Neuropsychiatric symptoms in Parkinson's disease

✍ Scribed by Joseph Friedman

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 51 KB
• Volume: 26
• Category: Article
• ISSN: 0885-3185
• DOI: 10.1002/mds.23175

✦ Synopsis

In their excellent review of neuropsychiatric problems in Parkinson's disease (PD), 1 the authors made one small error but more importantly raised an interesting question about drug trials. Also, as they wrote their article, both melperone (personal communication) and pimavanserin, 2 subjected to randomized, double blind placebo controlled trials (DBPCT), failed to be efficacious.

The authors erred in stating that clozapine was tested only on nondemented subjects. The American study 3 had no exclusion for dementia and the mean mini-mental state exam scores were 21.7 in one treatment arm and 23.8 in the other. 4 The French study required a MMSE score greater than 20. The mean score of their placebo treated group was 24.1. 4 The authors noted that ''more novel antipsychotics, such as ziprasidone and aripiprrazole, have not yet been tested systematically and preliminary reports are inconclusive.'' There have been numerous reports of aripiprazole worsening motor function in PD patients 5,6 but less so with ziprasidone. 5 More importantly, it has been a common observation in both movement disorder clinics and psychiatry treatment centers (personal communications) that both aripiprazole and ziprasidone induce dose dependent parkinsonism quite commonly in patients who are too young to likely have idiopathic PD. What data would be sufficient to prevent a doomed attempt to test either of these drugs? I doubt the authors would be more likely to participate in a trial of either of these drugs than they would be in a study of risperidone, which also has no level I evidence against its use.