Research output: Contribution to journal › Article › peer-review
Christoph Mueller, Anto P. Rajkumar, Yi Min Wan, Latha Velayudhan, Dominic ffytche, Kallol Ray Chaudhuri, Dag Aarsland
Original language | English |
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Pages (from-to) | 621-635 |
Number of pages | 15 |
Journal | CNS Drugs |
Volume | 32 |
Issue number | 7 |
Early online date | 20 Jul 2018 |
DOIs | |
Accepted/In press | 1 Jan 2018 |
E-pub ahead of print | 20 Jul 2018 |
Published | Jul 2018 |
Additional links |
Assessment and Management of_MUELLER_Firstonline20July2018_GREEN AAM
PDneuropsych_author_sacceptedmanuscript.pdf, 436 KB, application/pdf
Uploaded date:25 Jul 2018
Version:Accepted author manuscript
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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