Management of comorbid problems associated with Parkinson disease
- Daniel Tarsy, MD
Daniel Tarsy, MD
- Professor of Neurology
- Harvard Medical School
Parkinson disease (PD) is a chronic, progressive neurodegenerative disease characterized by any combination of four cardinal signs: rest tremor, rigidity, akinesia, and gait disturbance. The clinical features most suggestive of idiopathic PD rather than an atypical or secondary parkinsonian syndrome include asymmetric or unilateral onset, the presence of resting tremor, and a clear-cut response to treatment with L-dopa.
In addition to these typical features, patients with PD may experience problems related to the disease itself or to the medications used to treat it. These comorbid problems include psychosis, hallucinations, daytime sleepiness, depression, fatigue, and dementia.
Management of these comorbid problems will be reviewed here. Dementia in PD and the clinical aspects of nonmotor symptoms in PD are discussed separately. (See "Cognitive impairment and dementia in Parkinson disease" and "Clinical manifestations of Parkinson disease", section on 'Nonmotor symptoms'.)
PSYCHOSIS AND HALLUCINATIONS
Psychosis is a frequent complication of Parkinson disease (PD), and it is characterized mainly by visual hallucinations and delusions, which are often paranoid in flavor . Hallucinations are the most common manifestation, and they affect up to 40 percent of patients with PD, particularly those at an advanced stage of illness. (See "Clinical manifestations of Parkinson disease", section on 'Psychosis and hallucinations'.)
The treatment of hallucinations includes general measures that are similar to the treatment of delirium. (See "Delirium and acute confusional states: Prevention, treatment, and prognosis".)
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