Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Falls occur commonly in older persons and are the seventh leading cause of death. Falls are associated with functional deterioration and "fear of falling". Falls can be due to extrinsic factors such as poor lighting, throw rugs and other environmental hazards. Intrinsic causes of falls include physiological changes associated with aging, orthostatic hypotension, many medications, delirium, anemia, diabetes mellitus, Parkinson's disease, depression, cognitive impairment, syncope, partial complex seizures and vitamin D deficiency. Management of falls requires a multidisciplinary approach with a home assessment and modification where appropriate, a careful geriatric assessment, exercise programs focusing on balance, resistance and endurance exercise and adequate vitamin D replacement. All fallers should be assessed and treated for osteoporosis. The complexities of the causes and management of falls, make persons with frequent falls an ideal person to be referred for a geriatric consult.
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PMID:Falls--where do we stand? 1741 Aug 28

In the spirit of Adolf Mayer's medico-biological approach to the understanding of mental illnesses the article describes the advantages that neuropsychiatric approach brings to the diagnostic evaluation and treatment of psychiatric patients in a state hospital. Our review discusses the neuropsychiatric approach to the evaluation of state hospital patients with mild, moderate, and severe cognitive disturbances showing the role of neuropsychological testing, electroencephalography (EEG), and brain imaging in the neuropsychiatric assessment of primary and secondary mental illnesses. Neuropsychiatric evaluation helps to assess the peculiarities of movement disorder as a of side effects of regular psychiatric medications, e.g. the differences in diagnostic signs and treatment implication between Parkinson's disease and extrapyramidal syndrome (EPS) as a side effect of neuroleptics as well as the development of abnormal reflexes as a sign of tardive dyskinesia (TD) not directly related to the lesion of upper motor neuron. The article also discusses the development of hypokinetic delirium in the course of treatment of psychiatric patients not only as a side effect of neuroleptics but also of anticonvulsants, increasingly used as the mood stabilizers in modern psychiatry. Since aggressive behavior of psychiatric patients represents one of the major criteria for admission and often long term treatment in a state hospital, special consideration is given to the role of brain paroxysmal activity in the development of aggressive behavior, especially rage attacks, one of the main manifestations of aggressive behavior in a state hospital patients. Correspondingly, the use of anticonvulsants in the treatment of rage attacks is discussed. This article may serve as a model for the use of neuropsychiatric service in improvement of diagnostic evaluation and treatment of psychiatric patients in a state hospital.
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PMID:A neuropsychiatry service in a state hospital. Adolf Meyer's approach revisited. 1749 8

Parkinson's disease is a progressive and debilitating movement disorder that is diagnosed by its motor signs. The behavioral manifestations of Parkinson's disease are prevalent and frequently complicate the course of the disease. These may be due to the illness itself or its treatment and are often more disabling than the motor symptoms. This review focuses on the management of the most common behavioral symptoms of Parkinson's disease, including depression, anxiety, psychosis, dementia, delirium, sleep disorders, fatigue, apathy, emotionalism and compulsive behaviors.
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PMID:Management of the behavioral aspects of Parkinson's disease. 1756 53

It is essential to recognize and treat psychosis in Parkinson's disease for several reasons. Studies have shown that psychosis in Parkinson's disease patients is a strong risk factor for nursing home placement. Psychosis may be the greatest source of stress for caretakers of Parkinson's patients; it is often persistent, and its presence markedly increases mortality. Treatment of psychotic symptoms should occur only after potential medical and environmental causes of delirium have been eliminated or addressed. Initial pharmacologic changes should include limiting the patient's antiparkinsonian medications to those that are necessary to preserve motor function. Should that fail, an atypical antipsychotic is presently the treatment of choice. An emerging treatment option is acetylcholinesterase inhibitors. This article reviews what is currently known about the course, prognosis, and treatment strategies in Parkinson's disease psychosis.
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PMID:Course, prognosis, and management of psychosis in Parkinson's disease: are current treatments really effective? 1832 64

