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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.

People with Parkinson’s disease (PD) and their care partners frequently report cognitive decline as one of their greatest concerns. Mild cognitive impairment affects approximately 20–50% of people with PD, and longitudinal studies reveal dementia in up to 80% of PD. Through the Parkinson’s Disease Foundation Community Choice Research Award Program, the PD community identified maintaining cognitive function as one of their major unmet needs. In response, a working group of experts across multiple disciplines was organized to evaluate the unmet needs, current challenges, and future opportunities related to cognitive impairment in PD. Specific conference goals included defining the current state in the field and gaps regarding cognitive issues in PD from patient, care partner, and healthcare professional viewpoints; discussing non-pharmacological interventions to help maintain cognitive function; forming recommendations for what people with PD can do at all disease stages to maintain cognitive health; and proposing ideas for how healthcare professionals can approach cognitive changes in PD. This paper summarizes the discussions of the conference, first by addressing what is currently known about cognitive dysfunction in PD and discussing several non-pharmacological interventions that are often suggested to people with PD. Second, based on the conference discussions, we provide considerations for people with PD for maintaining cognitive health and for healthcare professionals and care partners when working with people with PD experiencing cognitive impairment. Furthermore, we highlight key issues and knowledge gaps that need to be addressed in order to advance research in cognition in PD and improve clinical care.

This study evaluated the feasibility of cognitive behavioral therapy (CBT) for Japanese Parkinson's disease (PD) patients with depression. To increase cultural acceptability, we developed the CBT program using manga, a type of Japanese comic novel. Participants included 19 non-demented PD patients who had depressive symptoms (GRID-Hamilton Rating Scale for Depression score ≥8). A CBT program comprising six sessions was individually administered. We evaluated the feasibility and safety of the CBT program in terms of the dropout rate and occurrence of adverse events. The primary outcome was depressive symptom reduction in the GRID-Hamilton Rating Scale for Depression upon completion of CBT. Secondary outcomes included changes in the self-report measures of depression (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale-Depression), anxiety (Hospital Anxiety and Depression Scale-Anxiety, State and Trait Anxiety Inventory, Overall Anxiety Severity and Impairment Scale), functional impairment, and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey). Of the 19 participants (mean age =63.8 years, standard deviation [SD] =9.9 years; mean Hohen-Yahr score =1.7, SD =0.8), one patient (5%) withdrew. No severe adverse event was observed. The patients reported significant improvements in depression (Hedges' g =-1.02, 95% confidence interval =-1.62 to -0.39). The effects were maintained over a 3-month follow-up period. Most of the secondary outcome measurements showed a small-to-moderate but nonsignificant effect size from baseline to post-intervention. This study provides preliminary evidence that CBT is feasible among Japanese PD patients with depression. Similar approaches may be effective for people with PD from other cultural backgrounds. The results warrant replication in a randomized controlled trial.

It has been well established that Parkinson's disease (PD) is not just a movement disorder (Weintraub and Burn, 2011). Fortunately, the past two decades have seen increased attention to the neuropsychiatric aspects of the disease process. Neuropsychiatric symptoms (e.g., mood, sleep, psychosis, and impulse control) are experienced by the overwhelming majority of people living with PD (PWP) and have a detrimental impact on physical and cognitive decline (Pontone et al., 2016), quality of life (van Uem et al., 2016), and caregiving relationships (Santos-García, 2015). As a field, all multidisciplinary providers involved in the care of PWP, inclusive of movement disorder specialists, geriatric psychiatrists, clinical psychologists, social workers, and other allied healthcare providers, must work to improve the recognition and treatment of key non-motor symptoms, such as depression and anxiety, as part of the standard of care (Cohen et al., 2016). Improved detection and management is critical, as the failure to appropriately treat psychiatric complications negatively impacts the overall course of the illness, functional aspects of daily life, and the PWP ability to fully engage in their own self-care (Pontone et al., 2016).

Although millions of individuals suffer from mental health problems worldwide, only a small fraction receives adequate treatment. The high prevalence of depression and anxiety observed worldwide, in conjunction with very low rates of treatment utilization, are of great clinical significance, as these psychiatric conditions are two of the most important determinants of quality of life (QoL). Telehealth interventions have been touted as potential solutions to these mental health care disparities, with great interest and utility demonstrated across a diverse array of medical and psychiatric populations. Telehealth interventions may be clinic-based or home-based. The primary objective of this paper is to highlight the extent to which telehealth-to-home interventions positively impact multiple facets of QoL for individuals with depression and anxiety disorders, including those with comorbid medical conditions. While QoL outcomes are important to consider in any assessment of treatment effectiveness, QoL enhancement has received limited attention in the telemental health literature to date. All studies included in the present review evaluate telehealth-to-home treatments, assess QoL outcomes, and incorporate some degree of live, synchronous therapist-patient contact. Recommendations to advance the application of telehealth-to-home approaches are proposed and include: additional research on video-to-home telehealth platforms, strategies to increase the adoption of telehealth-to-home interventions amongst mental health treatment providers, national legislative reform to establish fair and appropriate reimbursement parameters for telehealth-to-home care, standardized definitions of telehealth-to-home services to facilitate provider engagement and reimbursement, and systematic approaches for measuring the cost-effectiveness of telehealth-to-home treatments. Keywords: telehealth-to-home, quality of life, depression and anxiety disorders

