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Reprint of “Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson's disease”

Published:January 13, 2017DOI:https://doi.org/10.1016/j.jns.2017.01.026

      Highlights

      • Neuropsychiatric symptoms and behavioural disturbances are frequent in patients with Parkinson's disease.
      • Health related quality of life estimates the impact of a condition on the patient.
      • Neuropsychiatric disorders severely affect health-related quality of life.
      • The present review summarizes and updates current knowledge on the topic.

      Abstract

      Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient’ life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life. A considerable number of studies have demonstrated the importance of depression as a determinant of health-related quality of life in this population, but less evidence is available regarding the role of other neuropsychiatric symptoms such as anxiety, apathy, psychosis, and impulse control disorders. This narrative review analyses recent literature on this topic, focusing on studies in which neuropsychiatric symptoms were investigated as potential determinants of quality of life using regression techniques, including discussion of the assessment tools used.

      Keywords

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      References

        • Parkinson J.
        An essay on the shaking palsy.
        J. Neuropsychiatry Clin. Neurosci. 2002; 14: 223-236
        • Chaudhuri K.R.
        • Healy D.G.
        • Schapira A.H.
        Non-motor symptoms of Parkinson's disease: diagnosis and management.
        Lancet Neurol. 2006; 5: 235-245
        • Barone P.
        • Antonini A.
        • Colosimo C.
        • Marconi R.
        • Morgante L.
        • Avarello T.P.
        • et al.
        The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease.
        Mov. Disord. 2009; 24: 1641-1649
        • Martinez-Martin P.
        • Schapira A.H.V.
        • Stocchi F.
        • Sethi K.
        • Odin P.
        • MacPhee G.
        • et al.
        Prevalence of nonmotor symptoms in Parkinson's disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients.
        Mov. Disord. 2007; 22: 1623-1629
        • Reijnders J.S.A.M.
        • Ehrt U.
        • Weber W.E.J.
        • Aarsland D.
        • Leentjens A.F.G.
        A systematic review of prevalence studies of depression in Parkinson's disease.
        Mov. Disord. 2008; 23: 183-189
        • Broen M.P.G.
        • Narayen N.E.
        • Kuijf M.L.
        • Dissanayaka N.N.W.
        • Leentjens A.F.G.
        Prevalence of anxiety in Parkinson's disease: a systematic review and meta-analysis.
        Mov. Disord. 2016; 31: 1125-1133
        • den Brok M.G.H.E.
        • van Dalen J.W.
        • van Gool W.A.
        Moll van Charante EP, de Bie RMA, Richard E. Apathy in Parkinson's disease: a systematic review and meta-analysis: apathy in Parkinson's disease.
        Mov. Disord. 2015; 30: 759-769
        • Zhang G.
        • Zhang Z.
        • Liu L.
        • Yang J.
        • Huang J.
        • Xiong N.
        • et al.
        Impulsive and compulsive behaviors in Parkinson's disease.
        Front. Aging Neurosci. 2014; 6: 318
        • Chang A.
        • Fox S.H.
        Psychosis in Parkinson's disease: epidemiology, pathophysiology, and management.
        Drugs. 2016; 76: 1093-1118
        • Fénelon G.
        • Alves G.
        Epidemiology of psychosis in Parkinson's disease.
        J. Neurol. Sci. 2010; 289: 12-17
        • Ishihara L.
        • Brayne C.
        A systematic review of depression and mental illness preceding Parkinson's disease.
        Acta Neurol. Scand. 2006; 113: 211-220
        • Goetz C.G.
        • Stebbins G.T.
        Risk factors for nursing home placement in advanced Parkinson's disease.
        Neurology. 1993; 43: 2227-2229
        • Martinez-Martin P.
        • Rodriguez-Blazquez C.
        • Forjaz M.J.
        • Frades-Payo B.
        • Agüera-Ortiz L.
        • Weintraub D.
        • et al.
        Neuropsychiatric symptoms and caregiver's burden in Parkinson's disease.
        Parkinsonism Relat. Disord. 2015; 21: 629-634
        • Schrag A.
        • Hovris A.
        • Morley D.
        • Quinn N.
        • Jahanshahi M.
        Caregiver-burden in parkinson's disease is closely associated with psychiatric symptoms, falls, and disability.
