Neurol. praxi. 2013;14(2):92-95

Behavioral complications of dopaminergic therapy in advanced Parkinson´s disease

MUDr.Kateřina Menšíková¹, MUDr.Igor Nestrašil², prof.MUDr.Ján Pavlov Praško, CSc.³

¹ Neurologická klinika LF UP a FN Olomouc

² Brain Sciences Center, University of Minnesota, Minneapolis, MA, USA

³ Psychiatrická klinika LF UP a FN Olomouc

Parkinson´s disease may be at advanced stage accompanied by behavioral symptoms such as impulse control disorders and dopamine

dysregulation syndrome. Both the striationigral denervation induced by neurodegenerative process in substantia nigra and dopaminergic

therapy may play a role in the development of these disorders. Dopamin plays an important role in the brain reward system and

modulation of behavior. Specifically, disability of reward system induced by neuroadaptation changes and hypersensitization of striatal

dopaminergic neurons is considered to be the cause of development of these disorders. The risk factors for development of behavioral

complications include younger age at disease onset, higher doses of dopaminergic medication, history of depression, drug or alcohol

abuse and certain personality traits. Treatment is difficult and is mainly based on psychosocial intervention. Further the antidepressants,

atypical antipsychotics, mood stabilizers or inhibitors of glutamate NMDA receptors may be used; the switch to continuous dopaminergic

stimulation may also help. When necessary, the dose reduction or complete withdraval of dopaminergic therapy must be done.

syndrome.

Keywords: Parkinson´s disease, behavioral complications, dopaminergic therapy, impulse control disorders, dopamine dysregulation

Published: April 1, 2013  Show citation