ABSTRACT
BACKGROUND: Parkinson's disease (PD), commonly defined as a hypokinetic movement disorder, is hampered by the appearance of motor complications (MC), including dyskinesias and motor fluctuations, and non-motor symptoms such as behavioral, neuropsychiatric and cognitive disorders, which, in the last years, are gaining increasing attention. The factors affecting MC and these non-motor symptoms are still largely unknown and their interactions are not yet fully evaluated. OBJECTIVE: To identify the presence of behavioral, neuropsychiatric and cognitive disorders in PD patients with and without MC and to evaluate their association with MC. METHODS: Consecutive PD patients received a comprehensive structured clinical evaluation including pharmacologic treatment, MC and non-motor symptoms such as reward-seeking behaviors, neuropsychiatric symptoms (depression, anxiety, psychoses and hallucinations) and dementia. RESULTS: 349 patients were included in this analysis. Patient with MC showed enhanced frequency of dementia (p < 0.001), anxiety, depression and psychoses (p < 0.01). A higher frequency of impulse control disorders was detected in patients with dyskinesias (22.2% - p < 0.001) and motor complications (12.2% - p < 0.05). Dyskinesias were significantly more present in patients with hypersexuality (p < 0.05) and compulsive shopping (p < 0.001), while they were not significantly associated with pathological gambling and binge eating. Patients with dyskinesias also had significantly higher frequency of dopamine dysregulation syndrome, hallucinations and delusions (p < 0.001), with the exception of delusional jealousy. DISCUSSION: We found a higher frequency of behavioral, neuropsychiatric and cognitive disorders in patients with MC. The lack of detection of dyskinesias in several PD patients with pathological gambling in our study represents a very interesting issue. While binge eating mainly seems to be related to the use of dopamine agonists, the significant lack of association between dyskinesias and delusional jealousy suggests the hypothesis of a possible underlying psychopathological predisposition rather than a mere pharmacologic effect in PD patients with these behavioral complications.
Subject(s)
Cognition Disorders/etiology , Mental Disorders/etiology , Movement Disorders/complications , Parkinson Disease/complications , Aged , Antiparkinson Agents/therapeutic use , Binge-Eating Disorder/complications , Binge-Eating Disorder/psychology , Cognition Disorders/psychology , Dementia/complications , Dementia/psychology , Disruptive, Impulse Control, and Conduct Disorders/complications , Disruptive, Impulse Control, and Conduct Disorders/psychology , Female , Humans , Male , Mental Disorders/psychology , Movement Disorders/psychology , Neuropsychological Tests , Parkinson Disease/drug therapy , Parkinson Disease/psychology , Socioeconomic FactorsSubject(s)
Cerebellar Neoplasms/complications , Medulloblastoma/complications , Migraine Disorders/etiology , Vertebrobasilar Insufficiency/etiology , Adult , Basilar Artery , Brain Infarction/etiology , Brain Infarction/pathology , Cerebellar Neoplasms/pathology , Cerebellum/blood supply , Cerebellum/pathology , Humans , Magnetic Resonance Imaging , Male , Medulloblastoma/pathology , Migraine Disorders/pathology , Vertebrobasilar Insufficiency/pathologySubject(s)
Iodine Radioisotopes , Mutation/genetics , Pantothenate Kinase-Associated Neurodegeneration/diagnosis , Pantothenate Kinase-Associated Neurodegeneration/genetics , Phosphotransferases (Alcohol Group Acceptor)/genetics , Tomography, Emission-Computed, Single-Photon/methods , Adult , Female , Homozygote , Humans , Male , Pantothenate Kinase-Associated Neurodegeneration/enzymology , SiblingsABSTRACT
Five patients (4 women) with Parkinson's disease (PD) and primary major psychiatric disorder (PMPD) meeting DSM-IV criteria for the diagnosis of bipolar affective disorder (BAD) were studied. Four patients had early onset PD. Four developed a severe psychiatric disorder a few years after starting dopaminergic therapy in presence of a mild motor disability and a mild cognitive impairment, with no evidence of cerebral atrophy at CT or MRI. Two patients developed a clear manic episode; the other three presented a severe depressive episode (in one case featuring a Cotard syndrome). None showed previous signs of long term L-dopa treatment syndrome (LTS), hallucinosis or other minor psychiatric disorders. The two manic episodes occurred shortly after an increase of dopaminergic therapy and in one case rapid cyclic mood fluctuations were observed. At the onset of psychiatric symptoms, all patients had an unspecific diagnosis of chronic delusional hallucinatory psychosis (CDHP).
Subject(s)
Bipolar Disorder/chemically induced , Dopamine Agonists/adverse effects , Parkinson Disease/drug therapy , Age of Onset , Female , Humans , Male , Middle Aged , Parkinson Disease/psychologyABSTRACT
Chronic delusional psychosis with hallucinations (CDHP) is commonly assumed to complicate the later stages of Parkinson's disease, as a side effect of antiparkinsonian medication. We studied 7 patients with early onset PD, who had developed psychiatric manifestations consisting in CDHP after a few years of antiparkinsonian therapy. All patients underwent a neurological, psychiatric and brain imaging (CT or MRI) evaluation. Detailed clinical history was recorded in order to reveal prior psychiatric illness and to analyse the relationship between neurological disease, cognitive impairment and psychosis. Our findings suggest that CDHP occurring in patients with early onset PD, normal or slightly impaired cognitive functions and normal CT/MRI scans is invariably the expression of a coexisting psychiatric illness which prior to onset of the neurologic disease had not been correctly diagnosed and which has been disclosed by dopaminergic therapy.
