Neuropsychiatry Of Parkinson’s Flashcards
When might neurodegeneration in non dopaminergic nuclei occur in Parkinson’s?
A decade before motor symptoms
Serotonergic, cholinergic, noradrenergic nuclei
How common are delusions visual hallucinations in PD patients?
Delusions - 5%
Visual hallucinations - 8-40%
How common is lack of insight with PD hallucinations?
5%
Most patients have insight
What are the early stages of PD psychosis?
Passage and presence hallucinations
Illusions
Formed hallucinations (with preserved insight)
Unidentified figures
What are late symptoms of PD psychosis?
Loss of insight
Delusions
Misidentification (associated with lower MMSE)
Hallucinations of other senses
How do quetiapine and clozapine work at the low diesels used for Parkinson’s psychosis?
As serotonin receptor antagonists
What are cholinesterase inhibitors and memantine used for in PDP?
Mild hallucinations
Cognition
What is the strongest predictor of transition to institutional care in PD?
PD Psychosis
What is the prevalence of anxiety in PD?
40%
Particularly in younger patients
Panic attacks can occur with freezing episodes
Tremors often worsen with anxiety
What is the prevalence of depression in PD?
50%
Depression often comes 2 years before motor disorder
What psychotherapy was developed for Parkinson’s disease?
Metacognitive therapy
What antidepressants are useful for anxiety?
Citalopram - SSRI
Mirtazapine - NaSSA
Why aren’t TCAs used in PD?
Anticholinergic effects
Hypotension leads to falls
What is a potential interaction of rasagiline/selegiline with antidepressants?
Serotonin syndrome
Rasagiline and selegiline are MAOIs and can increase serotonin in combination with SSRIs
What is a possible area of aetiology of apathy in Parkinson’s?
Loss of dopamonergic activity in the mesolimbic cortex (nucleus accumbens)
What is the possible aetiology of impulse control disorders in PD?
Preserved ventral striatum is overdosed with dopamine by dopamine agonist medications causing over activity
What treatments exist for ICD?
Reduce dopamine therapies (careful of withdrawal)
CBT
Naltrexone (opiate antagonist)
What is the effect of DBS in ICD?
Can trigger impulse control disorder
Can reduce ICD as it allows for reduction in dopamine therapist
What is the risk of suicide in DBS?
4%
What is the prevalence of dopamine agonist withdrawal syndrome?
8-19%
Drug specific syndrome, have to go back on exactly what they came off
More common in people with ICD
What are the hallmarks of Lewy Body Dementia?
Visual hallucinations
Fluctuation cognition
Visuospatial impairments
What is the potential for DBS in Lewy Body Dementia?
Has been shown to help with psychosis but not with cognition
What features distinguish Parkinson’s plus syndromes from Parkinson’s?
Symmetrical onset
Lack of tremor
Absence of response to dopamine
What is the triad of Parkinson’s plus syndromes?
Progressive supra nuclear palsy
Corticobasal degeneration
Multiple system atrophy
