Management of behavioral and psychiatric problems in Parkinson's disease

Behavioral and psychiatric problems associated with idiopathic Parkinson's disease (PD) include cognitive dysfunction, drug-related psychosis, depress ion, anxiety, apathy, fatigue and sleep disturbance. These nonmotor symptom s are a significant cause of disability at all stages of illness. Cognitive dysfunction spans a continuum from circumscribed cognitive impairments to severe global dementia which can occur in up to 10-30% of advanced PD patie nts. Psychosis develops in 20-30% of PD patients receiving chronic antipark insonian therapy. Visual hallucinations and paranoid delusions are the most frequent symptoms. The gradual elimination of drugs of lesser priority tha t may affect cognition and/or cloud the sensorium constitutes the first ste p in the management of cognitive and psychotic symptoms. Atypical neurolept ic agents are an invaluable tool in those cases in which maximum drug regim en simplification is not adequate or results in unacceptable immobility. De pression and anxiety often go unrecognized although they are eminently trea table and may be important contributors to the morbidity of PD. They are pr esent in 30-40% of PD patients and frequently occur together in association with other nonmotor symptoms such as apathy, fatigue and sleep disturbance . A combination of early recognition, counseling, antidepressant therapy, a ntianxiety and well-balanced antiparkinsonian therapy sets the stage for im proved quality of life for patients with PD. (C) 2000 Published by Elsevier Science Ltd.