Psychotic symptoms in Parkinson's disease. From description to etiology.
Psychotic symptoms are common in Parkinson's disease (PD) and occur in at least 20% of medication-treated patients. Benign visual hallucinations usually appear earlier, while malignant hallucinations, confusional states, delusions, paranoid beliefs, agitation, and delirium become more frequent with disease progression. Virtually all antiparkinsonian drugs may produce psychotic symptoms. Cognitive impairment, increased age, disease duration and severity, depression, and sleep disorders have been consistently identified as independent risk factors for their development. Although the precise pathoetiologic mechanisms remain unknown, we review evidence that links ventral dopaminergic pathway dysfunction (overactivity) together with the involvement of other neurotransmitter system imbalances as likely contributors. The clinical importance of the proposed mechanism is that successful management of psychotic symptoms in PD may rely on a multitarget approach to restore neurotransmitter imbalances rather than focusing exclusively on the dopaminergic dysfunction.
Department of Neurology, University of Miami, School of Medicine, Room 4004, 1501 NW 9th Avenue, Miami FL 33136, USA. spapapetropoulos@med.miami.edu
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D000818:Animals; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001526:Behavioral Symptoms / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D001923:Brain Chemistry / Q000502:physiology; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D012307:Risk Factors
D000978:Antiparkinson Agents