Heterogeneity is an important feature of cognitive impairment in patients with Parkinson’s disease (PD), with emerging evidence linking insulin resistance to accelerated cognitive decline. Our investigation examined the relationship between the triglyceride-glucose (TyG) index-a marker of insulin resistance-and cognition and striatal dopamine transporter (DAT) alterations in PD through cross-sectional and longitudinal analyses. In the primary cohort, higher TyG correlated with lower Mini-Mental State Examination (MMSE) scores ( p  < 0.001) and increased dementia risk ( p  = 0.014). Longitudinal analysis in the PPMI cohort showed higher baseline TyG predicted greater Montreal Cognitive Assessment (MoCA) decline ( p  = 0.019) and reduced DAT activity in caudate ( p  = 0.033) and putamen ( p  = 0.019) over 4 years.DAT activity in the caudate mediated 24.1% of the TyG index’s longitudinal effect on MoCA scores, while the TyG index mediated 16.9% of CSF GLP-1R’s effect. These results highlight the TyG index as a potential biomarker for identifying PD patients at higher risk of cognitive impairment.

Parkinson s disease, a progressive disorder which leads to significant functional disability, is the second most common neurodegenerative disorder in the elderly. In the majority of individuals, the illness is complicated by co-occurring psychiatric problems. These disorders may complicate the course and management of the illness and lead to poor outcomes. Psychiatric disorders are under-recognized in clinical practice for a variety of reasons, and there is relatively little controlled research that can guide treatment. The etiology of these disorders is not well understood but some, including psychosis and disinhibition (which leads to gambling and hypersexuality), can be as a direct result of the dopaminergic medications used in the treatment of the movement disorder. This article reviews treatment recommendations, based on available evidence and clinical experience, for the most common of the psychiatric disorders, including depression, psychosis, disinhibition, cognitive impairment, sleep disorders and anxiety. Much research is needed to more definitively define these disorders and their treatment.

Parkinson's disease, a progressive disorder which leads to significant functional disability, is the second most common neurodegenerative disorder in the elderly. In the majority of individuals, the illness is complicated by co-occurring psychiatric problems. These disorders may complicate the course and management of the illness and lead to poor outcomes. Psychiatric disorders are under-recognized in clinical practice for a variety of reasons, and there is relatively little controlled research that can guide treatment. The etiology of these disorders is not well understood but some, including psychosis and disinhibition (which leads to gambling and hypersexuality), can be as a direct result of the dopaminergic medications used in the treatment of the movement disorder. This article reviews treatment recommendations, based on available evidence and clinical experience, for the most common of the psychiatric disorders, including depression, psychosis, disinhibition, cognitive impairment, sleep disorders and anxiety. Much research is needed to more definitively define these disorders and their treatment.

AbstractNeuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson’s disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.

Parkinson's disease (PD) is frequently complicated by depression and there is a paucity of controlled research that can inform the management of this disabling nonmotor complaint. A randomized controlled trial of nortriptyline, paroxetine, and placebo for the treatment of depression in PD (dPD) was recently completed. The purpose of this article is to describe the baseline pattern of depressive symptom presentation in PD, the specific symptoms of dPD that improve with pharmacotherapy, and the residual symptoms that remain in patients who meet a priori criteria for response or remission after acute treatment (8 weeks). The Departments of Psychiatry and Neurology at Robert Wood Johnson Medical School, New Jersey. Fifty-two depressed patients (major depression or dysthymia based on Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria) with Parkinson's disease (by research criteria). A randomized controlled trial of nortriptyline, paroxetine, and placebo. The four subscales (core mood, anxiety, insomnia, and somatic) and individual items from the Hamilton Rating Scale for Depression-17 were the focus of this study. These measures were assessed at baseline and Week 8. Baseline depressive symptoms were unrelated to motor functioning. Treatment response was associated with significant improvements in the core mood, anxiety, insomnia, and somatic symptoms seen in dPD. Residual symptoms, such as sadness and loss of interest, persisted in treatment responders in a milder form than was initially present. Antidepressants may influence all symptoms of dPD, including those that share great overlap with the physical disease process. Additional research regarding adjunctive interventions is needed to help optimize the management of dPD. (Am J Geriatr Psychiatry 2011; 19:222–229)