When people hear the word “Parkinson’s disease” (PD), they are likely to conjure an image of trembling and unsteady gait. But Parkinson’s disease has many manifestations that strike individuals unequally over the course of the disease.
Some people with Parkinson’s may experience mental impairment, which can lead to pleasant or unpleasant hallucinations that can make life difficult for both them and their families. A new drug called Nuplazid is available that appears to alleviate this troubling symptom, but the cost may make it impractical for many patients to use.
Parkinson’s Produces Both Physical and Mental Impairment
Parkinson’s disease is a neurological disorder that causes progressive deterioration of brain cells that produce dopamine. Dopamine is an important neurotransmitter chemical that allows normal movement. The death of brain cells, called neurodegeneration, causes a variety of symptoms affecting movement, speech and brain function that get progressively worse.
However, the symptoms can vary widely from person to person. One person may have to deal with an uncontrollably trembling hand or foot—or even trembling of the face.
Others may experience:
- slow movement
- stiffness
- and/or the sudden inability to take a step (called “freezing of the gait”)
Additional symptoms include:
- changes in handwriting (it may become smaller and tighter)
- a softened voice volume
- difficulty swallowing
- and non-motor problems such as:
- constipation
- sexual dysfunction
- loss of smell
- and mood problems
Mental symptoms of dementia, hallucination (being awake and seeing, hearing, or feeling things that aren’t really there), and delusion (having illogical or irrational views that aren’t based on reality) are other problems associated with this disease.
Visual hallucinations are the most common type of mental symptom in PD. When the person with PD is aware that what s/he is seeing is a hallucination—one family just accepted the small polka dot bunny their mother saw as a pet, because SHE accepted it—these symptoms may not cause too many problems.
However, less common hallucinations, such as hearing voices or feeling as if bugs are crawling on the skin, can be severely upsetting.
Medications For Psychiatric Symptoms of Parkinson’s Disease
A variety of medications are used to treat Parkinson’s disease. Most of these drugs are used to increase dopamine, the neurotransmitter chemical needed to regulate normal movement. Unfortunately, some of these important medications can also worsen hallucinations as a side effect.
Finding a way to improve muscle control, while still avoiding mental symptoms, has been a problem for Parkinson’s patients and their families.
A New Drug Comes To Market
Pimavanserin, sold under the brand name Nuplazid, was approved by the U.S. Food & Drug Administration in April of 2016. Pimavanserin is the first in a new class of treatments for PD psychosis that targets the area of the brain responsible for sensory perceptions and conscious thought.
There, it blocks certain receptors for the chemical messenger serotonin. The new drug, when taken over a six-week period, showed a 37 percent improvement in psychosis symptoms.
The drug improved nighttime sleep and provided more awake periods during the day. It did not worsen movement problems. In addition, caregivers for these patients reported that the drug made it easier to care for their loved ones.
The most dangerous side effects seen with pimavanserin, as explained in the Full Prescribing Information, is an irregular heart rhythm problem called QT prolongation. There are other side effects that you should read about, including a “black box warning” about the increased risk of death in elderly patients with dementia related psychosis.
This new medication could be a game changer in the treatment of Parkinson’s, but the cost may be too prohibitive for use by those who need it most.
This dilemma is often the case with new drugs when they first come to the market, denying the care that patients need to deal effectively with their illnesses.
Pharmaceutical companies hold the key to making life more livable for patients with Parkinson’s and other serious diseases. When cost gets in the way of their progress, it reflects badly on the companies and the country as a whole.
Pharmaceutical companies should provide more programs to make these drugs affordable for patients and their families. This action would improve their image with the public and help make the country a more compassionate place, in the eye of the public and the world.
One step in that direction taken by all pharmaceutical companies, is to have programs that help people gain access to the drugs they need. Several non-profit organizations and the Partnership for Prescription Assistance are just a few resources for help.
In the United States, the National Parkinson Foundation is a great resource for anyone interested in learning more about Parkinson’s.