        Parkinsonism Relat. Disord. 2006; 12: 35-41
        • Martínez-Martín P.
        An introduction to the concept of ‘quality of life in Parkinson's disease’.
        J. Neurol. 1998; 245: S2-S6
        • Martinez-Martin P.
        The importance of non-motor disturbances to quality of life in Parkinson's disease.
        J. Neurol. Sci. 2011; 310: 12-16
        • Forsaa E.B.
        • Larsen J.P.
        • Wentzel-Larsen T.
        • Herlofson K.
        • Alves G.
        Predictors and course of health-related quality of life in Parkinson's disease.
        Mov. Disord. 2008; 23: 1420-1427
        • Müller B.
        • Assmus J.
        • Herlofson K.
        • Larsen J.P.
        • Tysnes O.-B.
        Importance of motor vs. non-motor symptoms for health-related quality of life in early Parkinson's disease.
        Parkinsonism Relat. Disord. 2013; 19: 1027-1032
        • Kadastik-Eerme L.
        • Rosenthal M.
        • Paju T.
        • Muldmaa M.
        • Taba P.
        Health-related quality of life in Parkinson's disease: a cross-sectional study focusing on non-motor symptoms.
        Health Qual. Life Outcomes. 2015; 13: 83
        • Prakash K.M.
        • Nadkarni N.V.
        • Lye W.-K.
        • Yong M.-H.
        • Tan E.-K.
        The impact of non-motor symptoms on the quality of life of Parkinson's disease patients: a longitudinal study.
        Eur. J. Neurol. 2016; 23: 854-860
        • Marras C.
        • McDermott M.P.
        • Rochon P.A.
        • Tanner C.M.
        • Naglie G.
        • Lang A.E.
        • et al.
        Predictors of deterioration in health-related quality of life in Parkinson's disease: results from the DATATOP trial.
        Mov. Disord. 2008; 23: 653-659
        • Greene T.
        • Camicioli R.
        Depressive symptoms and cognitive status affect health-related quality of life in older patients with Parkinson's disease.
        J. Am. Geriatr. Soc. 2007; 55: 1888-1890
        • Carod-Artal F.J.
        • Ziomkowski S.
        • Mourão Mesquita H.
        • Martínez-Martin P.
        Anxiety and depression: main determinants of health-related quality of life in Brazilian patients with Parkinson's disease.
        Parkinsonism Relat. Disord. 2008; 14: 102-108
        • Klepac N.
        • Trkulja V.
        • Relja M.
        • Babić T.
        Is quality of life in non-demented Parkinson's disease patients related to cognitive performance? A clinic-based cross-sectional study.
        Eur. J. Neurol. 2008; 15: 128-133
        • McKinlay A.
        • Grace R.C.
        • Dalrymple-Alford J.C.
        • Anderson T.
        • Fink J.
        • Roger D.
        A profile of neuropsychiatric problems and their relationship to quality of life for Parkinson's disease patients without dementia.
        Parkinsonism Relat. Disord. 2008; 14: 37-42
        • Muslimovic D.
        • Post B.
        • Speelman J.D.
        • Schmand B.
        • de Haan R.J.
        • CARPA Study Group
        Determinants of disability and quality of life in mild to moderate Parkinson disease.
        Neurology. 2008; 70: 2241-2247
        • Rahman S.
        • Griffin H.J.
        • Quinn N.P.
        • Jahanshahi M.
        Quality of life in Parkinson's disease: the relative importance of the symptoms.
        Mov. Disord. 2008; 23: 1428-1434
        • Qin Z.
        • Zhang L.
        • Sun F.
        • Fang X.
        • Meng C.
        • Tanner C.
        • et al.
        Health related quality of life in early Parkinson's disease: impact of motor and non-motor symptoms, results from Chinese levodopa exposed cohort.
        Parkinsonism Relat. Disord. 2009; 15: 767-771
        • Quelhas R.
        • Costa M.
        Anxiety, depression, and quality of life in Parkinson's disease.
        J. Neuropsychiatry Clin. Neurosci. 2009; 21: 413-419
        • Žiropađa L.
        • Stefanova E.
        • Potrebić A.
        • Kostić V.S.
        Quality of life in Serbian patients with Parkinson's disease.
