A study conducted by doctors Jaume Kuliszewski and Javier Pagonabaraga, from the Sant Pau Research Institute, concluded that psychosis associated with Parkinson's disease should not be understood as a complication derived from the use of dopaminergic drugs – which increase the release of dopamine -, but is closely related to the brain changes of the disease.
The study was published in the journal Nature Reviews NeuroscienceIt identifies a pattern of cortical atrophy involving several brain regions, which explains how novel stimuli are misclassified. The findings provide a better understanding of psychosis in Parkinson's disease and open the door to new therapeutic strategies to improve patients' quality of life.
Psychosis associated with Parkinson's disease (PD) is a condition that causes delusions, hallucinations, and associated delusions in more than half of patients with this neurodegenerative disorder.
Although it was long thought to appear in advanced stages of the disease and as a result of treatment, it is now known that it can appear in the early stages and follow a continuum ranging from small hallucinations to organized hallucinations and hallucinations. Delusions. Neuroimaging studies have provided a new perspective and shown that this condition develops as a result of evolving brain changes.
People with Parkinson's disease “not only face problems with movement, but also mood disorders such as anxiety, depression and apathy,” explains Dr. Bagunaparaja, the study's lead researcher. During the course of the illness, between 40% and 60% of patients may also experience hallucinations and, in less cases, some episodes of delirium, the doctor says.
A window of opportunity
Bagunaparaja points out that hallucinations and delusions are a “hallmark” of the disease, which has pushed research towards a neurobiological model to better understand these phenomena.
Symptoms do not start suddenly. Long before people experience severe hallucinations, they begin to have more subtle and mild hallucinatory phenomena that often go unnoticed. “This, in a way, opens a temporary window where we can have an impact by treating them before they develop and become serious,” adds Dr. Bagunaparaja. “Treating them when they start to manifest themselves is much more effective than treating them when they are already serious and involve a loss of awareness of reality.” “.
Hallucinations associated with Parkinson's disease
The researcher explains that simple hallucinations are subtle forms of the disorder and can mainly be of two types. On the other hand, what is known as visual hallucinations, which relate to the feeling that someone is behind him, near his shoulder for example. The other is traffic hallucinations, the feeling that something is passing through the sides of the body. “It also happens in a very stereotypical way: from back to front. Patients feel as if something is happening on the side of the body. Most often they say it is a shadow of a person,” he explains.
A previous study conducted by the Parkinson's Disease and Movement Disorders Research Group in Saint Pau had previously noted that these minor hallucinations were present in 40% of Parkinson's patients from the first visit, that is, before taking any medication that increases dopamine levels.
As the disease progresses, the next step is organized visual hallucinations, not in the periphery, but in the patient's visual field. “They see animals and people. They can sometimes see flying faces or elongated people with an undefined face and a more defined body. Other times they may see young children, for example. They often have these hallucinations inside their home. “At first, patients see it, but they know it's not real, and that creates a little anxiety for them,” the neurologist says.
He warns that if these hallucinations are not treated, they tend to develop into more serious forms, with patients experiencing them repeatedly and “no longer realizing that they are false.” He adds: “Then they generate a lot of emotion, anxiety, and worry, which must be treated with medications that have a negative impact on the progression of the disease and on the mortality of patients,” and concludes: “For this reason, it is important to start treating psychosis early.”
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