Psychosis in Parkinson’s Disease: Current Treatment Options and Impact on Patients and Caregivers

2021 ◽  
Vol 34 (4) ◽  
pp. 274-279
Author(s):  
Gilad S. Segal ◽  
Sophie J. Xie ◽  
Saif-ur-Rahman Paracha ◽  
George T. Grossberg
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Atypical Antipsychotics ◽  
Treatment Options ◽  
Current Treatment ◽  
Visual Hallucinations ◽  
Mesolimbic Pathway ◽  
Sequential Development ◽  
Home Placement

Parkinson’s disease (PD) is the second most common neurodegenerative disease seen in older adults after Alzheimer’s disease, with increasing prevalence worldwide. Parkinson’s disease psychosis (PDP) is a common, non-motor feature of PD, which increases caregiver stress and is a risk-factor for nursing home placement. In this paper we review PDP epidemiology, features, diagnosis, and treatment. PDP most often presents with sequential development of minor and then increasingly complex visual hallucinations mediated by dopaminergic-serotonergic interactions activating the mesolimbic pathway, with contributions from other structures and neurotransmitters. Appropriate evaluation of differential diagnoses for psychosis is vital before diagnosing PDP. Initial treatment should involve non-pharmacologic approaches. If these are unsuccessful and PDP symptoms significantly impact the patient’s and or their caregivers’ quality of life and functions, then pharmacotherapy is indicated. Pimavanserin is a recently FDA-approved pharmacologic treatment for PDP with a better profile of balanced effectiveness and safety compared to previous use of atypical antipsychotics. Early diagnosis and safer, more effective treatments for PDP should help reduce caregiver burden and enable caregivers to continue to provide care at home versus institutionalization.

Selected natural and synthetic agents effective against Parkinson’s disease with diverse mechanisms

2021 ◽  
Vol 21 ◽  
Author(s):  
Hayrettin Ozan Gulcan
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Dopamine Metabolism ◽  
Dopaminergic Agonists ◽  
Alternative Drug ◽  
Synthetic Agents ◽  
Disease Modifying

: Similar to other neurodegenerative diseases, Parkinson’s disease (PD) has been extensively investigated with respect to its neuropathological background and possible treatment options. Since the symptomatic outcomes are generally related to dopamine deficiency, the current treatment strategies towards PD mainly employ dopaminergic agonists as well as the compounds acting on dopamine metabolism. These drugs do not provide disease modifying properties; therefore alternative drug discovery studies focus on targets involved in the progressive neurodegenerative character of PD. This study has aimed to present the pathophysiology of PD concomitant to the representation of drugs and promising molecules displaying activity against the validated and non-validated targets of PD.

scholarly journals Orthostatic Hypotension in Patients with Parkinson’s Disease and Atypical Parkinsonism

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Seyed-Mohammad Fereshtehnejad ◽  
Johan Lökk
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
Treatment Options ◽  
Motor Symptoms ◽  
Atypical Parkinsonism ◽  
Medical Databases ◽  
Risk Of Falls ◽  
Review Current

Orthostatic hypotension (OH) is one of the commonly occurring nonmotor symptoms in patients with idiopathic Parkinson’s disease (IPD) and atypical parkinsonism (AP). We aimed to review current evidences on epidemiology, diagnosis, treatment, and prognosis of OH in patients with IPD and AP. Major electronic medical databases were assessed including PubMed/MEDLINE and Embase up to February 2013. English-written original or review articles with keywords such as “Parkinson’s disease,” “atypical parkinsonism,” and “orthostatic hypotension” were searched for relevant evidences. We addressed different issues such as OH definition, epidemiologic characteristics, pathophysiology, testing and diagnosis, risk factors for symptomatic OH, OH as an early sign of IPD, prognosis, and treatment options of OH in parkinsonian syndromes. Symptomatic OH is present in up to 30% of IPD, 80% of multiple system atrophy (MSA), and 27% of other AP patients. OH may herald the onset of PD before cardinal motor symptoms and our review emphasises the importance of its timely diagnosis (even as one preclinical marker) and multifactorial treatment, starting with patient education and lifestyle approach. Advancing age, male sex, disease severity, and duration and subtype of motor symptoms are predisposing factors. OH increases the risk of falls, which affects the quality of life in PD patients.