        Qual. Life Res. 2009; 18: 833-839
        • Gallagher D.A.
        • Lees A.J.
        • Schrag A.
        What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?.
        Mov. Disord. 2010; 25: 2493-2500
        • Naismith D.S.L.
        • Hickie I.B.
        • Lewis S.J.
        The role of mild depression in sleep disturbance and quality of life in Parkinson's disease.
        J. Neuropsychiatry Clin. Neurosci. 2010; 22: 384-389
        • Winter Y.
        • Campenhausen S.
        • Gasser J.
        • Seppi K.
        • Reese J.-P.
        • Pfeiffer K.-P.
        • et al.
        Social and clinical determinants of quality of life in Parkinson's disease in Austria: a cohort study.
        J. Neurol. 2010; 257: 638-645
        • Benito-León J.
        • Cubo E.
        • Coronell C.
        • on behalf of the ANIMO Study Group
        Impact of apathy on health-related quality of life in recently diagnosed Parkinson's disease: the ANIMO study.
        Mov. Disord. 2012; 27: 211-218
        • Gómez-Esteban J.C.
        • Tijero B.
        • Somme J.
        • Ciordia R.
        • Berganzo K.
        • Rouco I.
        • et al.
        Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson's disease.
        J. Neurol. 2011; 258: 494-499
        • Martinez-Martin P.
        • Rodriguez-Blazquez C.
        • Kurtis M.M.
        • Chaudhuri K.R.
        NMSS validation group. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease.
        Mov. Disord. 2011; 26: 399-406
        • Leroi I.
        • Ahearn D.J.
        • Andrews M.
        • McDonald K.R.
        • Byrne E.J.
        • Burns A.
        Behavioural disorders, disability and quality of life in Parkinson's disease.
        Age Ageing. 2011; 40: 614-621
        • Winter Y.
        • von Campenhausen S.
        • Arend M.
        • Longo K.
        • Boetzel K.
        • Eggert K.
        • et al.
        Health-related quality of life and its determinants in Parkinson's disease: results of an Italian cohort study.
        Parkinsonism Relat. Disord. 2011; 17: 265-269
        • Bach J.-P.
        • Riedel O.
        • Klotsche J.
        • Spottke A.
        • Dodel R.
        • Wittchen H.-U.
        Impact of complications and comorbidities on treatment costs and health-related quality of life of patients with Parkinson's disease.
        J. Neurol. Sci. 2012; 314: 41-47
        • Hanna K.K.
        • Cronin-Golomb A.
        Impact of anxiety on quality of life in Parkinson's disease.
        Parkinsons Dis. 2012; 2012: 640707
        • Dubayova T.
        • Krokavcova M.
        • Nagyova I.
        • Rosenberger J.
        • Gdovinova Z.
        • Middel B.
        • et al.
        Type D, anxiety and depression in association with quality of life in patients with Parkinson's disease and patients with multiple sclerosis.
        Qual. Life Res. 2013; 22: 1353-1360
        • Rodríguez-Violante M.
        • Cervantes-Arriaga A.
        • Corona T.
        • Martínez-Ramírez D.
        • Morales-Briceño H.
        • Martínez-Martín P.
        Clinical determinants of health-related quality of life in Mexican patients with Parkinson's disease.
        Arch. Med. Res. 2013; 44: 110-114
        • Santos-García D.
        • de la Fuente-Fernández R.
        Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson's disease.
        J. Neurol. Sci. 2013; 332: 136-140
        • Duncan G.W.
        • Khoo T.K.
        • Yarnall A.J.
        • O'Brien J.T.
        • Coleman S.Y.
        • Brooks D.J.
        • et al.
        Health-related quality of life in early Parkinson's disease: the impact of nonmotor symptoms.
        Mov. Disord. 2014; 29: 195-202
        • Lawson R.A.
        • Yarnall A.J.
        • Duncan G.W.
        • Khoo T.K.
        • Breen D.P.
        • Barker R.A.
        • et al.
        Severity of mild cognitive impairment in early Parkinson's disease contributes to poorer quality of life.
        Parkinsonism Relat. Disord. 2014; 20: 1071-1075
        • Phu A.L.
        • Xu Z.
        • Brakoulias V.
        • Mahant N.
        • Fung V.S.C.
