Diagnosis and management of psychosis in Parkinson's disease

Latoo, Javed; Mistry, Minal; Dunne, Francis J

doi:10.1002/pnp.246

Cited by 3 publications

(6 citation statements)

References 14 publications

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“…In a relatively short period of 5 months, the patient’s cognition, his bADL and iADL had worsened significantly. Although Parkinson’s disease patients may eventually develop dementia and hallucination during the course of their disease, these symptoms do not usually occur early [9]. Our patient presented with several core and supporting features of DLB namely dementia, Parkinsonism, vivid hallucination, postural instability and severe autonomic dysfunction and his symptoms progressed in a short time frame.…”

Section: Discussionmentioning

confidence: 88%

FDG-PET in suspected dementia with Lewy bodies: a case report

et al. 2019

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Background Dementia with Lewy bodies (DLB) is still underdiagnosed or mistaken for other types of neurodegenerative diseases. Biomarkers such as 18-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) can be helpful. Case presentation A 72-year-old gentleman presented with postural hypotension, hallucination, Parkinsonism and recurrent falls. He also had rapidly progressing cognitive impairment. CT and MRI brain showed atrophy of the frontal lobes with preservation of the hippocampi. FDG-PET was suggestive of DLB. He was subsequently treated with Rivastigmine, with significant improvement of his symptoms. Conclusion This case highlights the challenges in diagnosis of an elderly patient with DLB, the use of neuro-imaging as a diagnostic biomarker, the avoidance of the use of antipsychotic and the response to pharmacological treatment with Rivastigmine after a probable diagnosis of DLB.

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Section: Discussionmentioning

confidence: 88%

FDG-PET in suspected dementia with Lewy bodies: a case report

et al. 2019

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“…This sequence implies anticholinergics first, then amantadine, dopaminergic agonists, monoamine oxidase-B (MAO-B), catechol O-methyltransferase (COMT) and eventually levodopa. However, these interventions may lead to motor symptoms worsening, so the main aim is to achieve an optimal balance between motor and psychotic symptoms of PD [2]. The treatment of psychotic symptoms in PD is challenging, because the treatment of motor symptoms leads to exacerbation of psychotic symptoms, and the treatment of psychotic symptoms leads to worsening of motor symptoms [35].…”

Section: Resultsmentioning

confidence: 99%

“…Parkinson's disease (PD) is a common neurodegenerative disease diagnosed based on motor impairment. It usually occurs in people older than 65 years, but it is estimated that 5% of patients are diagnosed before the age of 40 years [1,2]. PD predominantly affects subcortical brain structures and the cerebral cortex is affected during disease pro-gression.…”

Section: Introductionmentioning

confidence: 99%

Psychotic symptoms in Parkinson’s disease: Etiology, prevalence and treatment

Knežević¹,

Knežević²,

Simić³

et al. 2019

Med pregl

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Introduction. Parkinson's disease is the second most common neurodegenerative disease with as many as 50-70% of patients experiencing psychotic symptoms during the course of the illness. Our aim was to provide an evidence-based review on the etiology, prevalence and management of psychotic symptoms in Parkinson's disease. Material and Methods. We used references from the "Medline" database published from 1999 to 2019. Results. The most common psychotic symptoms in Parkinson's disease are visual hallucinations, which occur in 25-30% of patients, acoustic hallucinations in about 20%, and delusions in around 5% of these patients. The etiology of psychotic symptoms is not fully clarified, but researchers suggest a complex interrelationship of factors associated with the disease itself and the factors associated with antiparkinsonian medications. After exclusion of other etiologic causes of psychotic symptoms, it is necessary to revise the type and dose of antiparkinsonian drugs. Although pimavanserin has recently been approved by the United States Food and Drug Administration, the current treatment of choice for psychotic symptoms in Parkinson's disease is still quetiapine. Only patients who do not tolerate or do not respond to quetiapine are treated with clozapine, which has been proven more effective, but with significant side effects. Conclusion. Timely diagnosis and adequate treatment of psychotic symptoms in Parkinson's disease are essential, because they dramatically affect the quality of life of patients and their families. Therefore, it is necessary to establish more effective tools for screening and treatment of psychotic symptoms in Parkinson's disease.

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“…In drug-induced psychosis, it is thought that this occurs particularly in the limbic structures, which are ordinarily responsible for creating emotional significance to external sensory input. Hence, internal stimuli, such as PD symptoms, can be misattributed to having originated from the external world, particularly if this external stimuli that carries emotional meaning (Latoo, Mistry, & Dunne, 2012). In this case, the patient was convinced that her mobility issues were caused by an external force, and not her PD.…”

Section: Discussionmentioning

confidence: 99%

“…Other lesser-held theories for psychosis in PD include visual processing deficits, fragmented REM sleep, indirect dopaminergic neurochemical abnormalities, Lewy body deposition in the temporal lobes, and genetic predisposition (Latoo et al., 2012).…”

Section: Discussionmentioning

confidence: 99%