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Assessment and Management of Neuropsychiatric Symptoms in Parkinson’s Disease

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Abstract

Neuropsychiatric symptoms are highly prevalent in Parkinson’s disease and associated with decreased quality of life and adverse health outcomes. In this review, the assessment and management of common neuropsychiatric symptoms are discussed: depression, anxiety, psychosis, cognitive impairment, dementia and apathy. Validated assessment scales are now available for the majority of symptoms. Balancing dopaminergic therapy plays an important role in their management as increasing doses of dopaminergic agents might address depression and anxiety related to ‘off’ phases, non-motor fluctuations and apathy, while dose reduction might alleviate psychotic symptoms. More targeted treatment is possible through medications utilising different pathways. Although efficacy profiles of individual agents require further exploration, antidepressants as a drug class have shown utility in depression and anxiety in Parkinson’s disease. Psychological therapies, especially cognitive behavioural approaches, are effective. Pimavanserin allows the treatment of psychosis in Parkinson’s disease without directly affecting the dopaminergic and cholinergic system. The cholinergic system is currently the only target in Parkinson’s disease dementia, and antagonists of this system, as are many psychotropic drugs, need to be used with caution. Management of apathy largely relies on non-pharmacological strategies adapted from dementia care, with antidepressants being ineffective and the role of stimulant therapy needing further evaluation.

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Authors and Affiliations

  1. Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, De Crespigny Park, London, SE5 8AF, UK

    Christoph Mueller, Anto P. Rajkumar, Yi Min Wan, Latha Velayudhan, Dominic ffytche, Kallol Ray Chaudhuri & Dag Aarsland

  2. South London and Maudsley NHS Foundation Trust, London, UK

    Christoph Mueller, Anto P. Rajkumar, Latha Velayudhan & Dominic ffytche

  3. Ng Teng Fong General Hospital, Singapore, Singapore

    Yi Min Wan

  4. National Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK

    Kallol Ray Chaudhuri

  5. Stavanger University Hospital, Stavanger, Norway

    Dag Aarsland

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  1. Christoph Mueller
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Correspondence to Christoph Mueller.

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This article represents independent research partly funded by the National Institute for Health Research (NIHR) Biomedical Research Unit for Dementia in South London and Maudsley National Health Service (NHS) Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Conflict of Interest

K Ray Chaudhuri has consulted and served on advisory boards for Britannia, AbbVie, Neuronova, Mundipharma and UCB, and has also served on advisory boards for Synapsus and Medtronic. He has received honoraria from Boehringer Ingelheim, GlaxoSmithKline, AbbVie, Britannia, UCB, Mundipharma, Otsuka and Zambon, and grants from Boehringer Ingelheim, GlaxoSmithKline, Britannia, AbbVie, UCB and Neuronova. He holds intellectual property rights for the KPP scale and the PDSS, and receives royalties for the books Non-Motor Symptoms of Parkinson’s Disease and Fastfacts: Parkinson’s Disease. Dag Aarsland has received research support and/or honoraria from Astra-Zeneca, H. Lundbeck, Novartis Pharmaceuticals, GE Health, Easi and Heptares, and serves as a paid consultant for H. Lundbeck and Axovant. Christoph Mueller, Anto P. Rajkumar, Wan Yi Min, Latha Velayudhan and Dominic ffytche have no conflicts of interest directly relevant to the content of this article.

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Mueller, C., Rajkumar, A.P., Wan, Y.M. et al. Assessment and Management of Neuropsychiatric Symptoms in Parkinson’s Disease. CNS Drugs 32, 621–635 (2018). https://doi.org/10.1007/s40263-018-0540-6

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