We determined plasma amantadine concentrations in patients with Parkinson's disease (PD) in daily clinical practice and investigated the relationship between plasma concentration and adverse reactions to clarify the safe therapeutic range. Seventy-eight consecutive PD patients on stable amantadine treatment were recruited. Plasma concentration of amantadine was measured 3h after the administration of morning amantadine dose. Serum creatinine was measured to estimate renal function. The mean daily dose of amantadine was 135.1+/-62.3mg/day, and the mean plasma amantadine concentration was 812.5+/-839.5 ng/ml (range, 91-4400 ng/ml). Plasma amantadine concentration increased according to increasing renal dysfunction. Three patients exhibited adverse reactions, such as myoclonus, hallucinations, and delirium, and all of them showed plasma amantadine concentration >3000 ng/ml. None of the three cases had previously shown such side effects. PD patients who have not developed any psychiatric symptoms as adverse reactions to the treatment may develop myoclonus, hallucination, or delirium when the plasma concentration of amantadine exceeds 3000 ng/ml. It is therefore recommended to use amantadine at the plasma concentration of less than 3000 ng/ml in the treatment of Parkinson's disease, especially in elderly patients.
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PMID:Plasma amantadine concentrations in patients with Parkinson's disease. 1882 13

Light changes in mental function after operation occur in patients of all ages, but more frequent they are observed in older patients. The incidence of early postoperative cognitive dysfunction varies depending on surgical procedure and may be as high as 20-90% in aged patients, and occurs most often in patients undergoing cardiovascular surgery. Early postoperative cognitive dysfunction is a predictor of late postoperative cognitive dysfunction. Delirium develops in at least 50% of older surgical patients and even more frequently after cardiac surgeries (72%). Postoperative delirium, like delirium manifesting with co-existing disease, and late postoperative cognitive dysfunction are strong predictors of functional and cognitive decline in one-year period after discharge and are associated with higher morbidity and mortality, longer hospital stay, and a higher rate of institutionalization. The reasons of postoperative cognitive dysfunction and delirium are not well understood. An assessment of cognitive function should be completed as a routine in older patients, and effective prevention requires the identification of risk factors for delirium: advanced age, preexisting dementia and depression, visual and hearing impairment, Parkinson disease, emergency operation, anticholinergic drugs, and others. After operation, elderly patients must be carefully monitored for probable postoperative delirium. It is important to deepen health care professionals' knowledge of postoperative cognitive complications in older surgical patients.
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PMID:[Postoperative cognitive dysfunction of older surgical patients]. 2051 55

Dementia with Lewy-bodies (DLB) and Parkinson's disease dementia (PDD) are no rare causes of dementia. Both have neuropathologically, clinically, and neurochemically much in common. In the course of both conditions frequently psychotic symptoms occur, often induced by antiparkinsonian medication. Treatment of psychotic features with conventional antipsychotics is not tolerated in many cases. Therefore low-dose clozapine treatment is acknowledged usual practise for psychosis in Parkinson's disease and a case report indicates efficacy for psychosis in DLB, too. All other atypical antipsychotics except risperidone are not licensed for dementia in Germany, but risperidone is contraindicated in DLB due to manufacturer's notice and usually not well tolerated in DLB and Parkinson's disease. Open trials indicate safety for treatment of psychosis in DLB and PDD with quetiapine. Randomized controlled trials indicate, that quetiapine is less effective than clozapine against psychotic symptoms in both conditions, although comparatively safe. Cholinesterase inhibitors, especially rivastigmine, are a therapeutic alternative for treating both psychotic and cognitive symptoms in both conditions. Parkinsonism in DLB-patients responds worse to levodopa compared to patient with Parkinson's disease. Anticholinergic drugs often induce delirium in demented patients and therefore should be avoided. The same problem is associated with dopamine agonists in PDD and DLB. Amantadine, a NMDA-receptor antagonist like memantine, potentially bears the same risk of worsening psychotic symptoms. The following preliminary recommendation for drug treatment of PDD and DLB can be given: Stop all anticholinergic medication and reduce levodopa and other antiparkinsonian medication to the tolerated minimum. Levodopa alone is preferred. Treat with cholinesterase inhibitors to the maximum tolerated dose. If there is no adequate response regarding psychotic symptoms, add quetiapine. If this approach fails, replace quetiapine by low-dose clozapine. If behavioural disturbances are due to depression, anxiety, or irritability, treatment with an antidepressant, preferably citalopram, is an option.
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PMID:[Drug treatment of dementia with Lewy bodies and Parkinson's disease dementia--common features and differences]. 2142 15

