Drug Treatments for the Neuropsychiatric Complications of Parkinson's Disease

Barbara S Connolly; Susan H Fox


Expert Rev Neurother. 2012;12(12):1439-1449. 

In This Article

Abstract and Introduction


Psychiatric symptoms are now well described in Parkinson's disease (PD). Most are due to the disease pathology with exacerbation caused by dopaminergic treatment. Anxiety and depression may predate the onset of motor symptoms and can continue to occur with advancing disease. In patients with parkinsonism, well-formed hallucinations are highly specific for PD and some patients may progress to other psychotic symptoms. Cognitive impairment, ranging from mild impairment to dementia is common. Management of these symptoms involves initial recognition and secondly, appropriate medications. Pharmacological treatments are not specific for PD and are the same as those currently used in nonPD populations. The choice of agent is determined by a balance between potential benefit versus side effects, mostly in terms of worsening motor PD symptoms. This article will review current treatment approaches to mood disorders, psychosis and cognitive problems in PD, as well as management of dopamine-induced impulse control disorders.


Neuropsychiatric symptoms are well-described nonmotor features of Parkinson's disease (PD). Underdiagnosed and often undertreated, they substantially affect the lives of patients and their caregivers.[1] These symptoms are primarily due to the underlying pathology of the disease but can also be an outcome of treatment of PD motor features with dopaminergic medication. Neuropsychiatric features comprise mood disorders, including depression, anxiety, and apathy, psychotic symptoms such as hallucinations and delusions, cognitive impairment, and impulsive and compulsive behaviors.

Even when recognized, pharmacological management of neuropsychiatric symptoms can be challenging. There is limited availability of high quality research studies on use of medication to treat these conditions in PD patients. Practitioners must also remain cognizant about medications that could potentially worsen motor PD symptoms or exacerbate other features of the disease. This paper will review the literature surrounding treatment approaches to these neuropsychiatric features.