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Neurological Disorders

Mental Health Concerns in Parkinson’s Disease

Rebecca Gilbert, M.D., Ph.D.

Chief Scientific Officer, American Parkinson Disease Association

Parkinson’s disease can be accompanied by a number of mental health difficulties including cognitive decline and dementia; hallucinations and delusions; and depression and anxiety.

While every person’s experience with Parkinson’s disease (PD) is different, mental health challenges and changes are fairly common. It is important to understand the different types of issues so you know what to look for and the steps to take if you see these symptoms starting to arise.

Cognitive decline and dementia

Cognitive decline refers generally to a decrease in thinking abilities. The cognitive problems of PD are characterized by executive dysfunction, or the inability to plan and organize activities in order to solve problems and complete tasks with multiple steps. Visuo-spatial dysfunction, in which a person has trouble navigating the spatial world around them, is often seen as well. Other cognitive areas can be affected as the disease progresses.

Dementia is defined as cognitive decline that affects a person’s ability to independently carry out his or her daily activities, such as preparing meals or getting to appointments.

Hallucinations and delusions

Hallucinations are false perceptions. If hallucinations occur in PD, they are usually visual and can range from a fleeting image to a very vivid and scary vision.

Delusions are fixed beliefs that contradict reality or rational argument. In PD, delusions can be of a paranoid nature, including the belief that someone is stealing or that a spouse is having an affair.

Depression and anxiety

Depression is a mood disorder that causes persistent feelings of sadness. It can be a very early symptom of Parkinson’s, sometimes appearing before motor symptoms, and can also be prominent in more advanced stages as well. Although depression in PD can be reactive (you become depressed about having PD), a more prominent cause is the chemical imbalances of the disease itself.

Anxiety is the intense, excessive, and persistent worry and fear about everyday situations. Anxiety can be a prominent symptom in PD at all stages of disease. 

Managing mental health

Helpful tips when facing mental health issues in PD:

  • Consider other illnesses or conditions: Mental health issues can be triggered or exacerbated by the presence of another illness or condition. A very common scenario is that cognition worsens or hallucinations start as the initial sign of a urinary tract infection. Other conditions to consider include abnormal thyroid function, low vitamin B12, and head trauma.
  • Review medications with your doctor: Certain medications given for urinary frequency, migraine, seizures, anxiety, and other conditions can interfere with cognitive function. Be sure to review all medications frequently with your neurologist.
  • Consider whether the mental health issue is affected by PD medication dosing: Depression and anxiety, for example, can fluctuate with medication timing. If this is the case, adjusting PD medications (with a doctor’s supervision) may help.

Non-drug approaches to managing mental health issues should be tried first. These include:

  • Maintaining a regular routine
  • Engaging in mental, physical, and social activities
  • Joining a support group for both the person with PD and the care partner

Consider medications. There are medications available to treat cognitive changes, hallucinations, depression, and anxiety. Discuss the risks and benefits of these medications with your neurologist.

Most importantly, talk to your doctor. Bring up any new issues and concerns early so they can be properly assessed and addressed. Never be shy or embarrassed to talk about mental health challenges with your medical team.

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