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Psychiatric and cognitive disorders in Parkinson’s disease
  1. I Hegeman Richard

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    Edited by Sergio E Starkstein and Marcelo Merello. Published by Cambridge University Press, Cambridge, 2002, pp 160, £47.50. ISBN 0-521-66305-9

    This comprehensive account of the common (but frequently overlooked and under treated) emotional and cognitive aspects of Parkinson’s disease is thoughtfully organised and well written. The two authors have presented their material in a consistent manner, free from the difficulties (for example, redundancy) often associated with multiauthored texts. Tables and illustrative clinical vignettes are helpful. References are up to date and thorough. In general, the book is well edited (although the two figures demonstrating the cortico-subcortical connections need revision). The text itself is less than 200 pages and is relatively easy to read in its entirety, but each chapter can stand alone.

    The first few pages briefly highlight the content of and rationale for each of the chapters. The next 50 pages provide a useful background for the non-movement disorder specialist. Chapter two reviews motor features and their treatment. Interestingly, the discussion on surgical approaches is as long as the discussion of pharmacotherapy. This probably reflects the fact that deep brain stimulation is becoming more widely available. The third chapter provides a concise but thorough and clearly presented overview of the differential diagnosis of Parkinson’s disease, with a very relevant discussion of dementia with Lewy bodies. The discussion of Alzheimer’s disease might have been enhanced by a note that these patients can sometimes have “pseudoparkinsonism”, characterised by paratonia and gait apraxia (rather than true rigidity and a parkinsonian gait). Chapter four (the one chapter devoted solely to cognition) effectively conveys the notion that dementia in Parkinson’s disease may be not be a homogeneous phenomenon. The authors make the interesting point that bradyphrenia may be accounted for solely by depression and/or incipient cognitive decline. Chapter five (Depression in Parkinson’s disease) highlights how common depression is in this illness and provides evidence that untreated depression may result in cognitive decline, making a strong case for early recognition and treatment of depression. Chapter six includes a discussion of anxiety, apathy, and the debatable concept of a distinct premorbid personality type. Chapter seven mainly focuses on dopaminergic drug induced psychosis. Chapter eight deals with the treatment of depression and psychosis. The appendix consists of several Parkinson’s disease specific scales but does not include other scales commonly used to evaluate depression and anxiety in Parkinson’s disease.

    One would not necessarily want to use this book as a reference for specific treatment guidelines and/or dosing of medications. Dosages are not always discussed (for example, for quetiapine) and a few statements are subject to disagreement. In their discussion about unpredictable levodopa responses, the authors appropriately suggest switching from controlled release levodopa to more frequent doses of an immediate release formulation but state that one should keep the same total daily levodopa dosage. Because controlled release tends to have lower bioavailability, many neurologists would reduce the total dose of levodopa when switching to immediate release preparations. The figure demonstrating the treatment of psychosis in Parkinson’s disease suggests that one should check blood and urine for infection or metabolic problems, then check a CT scan before proceeding. Except in unusual circumstances, most Parkinson’s disease specialists would not embark on such an extensive diagnostic investigation. The suggestion that severe psychosis warrants mandatory admission and that one should consider stopping all anti-Parkinson’s disease medication does not reflect typical practice and could, in fact, be dangerous because of the risk of an NMS like syndrome.

    In summary, this well written book will enable readers to have an up to date and well rounded knowledge base regarding the cognitive and psychiatric aspects of Parkinson’s disease and would be quite helpful to all clinicians (including neurologists and non-neurologists) who deal with Parkinson’s disease patients.

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