Management Of Neuropsychiatric Symptoms

The Parkinson's-Reversing Breakthrough

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Pharmacological Treatment of PD

In light of the high prevalence and clinical importance of neuropsychiatric symptoms in patients with parkinsonian disorders, relatively few adequately designed clinical trials have been reported. In a recent evidence-based review of management of PD, including psychosocial treatments, produced by The Movement Disorder Society (112), the only neuropsychiatric treatment that was concluded to be "efficacious" was the atypical antipsychotic agent clozapine for hallucinations/psychosis. In addition, the tricyclic antidepressant nortriptyline was considered to be "likely efficacious." Too few or methodologically inadequate studies precluded positive conclusions for other treatments.

To our knowledge, only nine randomized, placebo-controlled studies of neuropsychiatric symptoms in parkinsonian disorders have been reported: four trials with cholinergic agents in DLB (rivastigmine) (113), PD (donepezil) (114), and PSP (donepezil and RS-86, a cholinergic agonist) (115,116), two trials with clozapine in PD (117,118), and three trials with antidepressants in PD (119-121). The studies have usually included few subjects, with a total number of 356 patients in the nine studies. Further details are provided in Table 2. In addition to the two studies showing efficacy of clozapine in PD with psychosis, rivastigmine improved neuropsychiatric symptoms in DLB (113),

Table 2

Placebo-Controlled Studies of Neuropsychiatrie Symptoms in Patients With Parkinsonian Disorders

Table 2

Placebo-Controlled Studies of Neuropsychiatrie Symptoms in Patients With Parkinsonian Disorders

Author

Disorder

Drug

Dose, mg/d

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