Management of psychiatric and cognitive complications in Parkinson’s disease

Daniel Weintraub; Dag Aarsland; Roberta Biundo; Roseanne Dobkin; Jennifer G. Goldman; Simon Lewis

doi:10.1136/bmj-2021-068718

Management of psychiatric and cognitive complications in Parkinson’s disease

Daniel Weintraub, Dag Aarsland, Roberta Biundo, Roseanne Dobkin, Jennifer G. Goldman, Simon Lewis

Research output: Contribution to journal › Review article › peer-review

21 Citations (Scopus)

Abstract

Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson’s disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.

Original language	English
Article number	e068718
Pages (from-to)	e068718
Journal	BMJ
Volume	379
Issue number	068718
DOIs	https://doi.org/10.1136/bmj-2021-068718
Publication status	Published - 24 Oct 2022

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https://www.bmj.com/content/379/bmj-2021-068718.full?ijkey=QCQI0nYFpQwMJTI&keytype=ref

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@article{2f51f1edd0d44fb7aa906a1e0ed6215c,

title = "Management of psychiatric and cognitive complications in Parkinson{\textquoteright}s disease",

abstract = "Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson{\textquoteright}s disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.",

author = "Daniel Weintraub and Dag Aarsland and Roberta Biundo and Roseanne Dobkin and Goldman, {Jennifer G.} and Simon Lewis",

note = "Funding Information: DW has received research funding or support from the Michael J Fox Foundation for Parkinson{\textquoteright}s Research, Alzheimer{\textquoteright}s Therapeutic Research Initiative, Alzheimer{\textquoteright}s Disease Cooperative Study, International Parkinson and Movement Disorder Society, National Institutes of Health, Parkinson{\textquoteright}s Foundation, US Department of Veterans Affairs, and Acadia Pharmaceuticals; honoraria for consultancy from Acadia Pharmaceuticals, Alkahest, Aptinyx, Cerevel Therapeutics, CHDI Foundation, Clexio, Clintrex LLC (Otsuka), EcoR1 Capital, Eisai, Ferring, Gray Matter Technologies, Great Lake Neurotechnologies, Intra-Cellular Therapies, Janssen, Merck, Sage, Scion, Signant Health, and Vanda; and license fee payments from the University of Pennsylvania for the QUIP and QUIP-RS. Funding Information: RD has received research support from the Michael J Fox Foundation for Parkinson{\textquoteright}s Research, the Health Services Research and Development Division of the Veteran Affairs (VA) Administration, and the VA Office of Rural Health. Funding Information: SL is supported by a National Health and Medical Research Council Leadership Fellowship (1195830) and has received research funding or support from the Michael J Fox Foundation for Parkinson{\textquoteright}s Research, Pharmaxis, and Acceler8. Funding Information: RB reports honorariums to speak from Bial. She is supported by the Ministry of Health under Grant Number GR-2016-02361986. Funding Information: JGG has received research funding or support from Acadia Pharmaceuticals, American Parkinson{\textquoteright}s Disease Association, the Lewy Body Dementia Association, Michael J Fox Foundation for Parkinson{\textquoteright}s Research, and Parkinson{\textquoteright}s Foundation; and honorariums as a consultant, educational speaker, or reviewer from the International Parkinson and Movement Disorder Society, Parkinson{\textquoteright}s Foundation, and Parkinson Study Group. Publisher Copyright: {\textcopyright} Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.",

year = "2022",

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doi = "10.1136/bmj-2021-068718",

language = "English",

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AU - Weintraub, Daniel

AU - Aarsland, Dag

AU - Biundo, Roberta

AU - Dobkin, Roseanne

AU - Goldman, Jennifer G.

AU - Lewis, Simon

N1 - Funding Information: DW has received research funding or support from the Michael J Fox Foundation for Parkinson’s Research, Alzheimer’s Therapeutic Research Initiative, Alzheimer’s Disease Cooperative Study, International Parkinson and Movement Disorder Society, National Institutes of Health, Parkinson’s Foundation, US Department of Veterans Affairs, and Acadia Pharmaceuticals; honoraria for consultancy from Acadia Pharmaceuticals, Alkahest, Aptinyx, Cerevel Therapeutics, CHDI Foundation, Clexio, Clintrex LLC (Otsuka), EcoR1 Capital, Eisai, Ferring, Gray Matter Technologies, Great Lake Neurotechnologies, Intra-Cellular Therapies, Janssen, Merck, Sage, Scion, Signant Health, and Vanda; and license fee payments from the University of Pennsylvania for the QUIP and QUIP-RS. Funding Information: RD has received research support from the Michael J Fox Foundation for Parkinson’s Research, the Health Services Research and Development Division of the Veteran Affairs (VA) Administration, and the VA Office of Rural Health. Funding Information: SL is supported by a National Health and Medical Research Council Leadership Fellowship (1195830) and has received research funding or support from the Michael J Fox Foundation for Parkinson’s Research, Pharmaxis, and Acceler8. Funding Information: RB reports honorariums to speak from Bial. She is supported by the Ministry of Health under Grant Number GR-2016-02361986. Funding Information: JGG has received research funding or support from Acadia Pharmaceuticals, American Parkinson’s Disease Association, the Lewy Body Dementia Association, Michael J Fox Foundation for Parkinson’s Research, and Parkinson’s Foundation; and honorariums as a consultant, educational speaker, or reviewer from the International Parkinson and Movement Disorder Society, Parkinson’s Foundation, and Parkinson Study Group. Publisher Copyright: © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.

PY - 2022/10/24

Y1 - 2022/10/24

N2 - Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson’s disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.

AB - Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson’s disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.

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U2 - 10.1136/bmj-2021-068718

DO - 10.1136/bmj-2021-068718

M3 - Review article

SN - 0959-8138

VL - 379

SP - e068718

JO - BMJ

JF - BMJ

IS - 068718

M1 - e068718

ER -

Management of psychiatric and cognitive complications in Parkinson’s disease

Abstract

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