Delirium, an acute confusional state with changes in attention and cognition, is a common cause of morbidity and mortality among hospitalized elders. Medications are responsible for up to 39% of delirium cases in the elderly. The incidence of drug-induced delirium is particularly high in this population due to the altered pharmacokinetics and pharmacodynamics of aging, high prevalence of polypharmacy and occurrence of co-morbid disease. Although certain medications are more often associated with the development of delirium, including opioids, benzodiazepines, anticholinergics and antidepressants, any medication can cause delirium in the elderly. Evaluation of delirium should include a thorough medication history, which should determine if any new medications have been initiated, if medications have been discontinued, and the details of any recent dosage adjustments. It is important to understand the utility of medications in preventing and treating delirium in the elderly. Acetylcholinesterase inhibitors have not been found to reduce the incidence of delirium or length of hospitalization. Study results regarding the utility of antipsychotic medications in preventing delirium have been mixed. Haloperidol prophylaxis did not reduce the occurrence of delirium, but it did reduce the severity and duration. Olanzapine and risperidone were associated with a reduced incidence of delirium compared with placebo. Pharmacological therapy to treat delirium should be implemented only if patients pose a safety risk to themselves or others. Typical and atypical antipsychotics are effective in treating the symptoms of delirium, but it is important to note that they are not approved by the US FDA for this indication. Short-acting benzodiazepines are second-line therapy and are typically reserved for patients with sedative/alcohol withdrawal, Parkinson's disease or neuroleptic malignant syndrome. Study results regarding the utility of acetylcholinesterase inhibitors have been mixed.
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PMID:Identification and management of in-hospital drug-induced delirium in older patients. 2191 39

Psychopharmaologic intervention for elderly patients requires careful considerations for physical characteristics, comorbid medical illness, and interaction between drugs for psychotropic and somatic diseases drugs. Elderly patients often suffer from depression, delirium, and dementia, which occasionally coexist with each other. Antidepressants, antipsychotics, anxiolytics and hypnotics are prescribed according to the targeted psychiatric symptoms. Drug effect tens to be strengthened and prolonged pharmacodynamically in elderly patients because of decline of drug clearance in liver and kidney, prolongation of elimination half life of lipophilic drug resulted from reduced muscle tissue, and elevated free serum drug level induced by low albuminemia. Elderly patients pharmacokinetically develop adverse effects in relatively lower serum drug level. Lower initial dose and slow titration should be strongly recommended. Cerebrovascular disease and neurodegerative disease are frequently observed among elderly patients. Significant number of patients with cerebrovascular disease are complicated with depression, delirium, and in lower prevalence, dementia. Although drugs used in acute phase stroke have no pharmacodynamic interaction with psychotropics, many patients be carefully titrated with continuous monitoring of PT-INR during concurrent use of tricyclic antidepressants and selective serotonin reuptake inhibitors. Alzheimer's disease and Parkinson's disease are highly prevalent and clinically important neurodegerative disease in elderly population. Patients with Alzheimer's disease frequently exhibit delirium soon after hospitalization, which necessitates appropriate pharmacotherapy with psychotropics. After Food and Drug Foundation warned against antipsychotic use for patients with dementia, this off-label use are considered to be avoided but disease frequently coincide with depression and receive antidepressant treatment. If selegiline id prescribed, antidepressants cannot be initiated without discontinuation of selegiline. When delirium develops in patients with Parkinson's disease, second generation antipsychotics such as quetiapine are firstly administered with caution for deterioration of motor symptoms.
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PMID:[Clinical issues on prescribing psychotropics for elderly patients]. 2309 91

Psychiatric disorders (PDs) in neurology are more frequent then it verified in routine exam, not only in the less developed but also in large and very developed neurological departments. Furthermore, psychiatric symptoms (PSs) in neurological disorders (NDs) among primary health care physicians and other specialties are often neglected. Anxiety and depression are most common, but hallucinations, delusions, obsessive-compulsive disorder and delirium or confusional state are also frequent comorbidity in many neurological conditions such as stroke, epilepsy, multiple sclerosis (MS), Parkinson disease (PD). Depression and NDs also have a bidirectional relationship, as not only are patients, for example with stroke at greater risk of developing depression, but patients with depression have a two-fold greater risk of developing a stroke, even after controlling for other risk factors. Dementia or cognitive impairment are part of clinical picture of PD, stroke patients, patients with MS, Huntington disease etc. The prototype of dementia in PD and other NDs is a dysexecutive syndrome with impaired attention, executive functions and secondarily impaired memory. So-called "functional" (or psychogenic or hysterical/conversion) symptoms are relatively infrequent in "neurological" conditions, but very often unrecognized and not properly treated. Treatment of PSs in neurology, basically are not different then treatment of these symptoms in psychiatry and should be include pharmacotherapy and psychiatry. This presentation gives an overview of frequency and type of PSs underlying necessity to recognize these disorders in every day routine exam and properly treatment.
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PMID:Psychiatric disorders in neurology. 2311 12


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