scholarly journals New Thoughts on Thought Disorders in Parkinson's Disease: Review of Current Research Strategies and Challenges

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Jennifer G. Goldman
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Research Strategies ◽  
Dopamine System ◽  
Extrinsic Factors ◽  
Thought Disorders ◽  
New Research ◽  
Home Placement

Psychosis is a frequent nonmotor complication in Parkinson's disease (PD), characterized by a broad phenomenology and likely due to a variety of intrinsic (i.e., PD-related) and extrinsic factors. Safe and effective therapies are greatly needed as PD psychosis contributes significantly to morbidity, mortality, nursing home placement, and quality of life. Novel research strategies focused on understanding the pharmacology and pathophysiology of PD psychosis, utilizing translational research including animal models, genetics, and neuroimaging, and even looking beyond the dopamine system may further therapeutic advances. This review discusses new research strategies regarding the neurobiology and treatment of PD psychosis and several associated challenges.

scholarly journals Bright Light Therapy in Parkinson's Disease: An Overview of the Background and Evidence

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Sonja Rutten ◽  
Chris Vriend ◽  
Odile A. van den Heuvel ◽  
Jan H. Smit ◽  
Henk W. Berendse ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Circadian Rhythm ◽  
Sleep Disorders ◽  
Treatment Options ◽  
Bright Light ◽  
Light Therapy ◽  
Current Treatment ◽  
Bright Light Therapy ◽  
Positive Effect

Sleep disorders are common in Parkinson's disease (PD) and seem to be strongly associated with depression. It has been suggested that sleep disorders as well as depression are caused by a disturbed circadian rhythm. Indeed, PD patients are prone to misalignment of their circadian rhythm due to various factors, and many patients with PD display a phase advance of their circadian rhythm. Current treatment options for sleep disorders and depression in patients with PD are limited and can have serious side effects; alternative treatments are therefore badly needed. Bright light therapy (BLT) restores circadian rhythmicity effectively in mood- and sleep-disturbed patients without PD. The few studies that focused on the efficacy of BLT in patients with PD demonstrated a positive effect of BLT not only on sleep and mood but also on motor function. More research on the neurobiology and efficacy of BLT in PD is warranted.

scholarly journals Towards optimising experimental quantification of persistent pain in Parkinson’s disease using psychophysical testing

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kirsty Bannister ◽  
Rory V. Smith ◽  
Patrick Wilkins ◽  
Tatum M. Cummins
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Treatment Options ◽  
Persistent Pain ◽  
Research Literature ◽  
Pain Processing ◽  
Motor Symptoms ◽  
Healthcare Provision ◽  
Psychophysical Testing

AbstractPeople with Parkinson’s disease (PD) may live for multiple decades after diagnosis. Ensuring that effective healthcare provision is received across the range of symptoms experienced is vital to the individual’s wellbeing and quality of life. As well as the hallmark motor symptoms, PD patients may also suffer from non-motor symptoms including persistent pain. This type of pain (lasting more than 3 months) is inconsistently described and poorly understood, resulting in limited treatment options. Evidence-based pain remedies are coming to the fore but therapeutic strategies that offer an improved analgesic profile remain an unmet clinical need. Since the ability to establish a link between the neurodegenerative changes that underlie PD and those that underlie maladaptive pain processing leading to persistent pain could illuminate mechanisms or risk factors of disease initiation, progression and maintenance, we evaluated the latest research literature seeking to identify causal factors underlying persistent pain in PD through experimental quantification. The majority of previous studies aimed to identify neurobiological alterations that could provide a biomarker for pain/pain phenotype, in PD cohorts. However heterogeneity of patient cohorts, result outcomes and methodology between human psychophysics studies overwhelmingly leads to inconclusive and equivocal evidence. Here we discuss refinement of pain-PD paradigms in order that future studies may enhance confidence in the validity of observed effect sizes while also aiding comparability through standardisation. Encouragingly, as the field moves towards cross-study comparison of data in order to more reliably reveal mechanisms underlying dysfunctional pain processing, the potential for better-targeted treatment and management is high.

