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Treatment of behavioural disturbances in Parkinson’s disease

  • F. Valldeoriola
  • F. A. Nobbe
  • E. Tolosa
Part of the Journal of Neural Transmission. Supplementa book series (NEURAL SUPPL, volume 51)

Summary

Behavioural disorders in Parkinson’s disease can grossly be subdivided in primary disturbances and those which are related to drug treatment.

Depression and anxiety are a common feature in parkinsonian patients. Both occur independently of drug treatment. In general, most current antide­pressive and anxiolytic drugs could be administered in Parkinson’s disease with the same precautions as in the normal population. However, in single case reports modern serotonin reuptake blockers in Parkinson’s disease have been accused to worsen parkinsonian motor condition. Combinations of serotonin reuptake inhibitors with MAO-inhibitors like selegiline should be used with caution.

In the case of cognitive decline firstly an underlying depression should be disclosed or if existent be treated. Depression seems to be the single most important factor associated with the severity of dementia and early antidepressant treatment seems to decrease cognitive decline in depressed parkinsonian patients. Anticholinergic medications should be discontinued since they may cause mental side effects.

Sleep disorders in Parkinson’s disease are mainly caused by nocturnal akinesia, which causes sleep fragmentation or altered dreaming and nightmares, which might be a side-effect of dopaminergic treatment. In the first case the administration of a controlled release preparation of levodopa at bedtime may be indicated. If the sleep disorder is considered to be due to dopaminergic medication, a reduction of long-term acting agents like modern dopamine agonists and controlled-release levodopa should be considered.

In severe psychotic states related to drug treatment antiparkinsonian therapy must be carefully analysed and, if possible, reduced. If motor condition worsens and/or psychiatric symptoms do not improve, initiation with “atypical” neuroleptics like clozapine is indicated. The pharmacological and clinical properties of new antipsychotic drugs that can be used in Parkinson’s disease are revised.

Keywords

Neurol Neurosurg Psychiatry Neuroleptic Malignant Syndrome Behavioural Disturbance Parkinsonian Patient Levodopa Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag/Wien 1997

Authors and Affiliations

  • F. Valldeoriola
    • 1
  • F. A. Nobbe
    • 1
  • E. Tolosa
    • 1
  1. 1.Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Hospital Clínic i Provincial de Barcelona, Institut Pi SunyerUniversity of BarcelonaSpain

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