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Sintomas neuropsiquiátricos na doença de Parkinson
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Introdução: A doença de Parkinson (DP) considerada primariamente como uma doença motora paradigmática, caracteriza-se pela presença de tremor de repouso, rigidez, bradicinesia e instabilidade postural. Não obstante, as manifestações neuropsiquiátricas são cada vez mais reconhecidas e valorizadas, na medida em que apresentam impacto significativo na qualidade de vida dos doentes e dos seus cuidadores.
Objectivo: Este trabalho teve como objectivo rever os principais aspectos epidemiológicos, clínicos, de diagnóstico e de tratamento dos sintomas neuropsiquiátricos (SNP) mais relevantes na DP, nomeadamente da demência, depressão, ansiedade, apatia, psicose, e perturbações do controlo dos impulsos.
Método: Revisão sistemática da literatura recorrendo à base de dados PubMed/MEDLINE de 2005 a 2015, sendo que dos artigos selecionados foram extraídas referências secundárias.
Conclusões: Os SNP podem resultar de alterações patológicas inerentes à DP, factores psicológicos e emocionais, ou ocorrer como efeito secundário da terapêutica de substituição de dopamina (TSD); constituem um desafio diagnóstico e terapêutico, particularmente nas fases avançadas da DP. As evidências disponíveis sugerem a eficácia de antidepressivos tricíclicos (desipramina e nortriptilina) e do pramipexole para o tratamento da depressão. Entre os antipsicóticos a clozapina e a quetiapina, são consideradas as melhores opções para o tratamento da psicose; e a rivastigmina a opção mais eficaz na demência associada à DP.
Contudo, são necessários mais estudos para avaliar a eficácia e orientar o tratamento das
morbilidades psiquiátricas na DP.
Background: Parkinson's disease (PD) is primarily considered a motor disease characterized by rest tremor, rigidity, bradykinesia and postural disturbances. However, neuropsychiatric complications are increasingly recognized and appreciated, to the extent that significantly impact the quality of life of patients and their caregivers. Objective: This paper aims to review the main key features on epidemiological, clinical, diagnosis and treatment of the most important neuropsychiatric symptoms in PD, regarding depression, anxiety, apathy, psychosis, dementia, and impulse control disorders. Method: Systematic review using the PubMed/MEDLINE database between 2005 to 2015. From the selected articles secondary referenced articles were extracted. Conclusions: The pathophysiologic features of these complications are multifaceted and include neuropathophysiologic changes of Parkinson’s disease itself, emotional reactions to Parkinsonism and treatment-related side-effects. Neuropsychiatric complications constitute a diagnostic and therapeutic challenge, especially in advanced stages. The available evidence suggests the effectiveness of tricyclic antidepressants (desipramine and nortriptyline) and pramipexole for the treatment of depression. Among the antipsychotic clozapine and quetiapine are considered the best options for management of psychosis in patients with PD; and rivastigmine the most effective option in PD’s dementia. However, more studies are needed to evaluate the efficacy and guide treatment of psychiatric morbidities in PD.
Background: Parkinson's disease (PD) is primarily considered a motor disease characterized by rest tremor, rigidity, bradykinesia and postural disturbances. However, neuropsychiatric complications are increasingly recognized and appreciated, to the extent that significantly impact the quality of life of patients and their caregivers. Objective: This paper aims to review the main key features on epidemiological, clinical, diagnosis and treatment of the most important neuropsychiatric symptoms in PD, regarding depression, anxiety, apathy, psychosis, dementia, and impulse control disorders. Method: Systematic review using the PubMed/MEDLINE database between 2005 to 2015. From the selected articles secondary referenced articles were extracted. Conclusions: The pathophysiologic features of these complications are multifaceted and include neuropathophysiologic changes of Parkinson’s disease itself, emotional reactions to Parkinsonism and treatment-related side-effects. Neuropsychiatric complications constitute a diagnostic and therapeutic challenge, especially in advanced stages. The available evidence suggests the effectiveness of tricyclic antidepressants (desipramine and nortriptyline) and pramipexole for the treatment of depression. Among the antipsychotic clozapine and quetiapine are considered the best options for management of psychosis in patients with PD; and rivastigmine the most effective option in PD’s dementia. However, more studies are needed to evaluate the efficacy and guide treatment of psychiatric morbidities in PD.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Doença de Parkinson Sintomas neuropsiquiátricos Demência Défice cognitivo ligeiro Perturbações do controlo dos impulsos Síndrome de desregulação da dopamina