Neuropsychiatric symptoms related to cholinergic deficits in Parkinson?s disease

PEREZ-LLORET, S.; PERALTA, M.C.; BARRANTES, FRANCISCO JOSÉ

Psychiatry and Neurosciences. Update 2016. Translational Research.

Springer

Año: 2016;

Given its ability to explain the mostfrequent motor symptoms of Parkinson?s disease (PD), degeneration ofdopaminergic neurons has been considered one of the disease´s mainpathophysiological features. Several studies have shown that neurodegenerationalso affects noradrenergic, serotoninergic, cholinergic and other monoaminergicneuronal populations. In this work, the characteristic contribution of cholinergicdeficits to cognitive dysfunction, psychosis and sleep disturbances in PD andtheir treatment will be explored. Important neurophysiologicalprocesses at the root of several motor and cognitive functions remit tocholinergic neurotransmission at the synaptic pathway and circuital levels. Thebulk of evidence highlights the link between cholinergic alterations and theaforementioned symptoms. The pathophysiology of these symptoms is related todegeneration of cholinergic nuclei, most importantly the nucleus basalis magnocellularisand the pedunculo-pontine nucleus. Rivastigmine, a drug that increasescholinergic tone by inhibiting the enzyme cholinesterase, is effective fordementia, whereas the use of Donepezil is still in the realm of investigation.Evidence on the clinical effects of these drugs for psychosis and REM-sleepdisturbances is still weak. Anticholinergic drugs should be used with cautionin PD, as they may aggravate these cholinergic symptoms.