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P20 - Increasing Complexity Awareness of Parkinson Disease Psychosis: Risk Factors, Symptoms, Diagnosing, and Management

After Alzheimer’s disease, Parkinson's disease (PD) is the second most common age-related neurodegenerative disorder globally. Approximately 1 million individuals in the United States (US) have PD; every year 60,000 more Americans are diagnosed. PD is a movement disorder caused by dopamine insufficiency in the substantia nigra. The disease process is complicated by falls, constipation, dysphagia, insomnia, anxiety, depression, and behavioral and cognitive disorders. Upon diagnosis, evidence-based symptom management should include individualized non-pharmacologic and pharmacological interventions and lifestyle changes that will promote positive outcomes.

More than 50% of persons diagnosed with PD develop psychotic symptoms. Parkinson’s disease psychosis (PDP) is a non-motor symptom and consists primarily of hallucinations and delusions. PDP is caused by neurotransmitter changes in the brain; some related to long-term use of parkinsonian medications. In many cases, PDP symptoms are mis-diagnosed as a chronic co-morbid condition, such as mild cognitive impairment or dementia.

Symptoms run from benign to aggressive. Undiagnosed and untreated symptoms can accelerate. Delirium caused by medications or infections may contribute to psychosis. Rapid eye movement sleep (REMS) disorder associated with PD results in daytime sleepiness and acting out dreams. All symptoms profoundly affect formal and informal caregivers. When underlying causes are identified by expert advanced practice registered nurses (APRN), symptoms may be reversible. There are many evidence-based paths to follow such as managing polypharmacy, appropriate prescribing patterns, and the effective use of nonpharmacologic interventions.

During this presentation the complexities of the disease are addressed including the toll PDP can have on the person living with PD, their caregiver(s) and the interdisciplinary healthcare team. It is imperative the APRN can simultaneously manage the overlapping motor symptoms and PDP to prevent physical and mental disabilities and improve quality of life. After attending this session, the APRN will be able to provide quality care to individuals living with PDP and their caregivers.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.