Psychiatric issues in cognitive impairment

Authors

  • Dag Aarsland MD, PhD,

    Corresponding author
    1. Alzheimer's Disease Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
    2. Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
    3. Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway
    • Correspondence to: Dag Aarsland; Alzheimer's Disease Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm Sweden. E-mail: daarsland@gmail.com

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  • John-Paul Taylor MD, PhD,

    1. Wellcome Trust Intermediate Clinical Fellow, Institute for Ageing and Health, and Honorary Consultant in Old Age Psychiatry, Northumberland, Tyne and Wear NHS Trust
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  • Daniel Weintraub MD

    1. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
    2. Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia, PA
    3. Mental Illness Research, Education and Clinical Center (MIRECC), Philadelphia, PA
    4. Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
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  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

ABSTRACT

Neuropsychiatric symptoms (NPS) such as depression, hallucinations and apathy commonly occur in Parkinson's disease (PD) and have major clinical consequences including a negative impact on quality of life. This review discusses the epidemiology, clinical features, diagnostic procedures and treatment issues of NPS in PD and related disorders in the perspective of cognitive impairment, focusing on depression, anxiety, visual hallucinations, apathy, sleep disturbances, impulse control disorder and non-motor fluctuations. The majority of NPS are more common in PD patients with dementia, possibly related to shared underlying pathologies. Recent studies also suggest that NPS are associated with mild cognitive impairment in PD, in particular with the amnestic type. Accurate diagnosis of NPS is important but can be difficult, due to overlapping symptoms and similar appearance of symptoms of motor symptoms of parkinsonism, cognitive impairment, mood disorders and apathy. There are few systematic studies focusing on the management of NPS in PD with cognitive impairment. © 2014 International Parkinson and Movement Disorder Society

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