Increasing Complexity Awareness of Parkinson Disease Psychosis: Risk Factors, Symptoms, Diagnosing & Management

Background:After Alzheimer’s disease, Parkinson’ disease (PD) is the second most common age-related neurodegenerative disorder globally. Approximately 1 million individuals in the United States (US) have PD; every year 60,000 more Americans are diagnosed. PD is a movement disorder caused by dopamine insufficiency in the substantia nigra. The disease process is complicated by falls, constipation, dysphagia, insomnia, anxiety, depression, and behavioral/cognitive disorders. Upon diagnosis, evidence-based symptom management should include individualized nonpharmacologic and pharmacologic interventions along with lifestyle changes that will promote positive outcomes.More than 50% of persons diagnosed with PD develop psychotic symptoms. Parkinson’s disease psychosis (PDP) is a non-motor symptom and consists primarily of hallucinations and delusions. PDP is caused by neurotransmitter changes in the brain, some related to long-term use of parkinsonian medications. In many cases, PDP symptoms are mis-diagnosed as a chronic co-morbid condition, such as mild cognitive impairment or dementia.Symptoms run from benign to aggressive. Undiagnosed and untreated symptoms can accelerate. Delirium caused by medications or infections may contribute to psychosis. Rapid Eye Movement Sleep (REMS) Disorder associated with PD results in daytime sleepiness and acting out dreams. All symptoms profoundly impact formal and informal care partners. When underlying causes are identified by expert clinicians, symptoms may be reversible. There are many evidence-based paths to follow such as managing polypharmacy, appropriate prescribing patterns, and the effective use of nonpharmacologic interventions.Conclusion:During this symposium the complexities of the disease are addressed including the toll PDP can have on the person living with PD, their care partner(s) and the interdisciplinary health care team. It is imperative clinicians can simultaneously manage the overlapping motor symptoms and PDP to prevent physical and mental disabilities and improve quality of life. After attending this session, clinicians will be able to provide quality care to individuals living with PDP and their care partners.