Emerging Neuropsychiatric Concepts in Parkinson’s Disease

By James M. Ellison

As Editor in Chief of the Journal of Geriatric Psychiatry and Neurology, I’m excited to announce the publication of a special issue on Emerging Neuropsychiatric Concepts in Parkinson’s Disease. Parkinson’s Disease (PD), the second most prevalent neurodegenerative disorder among older adults, currently affects more than 10 million persons in the world. In the United states, more than 60,000 people are newly diagnosed each year with this progressive and pleomorphic disorder.1 The JGPN is grateful to two prominent United States experts in PD, Drs. George Grossberg and Pratap Chand, for selecting an informative collection of reviews which will help clinicians improve their care of people with Parkinson’s Disease (PD).

Although PD is best known for tremor, rigidity, bradykinesia and postural instability, the underlying disease process also produces a host of lesser known and often overlooked symptoms which span the disciplines of neurology, psychiatry and internal medicine. A great challenge faced by those who diagnose and care for people with PD is recognition of the disease’s pervasive non-motor effects. The articles in this issue address aspects of PD motor disease and treatment but also shed light on PD’s non-motor manifestations.

Readers will learn from an important new review which highlights the relationship of the microbiota to PD and explores how microbial dysbiosis in the gut may contribute to the neuropathophysiology of PD. Dr. Gallop and colleagues discuss the growing awareness of inflammatory, immune and endocrine pathways through which the microbiome influences the pathophysiology of PD. The new findings in this area point toward potential advances in prevention and treatment.

Several of the papers in this collection address new and emerging treatment approaches for PD motor symptoms. The paper by Al Majali and colleagues discusses new pharmacotherapies for motor symptoms which offer hope to people who have responded suboptimally to currently available medications. Cleary and colleagues focus on how deep brain stimulation and other neuromodulatory treatments can contribute to the care of people with PD. Emig and colleagues review current evidence supporting the importance of physical exercise, which improves not only motor function but also reduces anxiety and mood symptoms and improves quality of life. Cognitive Behavior Therapy provides an additional non-pharmacologic intervention which helps people with PD cope better with both motor symptoms and the non-motor behavioral syndromes as well. The benefits of CBT in PD management are reviewed in detail by Lopes and associates.

Additional aspects of PD’s non-motor behavioral syndromes are addressed in several insightful reviews. Depression and anxiety disorders, which affect more than half of people with PD, are covered by Lintel and colleagues. These authors discuss early recognition and the use of therapeutic tools including medications and psychotherapy. PD psychosis, a debilitating behavioral complication of PD as well as of the medications used to treat it, is discussed by Segal and associations. A variety of management strategies can mitigate the disabling effects of this often treatable aspect of PD.

In the later stages of PD, the combination of advanced motor symptoms, progression of non-motor symptoms and medication-associated adverse effects undermine the quality of life for patient and caregiver. Hwang and colleagues thoughtfully discuss the balance between symptom management and treatment-associated complications in the later stages of PD treatment. Their focus is on the thoughtful balance of non-pharmacologic and pharmacologic strategies in treating people with advanced PD in order to relieve symptom burden while minimizing adverse medication effects.

The JGPN provides its readers with reviews and studies communicating the latest evidence-based information related to psychiatric and neurologic care of older adults. This special issue is certain to help clinicians from psychiatry, neurology, and medicine provide more current and comprehensive care for their patients with PD.

Read the special issue

Issue Details

Special Issue: Emerging Neuropsychiatric Concepts In Parkinsons Disease
James M. Ellison MD, MPH
Volume 34 Issue 4, July 2021
Journal of Geriatric Psychiatry and Neurology

About the Author

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James M. Ellison MD MPH is the Editor in Chief of the Journal of Geriatric Psychiatry and Neurology. He sees patients, educates residents in psychiatry and medicine, and participates in research in Delaware as the first appointee to the position of Swank Foundation Endowed Chair in Memory Care and Geriatrics. He is a professor of psychiatry and human behavior at the Sidney Kimmel College of Medicine, Thomas Jefferson University, in Philadelphia, PA, and the director of the Swank Center for Memory Care and Geriatrics at ChristianaCare in Wilmington, Delaware.