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Review
. 2022 Jan;21(1):89-102.
doi: 10.1016/S1474-4422(21)00330-6.

The neuropsychiatry of Parkinson's disease: advances and challenges

Daniel Weintraub  1 , Dag Aarsland  2 , Kallol Ray Chaudhuri  3 , Roseanne D Dobkin  4 , Albert Fg Leentjens  5 , Mayela Rodriguez-Violante  6 , Anette Schrag  7
Affiliations
Review

The neuropsychiatry of Parkinson's disease: advances and challenges

Daniel Weintraub et al. Lancet Neurol. 2022 Jan.

Abstract

In people with Parkinson's disease, neuropsychiatric signs and symptoms are common throughout the disease course. These symptoms can be disabling and as clinically relevant as motor symptoms, and their presentation can be similar to, or distinct from, their counterparts in the general population. Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics. The underlying neurobiology of these presentations is complex and not well understood, with the strongest evidence for neuropathological changes associated with Parkinson's disease, mechanisms linked to dopaminergic therapy, and effects not specific to Parkinson's disease. Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice. Mounting evidence supports a range of pharmacological and non-pharmacological interventions, but relatively few efficacious treatment options exist. Optimising the management of neuropsychiatric presentations in people with Parkinson's disease will require additional research, raised awareness, specialised training, and development of innovative models of care.

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Conflict of interest statement

Declaration of interests DW received research funding or support from Michael J Fox Foundation for Parkinson's Research, Alzheimer's Therapeutic Research Initiative, Alzheimer's Disease Cooperative Study, the International Parkinson and Movement Disorder Society, and the National Institute on Aging; honoraria for consultancy from Acadia, Aptinyx, CHDI Foundation, Clintrex LLC (Alkahest, Aptinyx, Avanir, and Otsuka), Eisai, Enterin, Great Lake Neurotechnologies, Janssen, Sage, Scion, Signant Health, Sunovion, and Vanda; and license fee payments from the University of Pennsylvania for the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease and Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale. DA received grants from Roche Diagnostics and Sanofi; consulting fees from Enterin, Acadia, and Wiley; and participated as an advisory board member for Biogen and served as committee chair for Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment Lewy Body Dementias Professional Interest Area. KRC received honoraria for advisory boards from AbbVie, Britannia Pharmaceuticals, UCB, Pfizer, Jazz Pharma, GKC, Bial, Cynapsus, Novartis, Lobsor, Stada, Medtronic, Zambon, Profile Pharma, Sunovion, Roche, Theravance Biopharma, and Scion; honoraria for lectures from AbbVie, Britannia Pharmaceuticals, UCB, Mundipharma, Zambon, Novartis, Boeringer Ingelheim Neuroderm, and Sunovion; grants from Britannia Pharmaceuticals, AbbVie, UCB, GKC, Bial; and academic grants from the EU (Horizon 2020), Innovative Medicines Initiative EU, Parkinson's UK, UK National Institute for Health Research, Parkinson's Disease Non Motor Group, Kirby Laing Foundation, US Parkinson's Foundation, and UK Medical Research Council. RDD received grant support from the Michael J Fox Foundation for Parkinson's disease Research and the US Veteran Affairs Administration; honoraria for lectures from the World Parkinson Congress, Movement Disorders Society, and Englewood Healthcare System; and served as co-chair of the Cognitive and Psychiatric Working Group for the Parkinson Study Group, an executive steering committee member for the Parkinson's Progression Markers Initiative sponsored by the Michael J Fox Foundation for Parkinson's disease research, and a scientific advisory board member for the David Phinney Foundation for Parkinson's disease Research. AFGL received royalties from De Tijdstroom Publishers and Springer Media; payment and honoraria from the European Brain Council for presenting at the European Psychiatric Association conference in 2019; and served as a member of the editorial board for the Journal of Psychosomatic Research (Elsevier) and a member of the Parkinson's disease guideline committee for the Knowledge Institute of the Federation of Medical Specialists. AS received a grant from GE Healthcare to study late-onset depression and an honorarium from Movement Disorder Society for a lecture on depression in Parkinson's disease.

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