Treatment of psychosis in Parkinson's disease and dementia with Lewy Bodies: A review |
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| Affiliation: | 1. Department of Psychiatry and Behavioral Sciences (NMF, JTH, KP, MDS, AB, GMP), Johns Hopkins School of Medicine, Baltimore, MD;2. Medical Scientist Training Program (JTH), Johns Hopkins School of Medicine, Baltimore, MD;3. Morris K. Udall Parkinson''s Disease Research Center of Excellence (CCB, ZM, KAM, LSR, AP, JCT, GMP), Johns Hopkins School of Medicine, Baltimore, MD;4. Clinical and Neuropathology Core (MM, OP, JCT), Johns Hopkins School of Medicine, Baltimore, MD;5. Department of Neurology (MPGB), Maastricht University Medical Centre, Maastricht, the Netherlands;6. Department of Neurology (AB, TMD, CLM, KAM, LSR, AP, GMP), Johns Hopkins School of Medicine, Baltimore MD;7. Neuroregeneration and Stem Cell Programs (TMD), Institute for Cell Engineering, Johns Hopkins School of Medicine, Baltimore, MD;8. Solomon H. Snyder Department of Neuroscience (TMD), Johns Hopkins School of Medicine, Baltimore, MD;9. Department of Pharmacology and Molecular Sciences (TMD), Johns Hopkins School of Medicine, Baltimore, MD,;10. Department of Psychiatry (AFGL), Maastricht University Medical Centre, Maastricht, The Netherlands;11. Lou Ruvo Center for Brain Health (ZM), Cleveland Clinic, Las Vegas, NV;12. Department of Biostatistics (JW), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;1. Department of Neurology, Wayne State University School of Medicine, 4201 St. Antoine, UHC 8D, Detroit, MI 48201, United States of America;2. Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America;3. Department of Neurology, University of Michigan, Neurology Service & GRECC, VAAAHS, 5023 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI 48109-2200, United States of America;4. Neurology Service & GRECC, VAAAHS, Ann Arbor, MI, United States of America;5. Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CR131, Portland, OR 97239-3098, United States of America |
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| Abstract: | There is a considerable overlap between Parkinson's Disease Dementia (PDD) and Dementia with Lewy Bodies (DLB). They present a challenge therapeutically, with regard to morbidity and mortality risk. In particular, symptoms of psychosis in these conditions augur a considerably increased burden.To date, there has been a myriad of prospective, retrospective and case studies examining the use of neuroleptics in the treatment of psychotic symptoms in PDD/DLB. Clozapine has the most robust evidence base however its use is limited by agranulocytosis risk and the associated need for frequent blood count monitoring. Quetiapine is more readily used, however, it has a more equivocal evidence base, in terms of efficacy. Other neuroleptics have thus far demonstrated mixed results with increased risk of extrapyramidal worsening. In addition to the atypical agents, the introduction of pimavanserin has provided another treatment option for Parkinson's Disease Psychosis (PDP), decreasing concern for deterioration in motor function. We await further research to confidently demonstrate its efficacy and safety in DLB psychosis. Cholinesterase inhibitors likely have a limited role in treating milder psychosis symptomatology in DLB and perhaps PDD.After review of the current literature for antipsychotic therapy in both PDD and DLB, we provide a logical framework for addressing psychotic symptoms in each condition. |
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| Keywords: | Parkinson's disease Psychosis Lewy body Neuroleptics Pimavanserin |
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