Drug and Disease Effects in Parkinson's Psychosis: Revisiting the Role of Dopamine.
DAT scan
Hallucination
PPMI
illusion
Journal
Movement disorders clinical practice
ISSN: 2330-1619
Titre abrégé: Mov Disord Clin Pract
Pays: United States
ID NLM: 101630279
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
24
07
2019
accepted:
14
09
2019
entrez:
24
1
2020
pubmed:
24
1
2020
medline:
24
1
2020
Statut:
epublish
Résumé
Levodopa and dopamine agonists (dopamine replacement therapy [DRT]) are implicated in Parkinson's disease psychosis (PDP), but the relationship between DRT and neurotransmitter dysfunction inherent to PD remains unclear. To examine the relationship between baseline striatal dopamine transporter (DAT) binding in drug-naïve idiopathic PD, introduction of DRT, or dose change and incident early-onset PDP. Baseline DAT binding was compared between patients with and without incident psychosis (defined here as hallucinations or delusions), controlling for age, sex, baseline cognition, and prospective DRT in the Parkinson's Progression Markers Initiative cohort. Incident illusions were not considered psychosis symptoms. Of 386 patients, 30 (8%) developed PDP (predominantly hallucinations, mean onset 42 months) and 355 (92%) had either no PDP symptoms (mean follow-up 64 months) or reported illusions only (111/355, 31%). Incident PDP was associated with reduced baseline striatal DAT binding, controlling for confounders ( The findings highlight the role of disease-related dopamine mechanisms in the pathophysiology of hallucinations in Parkinson's disease alongside medication. It remains to be determined how dopamine mechanisms, medication, and other neurotransmitter systems implicated in PDP interact.
Sections du résumé
BACKGROUND
BACKGROUND
Levodopa and dopamine agonists (dopamine replacement therapy [DRT]) are implicated in Parkinson's disease psychosis (PDP), but the relationship between DRT and neurotransmitter dysfunction inherent to PD remains unclear.
OBJECTIVES
OBJECTIVE
To examine the relationship between baseline striatal dopamine transporter (DAT) binding in drug-naïve idiopathic PD, introduction of DRT, or dose change and incident early-onset PDP.
METHODS
METHODS
Baseline DAT binding was compared between patients with and without incident psychosis (defined here as hallucinations or delusions), controlling for age, sex, baseline cognition, and prospective DRT in the Parkinson's Progression Markers Initiative cohort. Incident illusions were not considered psychosis symptoms.
RESULTS
RESULTS
Of 386 patients, 30 (8%) developed PDP (predominantly hallucinations, mean onset 42 months) and 355 (92%) had either no PDP symptoms (mean follow-up 64 months) or reported illusions only (111/355, 31%). Incident PDP was associated with reduced baseline striatal DAT binding, controlling for confounders (
CONCLUSION
CONCLUSIONS
The findings highlight the role of disease-related dopamine mechanisms in the pathophysiology of hallucinations in Parkinson's disease alongside medication. It remains to be determined how dopamine mechanisms, medication, and other neurotransmitter systems implicated in PDP interact.
Identifiants
pubmed: 31970209
doi: 10.1002/mdc3.12851
pii: MDC312851
pmc: PMC6962668
doi:
Types de publication
Journal Article
Langues
eng
Pagination
32-36Subventions
Organisme : Department of Health
ID : RP-PG-0610-10100
Pays : United Kingdom
Informations de copyright
© 2019 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Déclaration de conflit d'intérêts
No relevant funding sources or conflicts of interest given the nature of the article.
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