        • Moore G.D.
        • et al.
        Effect of impulse control disorders on disability and quality of life in Parkinson's disease patients.
        J. Clin. Neurosci. 2014; 21: 63-66
        • Alvarado-Bolaños A.
        • Cervantes-Arriaga A.
        • Rodríguez-Violante M.
        • Llorens-Arenas R.
        • Calderón-Fajardo H.
        • Millán-Cepeda R.
        • et al.
        Impact of neuropsychiatric symptoms on the quality of life of subjects with Parkinson's disease.
        J. Parkinsons Dis. 2015; 5: 541-548
        • Fereshtehnejad S.-M.
        • Shafieesabet M.
        • Farhadi F.
        • Hadizadeh H.
        • Rahmani A.
        • Naderi N.
        • et al.
        Heterogeneous determinants of quality of life in different phenotypes of Parkinson's disease.
        PLoS One. 2015; 10e0137081
        • Jones J.D.
        • Butterfield L.C.
        • Song W.
        • Lafo J.
        • Mangal P.
        • Okun M.S.
        • et al.
        Anxiety and depression are better correlates of Parkinson's disease quality of life than apathy.
        J. Neuropsychiatry Clin. Neurosci. 2015; 27: 213-218
        • Skorvanek M.
        • Rosenberger J.
        • Minar M.
        • Grofik M.
        • Han V.
        • Groothoff J.W.
        • et al.
        Relationship between the non-motor items of the MDS–UPDRS and Quality of Life in patients with Parkinson's disease.
        J. Neurol. Sci. 2015; 353: 87-91
        • Diaz A.P.
        • Freitas F.C.
        • de Oliveira Thais M.E.
        • da Silva Areas F.Z.
        • Schwarzbold M.L.
        • Debona R.
        • et al.
        Variables associated with physical health-related quality of life in Parkinson's disease patients presenting for deep brain stimulation.
        Neurol. Sci. 2016; 37: 1831-1837
        • Fan J.-Y.
        • Chang B.-L.
        • Wu Y.-R.
        Relationships among depression, anxiety, sleep, and quality of life in patients with Parkinson's disease in Taiwan.
        Parkinsons Dis. 2016; 2016: 4040185
        • Rieu I.
        • Houeto J.L.
        • Pereira B.
        • De Chazeron I.
        • Bichon A.
        • Chéreau I.
        • et al.
        Impact of mood and behavioral disorders on quality of life in Parkinson's disease.
        J. Parkinsons Dis. 2016; 6: 267-277
        • Vela L.
        • Martínez Castrillo J.C.
        • García Ruiz P.
        • Gasca-Salas C.
        • Macías Macías Y.
        • Pérez Fernández E.
        • et al.
        The high prevalence of impulse control behaviors in patients with early-onset Parkinson's disease: a cross-sectional multicenter study.
        J. Neurol. Sci. 2016; 368: 150-154
        • Peto V.
        • Jenkinson C.
        • Fitzpatrick R.
        • Greenhall R.
        The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease.
        Qual. Life Res. 1995; 4: 241-248
        • Jenkinson C.
        • Fitzpatrick R.
        • Peto V.
        • Greenhall R.
        • Hyman N.
        The PDQ-8: development and validation of a short-form Parkinson's disease questionnaire.
        Psychol. Health. 1997; 12: 805-814
        • de Boer A.G.
        • Wijker W.
        • Speelman J.D.
        • de Haes J.C.
        Quality of life in patients with Parkinson's disease: development of a questionnaire.
        J. Neurol. Neurosurg. Psychiatry. 1996; 61: 70-74
        • Marinus J.
        • Visser M.
        • Martínez-Martín P.
        • van Hilten J.J.
        • Stiggelbout A.M.
        A short psychosocial questionnaire for patients with Parkinson's disease: the SCOPA-PS.
        J. Clin. Epidemiol. 2003; 56: 61-67
        • Ware J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med. Care. 1992; 30: 473-483
        • EuroQol Group
        EuroQol—a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
        • Hunt S.M.
        • McKenna S.P.
        • McEwen J.
        • Williams J.
        • Papp E.
        The Nottingham Health Profile: subjective health status and medical consultations.
        Soc. Sci. Med. A. 1981; 15: 221-229
        • Martinez-Martin P.
