Parkinson’s disease and anxiety

Walsh, Kate; Bennett, Gerald

doi:10.1136/pmj.77.904.89

Cited by 167 publications

(109 citation statements)

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“…It must be highlighted that this class of drugs can worsen cognitive and motor symptoms of PD. Buspirone has a small to moderate effect on anxiety and can ameliorate dyskinesias, but can worsen parkinsonism in higher doses 38 . Low doses of tricyclics with less anticholinergic effects and the SSRIs can be useful, especially when comorbid depression exists.…”

Section: Anxietymentioning

confidence: 99%

Neuropsychiatry of Parkinson's disease

Kümmer

Teixeira

2009

Arq. Neuro-Psiquiatr.

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-Parkinson's disease (PD) is traditionally regarded as a movement disorder. In recent years, however, non-motor symptoms have been considered significant factors of disability at all stages of the illness. Behavioral and psychological symptoms or neuropsychiatric syndromes associated with PD are frequent and may represent a challenge in the management of these patients. They include anxiety, depression, psychosis, sleep, sexual and impulse control disorders, apathy and cognitive dysfunction. Their pathogenesis in PD is complex, involving neurodegenerative, drug-related and psychological mechanisms. We will review the current knowledge of this growing field, also focusing on the management of theses syndromes.KEY WORDS: Parkinson's disease, neuropsychiatry, psychology, psychiatric disorders. Neuropsiquiatria da doença de ParkinsonResumo -A doença de Parkinson (DP) é tradicionalmente conhecida como um distúrbio do movimento. Entretanto, os sintomas não-motores têm sido considerados recentemente como fatores relevantes de incapacidade em todos os estágios da doença. Sintomas motores e comportamentais ou síndromes neuropsiquiátricas associadas à DP são frequentes e seu manejo pode se tornar um verdadeiro desafio. São comuns quadros de ansiedade, depressão, psicose, distúrbios do sono, transtornos do controle do impulso, apatia e disfunções cognitivas. A patogênese desses transtornos na DP é complexa, envolvendo mecanismos degenerativos, psicológicos e relacionados ao tratamento. Neste artigo, revisamos o estado do conhecimento desse campo de interesse crescente, também enfocando o manejo dessas síndromes. PALAVRAS-CHAVE: doença de Parkinson, neuropsiquiatria, psicologia, transtornos psiquiátricos.

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Section: Anxietymentioning

confidence: 99%

Neuropsychiatry of Parkinson's disease

Kümmer

Teixeira

2009

Arq. Neuro-Psiquiatr.

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“…Anxiety may present prior to the motor features of the disease and is also associated with the neurotransmitter deficits seen in PD. 5 Given this, it is unlikely that anxiety is a purely reactive phenomenon following diagnosis. Severe anxiety may accompany 'off' periods in advanced disease, but this is not a consistent finding.…”

Section: Anxietymentioning

confidence: 99%

“…Severe anxiety may accompany 'off' periods in advanced disease, but this is not a consistent finding. 5 There is no good trial evidence to suggest which treatments are effective for anxiety in PD.…”

