Affiliations: Movement Disorders Program, Butler Hospital,
Department of Neurology, Alpert Medical School of Brown University, Providence,
RI, USA. Tel.: +1 401 455 6669; Fax: +1 401 455 6670; E-mail:
Joseph_Friedman@Brown.edu
Abstract: Psychotic symptoms are common in drug treated patients with
Parkinson's disease (PD). Visual hallucinations occur in about 30% and
delusions, typically paranoid in nature, occur in about 5%. These problems,
particularly the delusions, cause great distress for patient and caregivers,
and are among the most important precipitants for nursing home placement.
Psychotic symptoms carry a poor prognosis. They often herald dementia, and are
associated with increased mortality. These symptoms often abate with medication
reductions, but this may not be tolerated due to worsened motor function. Only
clozapine has level A evidence to support its use in PD patients with psychosis
(PDP), whether demented or not. While quetiapine has been recommended by the
American Academy of Neurology for "consideration," double blind placebo
controlled trials have demonstrated safety but not efficacy. Other
antipsychotic drugs have been reported to worsen motor function and data on the
effectiveness of cholinesterase inhibitors is limited. PDP remains a serious
problem with limited treatment options.
