title: Emotional manifestations of PD: Neurobiological basis.
abstract: Neuropsychiatric symptoms are common and disabling in PD. Their neurobiological bases are complex, partly because of the disease itself and partly because of the dopaminergic treatment. The aim of this review is to focus on the emotional manifestations stemming from the neurodegenerative process itself. We focus on depression, anxiety, apathy, and fatigue, which can all be part of the clinical spectrum of premotor disease and may be improved or masked by medications targeting parkinsonian motor signs or psychiatric symptoms as the disease progresses. Findings from clinical, neuroimaging, and animal studies are reviewed, showing a major contribution of the dopaminergic system to the pathophysiology of these disabling symptoms. Degeneration of noradrenergic and serotonergic projection systems also has an impact on psychiatric symptoms of PD. The available literature is reviewed, but at present there is a lack of studies that would allow disentangling the separate contribution of each of the monoaminergic systems. The use of a pragmatic classification of all these symptoms under the umbrella of hypodopaminergic behavioral syndrome seems clinically useful, as it emphasizes the crucial, although not exclusive, nature of their dopaminergic neurobiological basis, which has important implications in the clinical management of PD. © 2016 International Parkinson and Movement Disorder Society.
authors.affiliation: Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.|Inserm, U1216, Grenoble, France.|Movement Disorders Unit, Neurology Department, CHU de Grenoble, Grenoble, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Castrioto
authors.affiliation: CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France.|Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C; Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Lyon, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Thobois
authors.affiliation: Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.|Inserm, U1216, Grenoble, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Carnicella
authors.affiliation: CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Maillet
authors.affiliation: Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.|Inserm, U1216, Grenoble, France.|Movement Disorders Unit, Neurology Department, CHU de Grenoble, Grenoble, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
mesh_terms: D001007:Anxiety / Q000209:etiology*; D057565:Apathy; D003863:Depression / Q000209:etiology*; D005221:Fatigue / Q000209:etiology*; D006801:Humans; D010300:Parkinson Disease / Q000150:complications*
keywords: Parkinson's disease; anxiety; apathy; depression; dopamine