Parkinson's disease: the quintessential neuropsychiatric disorder

Abstract

Although diagnosed by characteristic motor features, Parkinson's disease may be preceded, and is frequently accompanied by, a wide range of cognitive and neuropsychiatric features. In addition to the most commonly studied disorders of dementia, depression, and psychosis, other relatively common and clinically significant psychiatric complications include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. These problems may be underrecognized and are frequently undertreated. The emergent focus on nonmotor aspects of Parkinson's disease over the past quarter of a century is highlighted by a nonlinear increase in the number of articles published devoted to this topic. Although the development of newer antidepressants, atypical antipsychotics, and cholinesterase inhibitors in recent years has had a positive benefit on the management of these troublesome and distressing symptoms, responses are frequently suboptimal, and this remains an area of major unmet therapeutic need.

FIG. 1

Number of articles published devoted to Parkinson's disease, 1986–2010. Cognition = Parkinson* and (dementia or cognitive impairment); Depression = Parkinson* and depression; Psychosis = Parkinson* and (psychosis or hallucination); Anxiety = Parkinson* and anxiety; ICD's = Parkinson* and (impulse control disorder or dopamine dysregulation syndrome); Sleep and wakefulness = Parkinson* and (insomnia or sleepiness or fatigue or REM); Apathy = Parkinson* and apathy.