Do we need drugs for psychiatric symptoms specifically for Parkinson's disease?

Although the need for better medications for the treatment of psychiatric symptoms in people with Parkinson's disease (PWP) is not disputed, the approach and targets for these medications needs further attention. Psychiatric symptoms occur at higher prevalence in PWP-many start in the prodromal phase of the disease-and have complex associations and interactions with the motor symptoms and their treatments, begging the question of whether they may be mechanistically connected. In this manuscript, we review the current evidence for pharmacologic treatments of psychiatric symptoms in PWP and explore the potential next steps needed to develop new medications for psychiatric symptoms in PD.

Apathy in Parkinson's Disease: A Diagnostic Conundrum Explored in a Cohort Characterization Study.

Objective: Apathy is a prevalent neuropsychiatric feature of Parkinson's disease (PD), marked by reduced goal-directed behavior. Apathy is distinct from depression and significantly affects daily functioning and quality of life. Despite this, the DSM-5 does not acknowledge apathy as its own diagnostic category.

Investigating Dopamine Replacement-Associated Fluctuations in Cognition and Mood in Cognitively Unimpaired Parkinson's Disease.

Background: Non-motor fluctuations, characterized by variability in mood and cognition, are prevalent in advanced Parkinson's disease (PD), but less is known about these fluctuations in early PD.

Objective: The objective was to characterize fluctuations in cognition and mood in early PD without cognitive impairment.

Methods: Individuals with PD but without cognitive impairment were evaluated "on" and "off" dopaminergic medications for minimal clinically important differences (MCID) in depression, anxiety, and cognition.

Using Principles of Cognitive Behavioral Therapy to Treat Anxiety in Parkinson's Disease.

Anxiety significantly affects persons with Parkinson's disease (PwP), often emerging in the prodromal phase before the onset of symptoms and persisting throughout the disease's course. It is among the most disabling, stigmatizing, and under-recognized symptoms of Parkinson's disease (PD). Consequently, it is critical to provide tools that can be universally applied and that are accessible to help all PwP live better.

Potential Risk Factors for Psychosis in Parkinson's Disease: A Review of Cohort and Case-Control Studies.

BackgroundAmong neuropsychiatric sequelae of Parkinson's disease (PD), psychosis may have the most adverse impacts on prognosis and quality of life.ObjectivesTo summarize and critically review the literature on potential risk factors for psychosis in PD, with particular focus on potentially modifiable risk factors.MethodsWe conducted a literature review using PubMed and EMBASE.

Refractory Psychosis as a Red Flag for End of Life in Individuals With Dementia With Lewy Bodies: A Case Series and Re-analysis of Prior Qualitative Data.

Objectives: Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life.

Methods: We present 4 exemplar cases where individuals with DLB experienced refractory psychosis before death.

Clinically probable RBD is an early predictor of malignant non-motor Parkinson's disease phenotypes.

Non-motor symptoms (NMS) in Parkinson's disease (PD) significantly impact quality of life, especially in later stages. REM sleep behavior disorder (RBD) affects approximately 42% of all PD patients and frequently precedes motor PD symptoms. RBD is linked to increased rates of depression and cognitive decline.

Does exercise demonstrate a dose-dependent benefit with cognition in Parkinson's disease?

Background: Exercise confers motor benefits in Parkinson's disease (PD) and may even have disease modifying effects. While the impact of exercise on motor symptoms and quality of life is well-studied in PD, its relationship with cognitive performance warrants further attention.

Methods: In people with PD, self-reported exercise information was quantified using the Rapid Assessment of Physical Activity (RAPA).

The Effect of Dysautonomia on Motor, Behavioral, and Cognitive Fluctuations in Parkinson's Disease.

Background: Motor and nonmotor fluctuations adversely impact the quality of life in Parkinson's disease (PD). Dysautonomia, a feature frequently associated with PD and a possible adverse effect of dopaminergic therapy, may be comorbid with fluctuations.

Objective: We sought to evaluate the effect of dysautonomia on motor and nonmotor fluctuations in PD.

The effect of dysautonomia on motor, behavioral and cognitive fluctuations in Parkinson's disease.

Background: Motor and non-motor fluctuations adversely impact quality of life in Parkinson's disease (PD). Dysautonomia, a feature frequently associated with PD and a possible adverse effect of dopaminergic therapy, may be comorbid with fluctuations.

Objectives: We sought to evaluate the effect of dysautonomia on motor and non-motor fluctuations in PD.

Gaps and Controversies in Catatonia as a Movement Disorder.

