Depression and anxiety are the most frequently occurring neuropsychiatric signs and symptoms, with depression prevalence rising more rapidly than anxiety in early disease.

• Psychosis and impulse control disorders are often associated with advanced Parkinson's disease, with the timing of impulse control disorders varying depending on dopaminergic medication prescribing practices.

• Apathy in Parkinson's disease has been much less studied than other neuropsychiatric presentations, with the reported prevalence ranging between studies.

• Correlates and risk factors of neuropsychiatric signs and symptoms can facilitate targeted screening, increasing the likelihood of early detection, management, and potential prevention.

• Several neuropsychiatric signs and symptoms observed in Parkinson's disease have bidirectional risk associations, suggesting that brainstem pathophysiological changes may be responsible for neuropsychiatric presentations in the prodromal phase.

• Psychosocial factors can also have an important role in the presentation of neuropsychiatric symptoms.

• Longitudinal studies suggest that psychosis in Parkinson's disease is most strongly associated with cognitive impairment, age, and disease duration.Neuropsychiatric symptoms in Parkinson's disease: recognition and treatment

• Neuropsychiatric symptoms are common in Parkinson's disease and include depression, anxiety, apathy, psychosis, and impulse control disorders.

• These symptoms have a significant impact on quality of life, disability, and caregiver burden.

• Risk factors for these symptoms include age, sex, disease severity, and medication use.

• Screening for these symptoms should be done regularly using validated instruments such as the International Parkinson and Movement Disorder Society Non-Motor Rating Scale and the Neuropsychiatric Inventory.

• Additional assessment can be done with disorder-specific rating scales and self-report forms.

• Non-pharmacological interventions such as psychotherapy and exercise have shown promise in treating depression.

• Pharmacological interventions such as antidepressants and selective serotonin reuptake inhibitors have also been effective in treating depression.

• Front-line psychopharmacology for anxiety in Parkinson's disease is typically a selective serotonin reuptake inhibitor.

• Good management principles for Parkinson's disease psychosis include ruling out delirium, decreasing dopaminergic therapy, and minimizing anticholinergic medication use.

• Pimavanserin, a serotonin 2A receptor inverse agonist and antagonist, is the frontline treatment for Parkinson's disease psychosis and has demonstrated efficacy for dementia-related psychosis.

• Clozapine is efficacious but rarely used, and quetiapine has little robust evidence to support its use.

• Interdisciplinary collaboration between psychiatrists, psychologists, and neurologists is needed for adequate treatment of these symptoms.Neuropsychiatry in Parkinson's disease: advances and challenges

• Neuropsychiatric symptoms in Parkinson's disease have a cumulative frequency greater than 50% and are associated with excess disability, worse quality of life, and greater burden for caregivers.

• The aetiology of neuropsychiatric symptoms in Parkinson's disease is a complex interaction of biological, psychological, and social factors.

• Parkinsonian treatments have varied effects on neuropsychiatric symptoms and optimal management is limited by the existence of few treatment options that are both efficacious and well-tolerated.

• Impulse control disorders in Parkinson's disease are associated with altered dopamine receptor function and downstream dysfunction in extrastriatal regions.

• Apathy in Parkinson's disease involves not only dopamine agonist pathways but also non-dopamine agonist pathways such as serotonin, norepinephrine, acetylcholine, and adenosine.

• Depression in Parkinson's disease could be related to dysfunction in subcortical nuclei and the prefrontal cortex, striatal-thalamic-prefrontal cortex circuits, brainstem monoamine and indolamine systems, and cerebral small vessel disease.

• Anxiety in Parkinson's disease is associated with alterations in the fear circuit and the limbic cortico-striato-thalamocortical circuit, and impairments in the dopamine system.

• Psychosis in Parkinson's disease is associated with dopaminergic therapy, cholinergic deficits, and a serotonin-dopamine imbalance.

• There is preliminary evidence that monogenic forms of Parkinson's disease might vary in terms of neuropsychiatry, with patients with GBA mutations having more severe symptoms and rapid progression than patients with LRKK2 mutations.

• Clinical-genetic models and pupillary reward sensitivity measures have been explored as potential personalised treatment approaches for impulse control disorders in Parkinson's disease.

• Advances in neurobiology can lead to improved recognition of signs and symptoms and the development of new treatments for neuropsychiatric symptoms in Parkinson's disease.

• Developing and testing new treatments for neuropsychiatric symptoms in Parkinson's disease is challenging due to the difficulty in recruiting for clinical trials and the complexity of multimorbid presentations with non-motor and motor symptoms.Non-motor symptoms in Parkinson's disease: a comprehensive overview

• Non-motor symptoms of Parkinson's disease (PD) can occur before motor symptoms and have a significant impact on quality of life.

• Neuropsychiatric symptoms, such as depression, anxiety, and apathy, are common in PD and can occur at any stage of the disease.

• Impulse control disorders, such as gambling and hypersexuality, are often associated with dopamine agonist use and affect up to 14% of PD patients.

• Psychosis, including hallucinations and delusions, is a common non-motor symptom of PD and affects up to 60% of patients.

• Sleep disturbances, such as REM sleep behavior disorder, are common in PD and can precede motor symptoms by years.

• Fatigue is a common non-motor symptom of PD and affects up to 50% of patients.

• Non-motor symptoms can be more disabling than motor symptoms and can be challenging to treat.

• Non-motor symptoms can be predictive of cognitive decline and dementia in PD.

• Risk factors for non-motor symptoms in PD include older age, longer disease duration, and greater motor severity.

• Treatment options for non-motor symptoms include pharmacological and non-pharmacological interventions, such as cognitive-behavioral therapy and exercise.

• Screening for non-motor symptoms should be a routine part of PD care, and interdisciplinary management is recommended.

• Further research is needed to better understand the underlying mechanisms of non-motor symptoms in PD and to develop more effective treatments.