The Parkinson's-Reversing Breakthrough

Treatment for Parkinsons

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Battery, MMSE POMS"

Battery, MMSE POMS"

'Apathy Evaluation Scale (135). "Profile of Mood States (136).

NPI, Neuropsychiatrie Inventory, PD, Parkinson's disease; PSP, Progressive supranuclear palsy, DLB, Dementia with Lewy bodies; MMSE, Mini-Mental State Examination; BPRS, Brief Psychiatric Rating Scale; PANSS, Positive and Negative Syndrome Scale; CGIC, Clinical Global Impression of Change; HDRS, Hamilton Depression Scale; MADRS, Montgomery & Asberg Depression Rating Scale.

donepezil improved cognition in PD (114) but not in PSP (115,116), whereas nortriptyline (119) but neither citalopram (120) nor sertraline (121) were more effective than placebo for depression in PD. Two randomized studies suggest that in PD with psychosis, clozapine is better tolerated than olanzapine (122) and risperidone (123). In addition, a range of case reports and case series reporting the use of cholinesterase inhibitors, antidepressants, and atypical antipsychotics have been published. The vast majority of these studies have included patients with PD or DLB. Although positive results have been reported, these should be interpreted with caution because of the open, uncontrolled design. The literature of treatment studies of the atypical parkinsonian disorders is reviewed below. (See recent excellent reviews for the treatment of neuropsychiatric symptoms in PD in refs. 55, 112, and 124.) Importantly, in patients with parkinsonism and neuropsychiatric symptoms, general measures, including counseling, education, and supportive measures, should be considered. Attention to general medical conditions that could contribute to neuropsychiatric symptoms, such as hypoxemia, infection, or electrolyte disturbances, and the taking of nonessential drugs are important in the management of patients with parkinsonian disorders and neuropsychiatric disorders. Anticholinergic agents can induce delirium and psychosis and should be discontinued. Curtailing doses of dopaminergic agents should also be considered in patients with psychotic or delirious symptoms.

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