Range of neuropsychiatric disturbances in patients with Parkinson's disease

Abstract

Objectives-Disturbances of cognition and emotion are common in patients with Parkinson's disease. Most previous studies of psychopathology in Parkinson's disease have focused on a single psychiatric diagnosis or condition. The objective of this study was to describe the range of neuropsychiatric symptoms in a representative sample of patients with Parkinson's disease. Methods-The sample of 139 patients was drawn from an epidemiological study of Parkinson's disease in Rogaland county, Norway, and represented 93% of those who had survived during the 4 years since the initial assessment. The diagnosis of Parkinson's disease was based on published criteria. Neuropsychiatric symptoms were assessed using the neuropsychiatric inventory, a caregiver based structured interview, which assesses severity and frequency of 10 psychiatric symptoms present during the past month. Results-At least one psychiatric symptom was reported in 61% of the sample. The most common behaviours were depression (38%) and hallucinations (27%), and the least common symptoms were euphoria and disinhibition. The highest mean scores were found for depression, apathy, and hallucinations. Factor analysis showed that hallucinations, delusions, and irritability clustered into one factor, and apathy and anxiety constituted another factor. Psychiatric symptoms were more common among patients living in nursing homes compared with home dwelling patients, and correlated with stage of disease and cognitive impairment, but not with age or duration of disease. No relation to left or right sided parkinsonism was found. Conclusion-This study emphasises the importance of psychiatric symptoms in Parkinson's disease, which were present in most patients. Clinicians should focus on the emotional and cognitive disturbances in addition to the motor manifestations of the disease. (J Neurol Neurosurg Psychiatry 1999;67:492-496)

Cognitive and neuroanatomical correlates of neuropsychiatric symptoms in Parkinson's disease: A systematic review

“…Apathy was found to be significantly associated with dementia and an executive function task, i.e. the Stroop test [14]. Other studies found that apathy was significantly associated with executive dysfunctions, evaluated with the Executive Interview [61] and category and letter fluency [45] (In this study patients were treated with Levodopa and their average disease duration was 4.3 years).…”

“…In PD patients with dementia the prevalence of neuropsychiatric symptoms was found to be higher. In the Aarsland et al study, 50 out of 139 patients were demented [14] and in a further study, Leroi et al [16] reported that 96% of PD patients with dementia presented with at least one neuropsychiatric symptom. Another study demonstrated an association between the total Neuropsychiatric Inventory (NPI) score [17] and depression and anxiety (as measured by the Hospital Anxiety and Depression Scale) [18] in non-demented PD patients.…”

“…According to Aarsland et al [14] the overall prevalence of neuropsychiatric symptoms in PD patients is 61%. The most common symptoms are depression (38%), hallucinations (27%), anxiety (20%) and apathy (16.5%).…”

“…It has been indicated that the prevalence rate of depression in this disease is approximately 40% [14,20,21].…”

“…For instance, Aarsland et al [14] examined cognitive functions in PD patients with and without dementia. Apathy was found to be significantly associated with dementia and an executive function task, i.e.…”