Section: Anxietymentioning

confidence: 99%

Neuropsychiatric features of Parkinson’s disease

Turnbull

Fitzsimmons²

2009

JRCPE

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tel. +44 (0)151 6047445 fax. +44 (0)151 6047192 e-mail pfitz@doctors.org.uk typical antipsychotics (phenothiazines and butyrophenones) exacerbate the motor features of PD and should not be used. The atypical antipsychotic clozapine has been shown in randomised trials to reduce the psychotic symptoms of PD without worsening motor features, and is the treatment of choice.1,2 However, the use of clozapine is limited due to the risk of potentially fatal agranulocytosis requiring mandatory registration with the clozapine patient monitoring scheme and stringent blood count monitoring.1 Quetiapine does not require monitoring and as such is used by many physicians prior to clozapine; however, the evidence for its effectiveness is less robust. 1,2The limited evidence available suggests that olanzapine does not improve psychosis, worsens the motor features of PD 1,2 and should be avoided. In the context of PD dementia, cholinesterase inhibitors are effective in treating psychotic symptoms (see below). 7 DementiADementia is common in PD, with 20-50% of patients developing cognitive impairment during the course of the condition. 8 The pathogenesis of Parkinson's disease dementia (PDD) is not fully understood, with deficits in multiple neurotransmitter systems, including dopaminergic, cholinergic, serotonergic and noradrenergic transmitters. In addition, cortical Lewy bodies have been implicated. 8 Psychotic features, especially visual hallucinations, often accompany PDD, with PDD being strongly predictive for the development of psychosis. 6Diagnostic criteria for PDD have been suggested but await validation. Currently, generic criteria such as the American Psychiatric Association DSM-IV 'dementia due to other general medical conditions' criteria are used for research purposes but, again, are not validated.The Mini Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCog) are useful screening tools for PDD. Both display similar sensitivity (98% and 95% respectively) in identifying dementia as defined by the DSM-IV criteria.2 The CAMCog also includes additional domains of cognition.2 The executive clock drawing task CLOX-1 may be a more sensitive test of subcortical dementia seen in PD.Management should initially involve investigation for reversible causes of cognitive decline and the cessation of medications known to have deleterious affects on cognition, such as anticholinergic agents.The dual cholinesterase inhibitor rivastigmine has been shown in a RCT of 541 PDD patients to produce moderate improvements in cognition across a number of outcome measures when compared with placebo. Rivastigmine also significantly improved non-cognitive neuropsychiatric parameters, including delusions and hallucinations. Adverse effects were not uncommon with significant increases in nausea (29%), vomiting (16.6%) and tremor (10.2%) in the rivastigmine group.7 Current guidelines support the use of rivastigmine in PDD. 1,2 sleep DisorDersSome form of sleep disorder affects almost all PD patients. Advice regarding good s...

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“…86 In addition, memory dysfunctions are related to dopaminergic and N-methyl-d-aspartate (NMDA) neuronal functions. 8,87,88 Interestingly, smoking and nicotine protect dopaminergic neurons in the MPTP mouse model, and nicotine also has protective effects in the primate MPTP model and in the 6-OHDA-, rotenone-, and paraquat-induced animal models of PD (review). 26 Nicotine reduces the loss of striatal TH immunoreactivity induced by 6-OHDA, which leads to neuroprotection of the nigrostriatal region, but the precise mechanism remains unknown yet.…”

Section: Experimental Applications Of Animal Models and The Related Cmentioning

confidence: 99%

“…6 In addition, patients with PD suffer from a variety of non-motor disorders that appear at the early or late stages of PD, including affective disorders, such as anxiety disorders and depression, and cognitive function disorders, such as learning and memory impairments. 7,8 Although l-DOPA therapy has been found to improve anxiety disorders in PD, 9 in general, the non-motor disorders are not improved or are even sometimes worsened by chronic l-DOPA administration. 10,11 many bioactive and natural adjunctive agents have been developed that relieve the symptoms of PD (described in the "Experimental applications of animal models and the related clinical studies" section).…”

Section: Introductionmentioning

confidence: 99%

Animal models of Parkinson's disease and their applications

Park

Zhao²,

Lee

2016

JPRLS

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Abstract:Parkinson's disease (PD) is a progressive neurodegenerative disorder that occurs mainly due to the degeneration of dopaminergic neuronal cells in the substantia nigra. l-3,4-Dihydroxyphenylalanine (l-DOPA) is the most effective known therapy for PD. However, chronic l-DOPA administration results in a loss of drug efficacy and irreversible adverse effects, including l-DOPA-induced dyskinesia, affective disorders, and cognitive function disorders. To study the motor and non-motor symptomatic dysfunctions in PD, neurotoxin and genetic animal models of PD have been widely applied. However, these animal models do not exhibit all of the pathophysiological symptoms of PD. Regardless, neurotoxin rat and mouse models of PD have been commonly used in the development of bioactive components from natural herbal medicines. Here, the main animal models of PD and their applications have been introduced in order to aid the development of therapeutic and adjuvant agents.

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Parkinson’s disease and anxiety

Abstract: There has been a recent surge of interest in

Cited by 167 publications

References 43 publications

Neuropsychiatry of Parkinson's disease

Neuropsychiatry of Parkinson's disease

Neuropsychiatric features of Parkinson’s disease

Animal models of Parkinson's disease and their applications

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Parkinson’s disease and anxiety

Abstract: There has been a recent surge of interest in

Cited by 167 publications

References 43 publications

Neuropsychiatry of Parkinson's disease

Neuropsychiatry of Parkinson's disease

Neuropsychiatric features of Parkinson’s disease

Animal models of Parkinson&#39;s disease and their applications

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Animal models of Parkinson's disease and their applications