The term "catatonia" was introduced by German psychiatrist Karl Kahlbaum in 1874. Although historically tied to schizophrenia, catatonia exhibits a diverse range of phenotypes and has been observed in various medical and neuropsychiatric conditions. Its intrinsic movement characteristics and association with hypokinetic and hyperkinetic phenomenologies place catatonia within the purview of movement disorders.

Exploring Psychosis in Neurodegenerative Dementia: Connecting Symptoms to Neurobiology.

The following commentary discusses a review by Cressot et al. entitled: 'Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review'. The authors describe the epidemiology and phenomenology of psychosis across neurodegenerative dementias.

On the Optimal Diagnosis and the Evolving Role of Pimavanserin in Parkinson's Disease Psychosis.

Parkinson's disease (PD) is associated with the development of psychosis (PDP), including hallucinations and delusions, in more than half of the patient population. Optimal PD management must therefore involve considerations about both motor and non-motor symptoms. Often, clinicians fail to diagnosis psychosis in patients with PD and, when it is recognized, treat it suboptimally, despite the availability of multiple interventions.

Impact of Acute Dopamine Replacement on Cognitive Function in Parkinson's Disease.

Background: PD causes striatal dopaminergic denervation in a posterior/dorsal to anterior/ventral gradient, leaving motor and associative cortico-striato-pallido-thalamic loops differentially susceptible to hyperdopaminergic effects with treatment. As the choice and titration of symptomatic PD medications are guided primarily by motor symptoms, it is important to understand their cognitive implications.

Objective: To investigate the effects of acute dopaminergic medication administration on executive function in Parkinson's disease (PD).

The Association of Antidepressant Use and Impulse Control Disorder in Parkinson's Disease.

Objectives: To examine whether initiation of an antidepressant is associated with the development of impulse control disorder (ICD) in patients with Parkinson's disease (PD).

Design: We performed a retrospective analysis utilizing data from the Parkinson's Progression Markers Initiative (PPMI). Two-sample Mann-Whitney tests were used for comparison of continuous variables and Pearson χ tests were used for categorical variables.

Examining the link between impulse control disorder and antidepressant use in Parkinson's disease.

Introduction: Impulse control disorders (ICD) in Parkinson's disease (PD) and hypomanic episodes of bipolar disorder show overlapping symptoms, suggesting a shared neurobiology. To explore this, the following hypotheses are tested: (1) larger changes in affective symptoms from OFF to ON medication states will be associated with ICD, (2) antidepressant exposure will be associated with larger OFF to ON affective symptom changes, and (3) antidepressant exposure will be associated with ICD.

Methods: 200 participants (mean age 65, 61 % male) were evaluated in "off" and "on" dopamine states.

Anxiety Change After Dopamine Therapy in Parkinson Disease is Independent of Motor Improvement.

Background: Several anxiety syndromes have been associated with Parkinson disease (PD), but their interactions with dopamine replacement therapy (DRT) and motor function dynamics are not completely understood. We sought to delineate how DRT impacts anxiety phenomenology in PD and whether these changes are dissociable from improved motoric function.

Methods: We compared anxiety responses to DRT in two cohorts: 1) a study of 200 PD participants who completed neuropsychiatric assessments before and after taking their dopaminergic medications ("On-Off"); 2) participants in the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort who completed the State-Trait Anxiety Inventory (STAI) at the time of DRT initiation and a subsequent study visit (n = 113, mean 8-month interval).

Staying hidden: The burden of stigma in PD.

Background: Despite the myriad motor and non-motor challenges associated with Parkinson's disease (PD) diagnosis, the hidden issue of stigma may be among the most influential factors negatively affecting quality of life. A number of qualitative studies have been published assessing various aspects of stigma in PD, and quantitative studies assert that most people with PD experience stigma during the course of their disease. Stigma is associated with poorer mental and physical health, poorer quality of life, decreased levels of hope, self-esteem and self-efficacy.

Minor Phenomena in Parkinson's Disease-Prevalence, Associations, and Risk of Developing Psychosis.

Background: Minor phenomena, including passage phenomena, feeling of presence, and illusions, are common and may represent a prodromal form of psychosis in Parkinson's disease (PD). We examined the prevalence and clinical correlates of minor phenomena, and their potential role as a risk factor for PD psychosis.

Methods: A novel questionnaire, the Psychosis and Mild Perceptual Disturbances Questionnaire for PD (PMPDQ), was completed by Fox Insight cohort participants with and without PD.