        • Jeukens-Visser M.
        • Lyons K.E.
        • Rodriguez-Blazquez C.
        • Selai C.
        • Siderowf A.
        • et al.
        Health-related quality-of-life scales in Parkinson's disease: critique and recommendations.
        Mov. Disord. 2011; 26: 2371-2380
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr. Scand. 1983; 67: 361-370
        • Schrag A.
        • Barone P.
        • Brown R.G.
        • Leentjens A.F.G.
        • McDonald W.M.
        • Starkstein S.
        • et al.
        Depression rating scales in Parkinson's disease: critique and recommendations.
        Mov. Disord. 2007; 22: 1077-1092
        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch. Gen. Psychiatry. 1961; 4: 561-571
        • Leentjens A.F.G.
        • Dujardin K.
        • Marsh L.
        • Martinez-Martin P.
        • Richard I.H.
        • Starkstein S.E.
        • et al.
        Anxiety rating scales in Parkinson's disease: critique and recommendations.
        Mov. Disord. 2008; 23: 2015-2025
        • Beck A.T.
        • Epstein N.
        • Brown G.
        • Steer R.A.
        An inventory for measuring clinical anxiety: psychometric properties.
        J. Consult. Clin. Psychol. 1988; 56: 893-897
        • Starkstein S.E.
        • Mayberg H.S.
        • Preziosi T.
        • Andrezejewski P.
        • Leiguarda R.
        • Robinson R.G.
        • et al.
        Reliability, validity, and clinical correlates of apathy in Parkinson's disease.
        J. Neuropsychiatry Clin. Neurosci. 1992; 4: 134-139
        • Leentjens A.F.G.
        • Dujardin K.
        • Marsh L.
        • Martinez-Martin P.
        • Richard I.H.
        • Starkstein S.E.
        • et al.
        Apathy and anhedonia rating scales in Parkinson's disease: critique and recommendations.
        Mov. Disord. 2008; 23: 2004-2014
        • Sockeel P.
        • Dujardin K.
        • Devos D.
        • Denève C.
        • Destée A.
        • Defebvre L.
        The Lille apathy rating scale (LARS), a new instrument for detecting and quantifying apathy: validation in Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 2006; 77: 579-584
        • Drijgers R.L.
        • Dujardin K.
        • Reijnders J.S.A.M.
        • Defebvre L.
        • Leentjens A.F.G.
        Validation of diagnostic criteria for apathy in Parkinson's disease.
        Parkinsonism Relat. Disord. 2010; 16: 656-660
        • García-Ramos R.
        • Villanueva Iza C.
        • Catalán M.J.
        • Reig-Ferrer A.
        • Matías-Guíu J.
        Validation of a Spanish version of the Lille apathy rating scale for Parkinson's disease.
        Sci. World J. 2014; 2014: 849834
        • Weintraub D.
        • Stewart S.
        • Shea J.A.
        • Lyons K.E.
        • Pahwa R.
        • Driver-Dunckley E.D.
        • et al.
        Validation of the questionnaire for impulsive-compulsive disorders in Parkinson's disease (QUIP).
        Mov. Disord. 2009; 24: 1461-1467
        • Martinez-Martin P.
        • Leentjens A.F.G.
        • de Pedro-Cuesta J.
        • Chaudhuri K.R.
        • Schrag A.E.
        • Weintraub D.
        Accuracy of screening instruments for detection of neuropsychiatric syndromes in Parkinson's disease.
        Mov. Disord. 2016; 31: 270-279
        • Fernandez H.H.
        • Aarsland D.
        • Fénelon G.
        • Friedman J.H.
        • Marsh L.
        • Tröster A.I.
        • et al.
        Scales to assess psychosis in Parkinson's disease: critique and recommendations.
        Mov. Disord. 2008; 23: 484-500
        • Cummings J.L.
        • Mega M.
        • Gray K.
        • Rosenberg-Thompson S.
        • Carusi D.A.
        • Gornbein J.
        The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.
        Neurology. 1994; 44: 2308-2314
        • Fahn S.
        • Elton R.L.
        Members of the UPDRS Development Committee. Unified Parkinson's Disease Rating Scale.
        in: Fahn S. Marsden C.D. Calne D.B. Goldstein M. Recent Developments in Parkinson's Disease. Vol. 2. Macmillan Healthcare Information, Florham Park, NJ1987: 153-164
        • Goetz C.G.