scholarly journals Personalized Medicine in Parkinson’s Disease: New Options for Advanced Treatments

2021 ◽  
Vol 11 (7) ◽  
pp. 650
Author(s):  
Takayasu Mishima ◽  
Shinsuke Fujioka ◽  
Takashi Morishita ◽  
Tooru Inoue ◽  
Yoshio Tsuboi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Personalized Medicine ◽  
Focused Ultrasound ◽  
Treatment Options ◽  
Advanced Treatment ◽  
Multiple Treatment ◽  
Advanced Stages ◽  
Deep Brain

Parkinson’s disease (PD) presents varying motor and non-motor features in each patient owing to their different backgrounds, such as age, gender, genetics, and environmental factors. Furthermore, in the advanced stages, troublesome symptoms vary between patients due to motor and non-motor complications. The treatment of PD has made great progress over recent decades and has directly contributed to an improvement in patients’ quality of life, especially through the progression of advanced treatment. Deep brain stimulation, radiofrequency, MR–guided focused ultrasound, gamma knife, levodopa-carbidopa intestinal gel, and apomorphine are now used in the clinical setting for this disease. With multiple treatment options currently available for all stages of PD, we here discuss the most recent options for advanced treatment, including cell therapy in advanced PD, from the perspective of personalized medicine.

Mood Disorders and Anxiety in Parkinson’s Disease: Current Concepts

2021 ◽  
Vol 34 (4) ◽  
pp. 280-288
Author(s):  
Hendrik Lintel ◽  
Timothy Corpuz ◽  
Saif-ur-Rahman Paracha ◽  
George T. Grossberg
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Mood Disorders ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Anxiety And Depression ◽  
Current State ◽  
Non Motor Symptoms ◽  
Impaired Quality

Mood disorders and anxiety significantly impact the prognosis and disease course of Parkinson’s disease. Non-motor symptoms of Parkinson’s disease such as apathy, anhedonia, and fatigue overlap with diagnostic criteria for anxiety and depression, thus making accurate diagnosis of mood disorders in Parkinson’s disease patients difficult. Furthermore, treatment options for mood disorders can produce motor complications leading to poor adherence and impaired quality of life in Parkinson’s disease patients. This review aims to clarify the current state of diagnostic and treatment options pertaining to anxiety and mood disorders in Parkinson’s disease. It explores both the pharmacologic and non-pharmacologic treatment modalities for various mood disorders in comorbid Parkinson’s disease with a brief discussion of the future outlook of the field given the current state of the literature.

scholarly journals Gambling Disorder during Dopamine Replacement Treatment in Parkinson’s Disease: A Comprehensive Review

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Domenico Pirritano ◽  
Massimiliano Plastino ◽  
Domenico Bosco ◽  
Luca Gallelli ◽  
Antonio Siniscalchi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Gambling Disorder ◽  
Adult Population ◽  
Treatment Options ◽  
Caregiver Education ◽  
Diagnostic And Statistical Manual ◽  
Replacement Treatment ◽  
Dsm V

Gambling Disorder (GD) is characterized by “the failure to resist gambling impulses despite severe personal, family or occupational consequences”. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), GD replaces the DSM-IV diagnosis of Pathological Gambling (PG). GD estimated prevalence ranges between 0.4% and 3.4% within the adult population and it seems to be more common in patients with Parkinson’s disease (PD). In this population, GD recently has become more widely recognized as a possible complication of dopamine agonist (DA) therapy. This association has aroused great interest for the dramatic impact GD has on patients’ quality of life. Management of PG in patients with PD could be demanding. It is based on patient and caregiver education, modification of dopamine replacement therapy, and in some cases psychoactive drug administration. In this review article, the authors provide an overview of GD pathogenesis during DA therapy as well as a summary of available treatment options.

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