TREATMENT OF BEHAVIORAL DISTURBANCES IN PARKINSONS-DISEASE

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 Parkinso n's disease with the same precautions as in the normal population. How ever, in single case reports modern serotonin reuptake blockers in Par kinson's disease have been accused to worsen parkinsonian motor condit ion. 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 ex istent be treated. Depression seems to be the single most important fa ctor associated with the severity of dementia and early antidepressant treatment seems to decrease cognitive decline in depressed parkinsoni an patients. Anticholinergic medications should be discontinued since they may cause mental side effects. Sleep disorders in Parkinson's dis ease are mainly caused by nocturnal akinesia, which causes sleep fragm entation or altered dreaming and nightmares, which might be a side-eff ect of dopaminergic treatment. In the first case the administration of a controlled release preparation of levodopa at bedtime may be indica ted. If the sleep disorder is considered to be due to dopaminergic med ication, a reduction of long-term acting agents like modern dopamine a gonists and controlled-release levodopa should be considered. In sever e psychotic states related to drug treatment antiparkinsonian therapy must be carefully analysed and, if possible, reduced. If motor conditi on worsens and/or psychiatric symptoms do not improve, initiation with ''atypical'' neuroleptics like clozapine is indicated. The pharmacolo gical and clinical properties of new antipsychotic drugs that can be u sed in Parkinson's disease are revised.