        • Tilley B.C.
        • Shaftman S.R.
        • Stebbins G.T.
        • Fahn S.
        • Martinez-Martin P.
        • et al.
        Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results.
        Mov. Disord. 2008; 23: 2129-2170
        • Chaudhuri K.R.
        • Martinez-Martin P.
        • Schapira A.H.V.
        • Stocchi F.
        • Sethi K.
        • Odin P.
        • et al.
        International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study.
        Mov. Disord. 2006; 21: 916-923
        • Chaudhuri K.R.
        • Martinez-Martin P.
        • Brown R.G.
        • Sethi K.
        • Stocchi F.
        • Odin P.
        • et al.
        The metric properties of a novel non-motor symptoms scale for Parkinson's disease: results from an international pilot study.
        Mov. Disord. 2007; 22: 1901-1911
        • Rieu I.
        • Martinez-Martin P.
        • Pereira B.
        • De Chazeron I.
        • Verhagen Metman L.
        • Jahanshahi M.
        • et al.
        International validation of a behavioral scale in Parkinson's disease without dementia.
        Mov. Disord. 2015; 30: 705-713
        • Martinez-Martin P.
        • Frades-Payo B.
        • Agüera-Ortiz L.
        • Ayuga-Martinez A.
        A short scale for evaluation of neuropsychiatric disorders in Parkinson's disease: first psychometric approach.
        J. Neurol. 2012; 259: 2299-2308
        • Schrag A.
        Quality of life and depression in Parkinson's disease.
        J. Neurol. Sci. 2006; 248: 151-157
        • Pontone G.M.
        • Bakker C.C.
        • Chen S.
        • Mari Z.
        • Marsh L.
        • Rabins P.V.
        • et al.
        The longitudinal impact of depression on disability in Parkinson disease: depression and disability in Parkinson disease.
        Int. J. Geriatr. Psychiatry. 2016; 31: 458-465
        • Butterfield L.C.
        • Cimino C.R.
        • Oelke L.E.
        • Hauser R.A.
        • Sanchez-Ramos J.
        The independent influence of apathy and depression on cognitive functioning in Parkinson's disease.
        Neuropsychology. 2010; 24: 721-730
        • Lawson R.A.
        • Yarnall A.J.
        • Duncan G.W.
        • Khoo T.K.
        • Breen D.P.
        • Barker R.A.
        • et al.
        Quality of life and mild cognitive impairment in early Parkinson's disease: does subtype matter?.
        J. Parkinsons Dis. 2015; 4: 331-336
        • Leroi I.
        • McDonald K.
        • Pantula H.
        • Harbishettar V.
        Cognitive impairment in Parkinson disease: impact on quality of life, disability, and caregiver burden.
        J. Geriatr. Psychiatry Neurol. 2012; 25: 208-214
        • Schrag A.
        • Jahanshahi M.
        • Quinn N.
        What contributes to quality of life in patients with Parkinson's disease?.
        J. Neurol. Neurosurg. Psychiatry. 2000; 69: 308-312
        • Shulman L.M.
        Apathy in patients with Parkinson's disease.
        Int. Rev. Psychiatry. 2000; 12: 298-306
        • Antonini A.
        • Tesei S.
        • Zecchinelli A.
        • Barone P.
        • De Gaspari D.
        • Canesi M.
        • et al.
        Randomized study of sertraline and low-dose amitriptyline in patients with Parkinson's disease and depression: effect on quality of life.
        Mov. Disord. 2006; 21: 1119-1122

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      • Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson's disease
        Journal of the Neurological SciencesVol. 373
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          Parkinson's disease is a complex neurodegenerative disorder characterized by motor and non-motor symptoms, with neuropsychiatric manifestations among the most frequent non-motor symptoms. Health-related quality of life is a patient-reported outcome that reflects the impact of the disease on physical, mental, and social wellbeing, and on other aspects of patient’ life. Although older studies on health-related quality of life in Parkinson's disease mainly investigated the role of the motor impairment, recent research focused on non-motor symptoms has highlighted the critical role that behavioural disturbances due to neuropsychiatric symptoms play in determining health related quality of life.
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