Vol 6 n° 3 - Parkinson's disease
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arkinson’s disease (PD) is now being recog- nized as a complex illness with numerous behavioral symptoms,  in  addition  to  the  well-recognized  motor symptoms such as tremor, rigidity, postural instability, and bradykinesia. Depression, anxiety, psychosis, and cognitive changes are all extremely common in PD. The magnitude of these symptoms in PD has been revealed by several large studies of patients with PD. Over half of all PD patients experience psychiatric illness at some point in the disease. Depression and hallucinations are the most commonly described psychiatric symptoms, but many others occur. Studies have shown that psychiatric symptoms are often unrecognized in PD patients by their physicians and—when they are recognized—often go undertreated. Specific cognitive deficits have been described in early PD, and at least a third of PD patients develop dementia. Surgical procedures to treat motor symptoms are also increasingly being implicated as a cause of behavioral changes, both positive and negative, in patients with PD. Mood disorders Depression  has  been  shown  to  occur  more  often  in patients with PD than in age-matched samples. 1 Reports of prevalence of depression in PD have varied widely, depending on how the diagnosis of depression is made. Reviews of prior work indicate that about 40% of PD patients are depressed.These studies may not fully repre- sent the frequency of depression, however, since most were based on information gathered from patients in clinics. Scott et al 2 examined a sample of 948 patients and found that  36%  of  PD  patients  complained  of  depression. However, depression was not identified by the patients as the most distressing symptom.A population-based study of 97 PD patients found that 36.1% reported mild depres- sive symptoms, while another 10% reported moderate and 3 2 3 C l i n i c a l   r e s e a r c h P Copyright © 2004 LLS SAS.  All rights reserved www.dialogues-cns.org Behavioral disturbances in Parkinson’s disease Karen E. Anderson, MD Keywords:  Parkinson’s disease; mood disorder; anxiety disorder; hallucination;psychosis; cognitive change; deep brain stimulation Author affiliations:  Assistant Professor, Psychiatry and Neurology, University of Maryland, School of Medicine, Movement Disorders Division, Department of Neurology, Baltimore, Md, USA Address for correspondence: University of Maryland, School of Medicine, Room N4W49A,  Movement  Disorders  Division,  Department  of  Neurology, 22 South Greene Street, Baltimore, MD 21201, USA (e-mail: kanderson@psych.umaryland.edu) Treatment of Parkinson’s disease (PD) is complex and often involves addressing behavioral changes in addition to the movement disorder. Patients with PD are susceptible to any psychiatric condition seen in the general population; some disorders, such as depression and anxiety, may result from PD-related neuropathological changes. Medication- related hallucinations are seen in many PD patients who are treated with dopaminergic agents for motor symp- toms. Cognitive impairment is also seen and can be multi- factorial. Treatment of behavioral symptoms in PD can greatly improve patients’ overall function and quality of life. As surgical interventions to treat motor symptoms, such as deep brain stimulation of the subthalamic nucleus of  the  substantia  nigra,  become  more  prevalent,  the behavioral  effects  of  these  procedures  must  also  be addressed.   © 2004, LLS SAS Dialogues Clin Neurosci . 2004;6:323-332.