Mov Disord: Bipolar disorder makes Parkinson "worse worse"

Bipolar spectrum disorder (BSD), including bipolar type I disorder, bipolar type II disorder, and cyclic thyroid disorder, is rarely discussed in Parkinson's disease (PD), PD with dementia, and dementia with Lewy bodies
.

Recent reviews of neuropsychiatric disorders in PD only list impulse control disorders (ICD), psychosis with delusions and hallucinations, and physical symptoms and dysfunction (SFD)

Early literature clearly listed mania or mania as one of the possible complications of PD and involved precautions
.

Some case reports indicate that PD patients have pre-existing or simultaneous BSD

Mania/mania disappeared from the list of psychiatric complications of PD, which may be due to the conceptual reframing of the non-motor aspects of PD and the identification of ICD as a specific psychiatric aspect of PD.
In patients exposed to dopamine agonist (DA) therapy
.

ICDs include risky behaviors such as gambling, hypersexuality, shopping spree, bulimia, aggressive driving, or hoarding, and were identified for the first time by Andew Lees as a clinical entity related to dopaminergic treatment exposure.
He named this disease hedonistic homomorphism Behavior
.

Driven by individual and class actions related to DAs, PD's ICD has become a unique clinical entity and has gained a wide range of space on social media
.

However, the behavior listed in the ICD is quite similar to the unique aspects of BSD listed in DSM-534
.

In addition, a recent large population study and a meta-analysis study confirmed early epidemiological findings and pointed out that BSD is associated with an increased risk of PD by 3.

These studies show that the prevalence of BSD in PD is higher than that in the control group
.

Following the epidemiological report, the new research involves BSD in PD, and the disorder described is generally named mania

In this way, Marco Onofrj and others of the University of Chieti-Pescara, Italy, studied whether the previous diagnosis of BSD would affect the phenotype of PD
.

Investigate whether the previous diagnosis of BSD affects the phenotype of PD
.

diagnosis

It is also assumed that:
(1) The previous diagnosis of BSDs (ie, BSDs assessed before the onset of PD motor symptoms) affects the development of motor symptoms; (2) BSDs affects the non-motor and psychiatric symptoms of PD;
(3) BSDs and identifiable genetics The tendency is related;
(4) Among those patients who were previously diagnosed with BSDs, the results of PD treatment were affected
.

Among the 2660 PD patients who were followed up for at least 6 years (6-27), 250 (BSD-PD) had BSD 6-20 years before the diagnosis of PD; 48%-43% had a family history of PD or BSD, and 34 Carry glucocerebrosidase (GBA) and Parkin (PRKN) mutations
.

The cohort was divided into a subset of 213 BSD-PD patients, compared with 426 matched PD patients without BSD, and a subset of 34 BSD-PD and 79 PD patients with GBA or PRKN mutations

They found that: Compared with PD patients, BSD-PD showed: (1) Family history of PD (probability ratio [OR]3.

31;2.
32-4.
71) and BSD (OR 6.
20;4.
11-9.
35)5) are more frequent;

(2) The incidence of impulse control disorders is higher (hazard ratio [HR] 5.
95, 3.
89-9.
09);

(3) The frequency of dysfunction before PD treatment is higher (HR, 5.
67, 3.
95-8.
15);

(4) Early occurrence of delusions or mild dementia (HR, 7.
70, 5.
55-10.
69; HR, 1.
43, 1.
16-1.
75); and (5) Early death (1.
48; 1.
11-1.
97)
.

Subjects with hereditary BSD-PD showed the same clinical characteristics as subjects with non-hereditary BSD-PD
.

Compared with the control group, the quality of life of BSD-PD patients treated with STN-DBS did not improve

Subjects with hereditary BSD-PD showed the same clinical characteristics as subjects with non-hereditary BSD-PD

BSD, as a prodromal symptom of PD, is not conducive to the development of its course, and is related to harmful neuropsychiatric characteristics and treatment results

Original source:
Onofrj M, Di Iorio A, Carrarini C, et al.
P reexisting Bipolar Disorder Influences the Subsequent Phenotype of Parkinson's Disease.
Mov Disord .
Published online August 24, 2021:mds.
28745.
doi:10.
1002/mds.
28745

reexisting Bipolar Disorder Influences the Subsequent Phenotype of Parkinson's Disease.
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