Behavioral problems of Parkinson's patients and ways of treating them" - summary of Prof. Rabei's lecture at the Tel Aviv branch, 29-5-2003

Parkinson's disease is seen by the general public as a disease characterized by tremors and slowness of movement in old people, while in practice the average age at which the disease is detected is 57 and beyond the tremors that are not always present, the disease affects many systems in the body and sometimes even causes the following mental problems:

1. depression
2. Panic attacks
3. Hallucinations and delusions

People suffering from depression have a high chance of being diagnosed with Parkinson's disease after a while. About 25% of those diagnosed with Parkinson's already suffer from depression at the stage of Parkinson's disease diagnosis. About 50% of Parkinson's patients also suffer from depression at one stage or another of their disease. In depressed patients, a low level of serotonin was found and the assumption is that this is caused by shared biochemical processes. The claim that Parkinson's patients are depressed as a result of their severe physical problems was disproved when studies showed that the percentage of depressed among Parkinson's patients is much higher than the percentage of depressed among patients with other diseases Other chronic conditions, such as chronic arthritis for example.

The typical symptoms of depression are:

1. Changes in behavior patterns
2. Excessive drowsiness or insomnia
3. Changes in eating habits
4. Passivity and unwillingness to participate in activities

Today, there are good drugs to increase the level of serotonin in the body and effective anti-depressant drugs, and patients with depression should not be satisfied with the administration of anti-parkinsonian drugs. The anti-depressant drugs are not effective in the treatment of anxiety attack problems and therefore anti-psychotic drugs must be used.
Psychosis problems, such as hallucinations and delusions, only appear after the age of 65. There is a problem that the drugs for the treatment of psychotic problems are not defined in the health basket as drugs that a neurologist may prescribe for Parkinson's patients, since the pharmaceutical companies did not prescribe the psychotic drugs as also intended for Parkinson's patients. Such a double registration would have required them to perform extensive tests that cost a lot of money, the investment of which by the drug companies is not worthwhile due to the number of Parkinson's patients who also suffer from psychotic symptoms, compared to patients with only psychotic diseases.
Parkinson's patients make up only about 0.1% (one per mille) of the population while patients with psychotic illnesses make up about 1% (one percent) of the population. Most of the hospitalizations of Parkinson's patients are due to the mental problems and not the physical/motor problems, since the family members are able to successfully deal with the physical/motor problems but are not able to deal with the mental problems.

If during the first ten years of the disease mental problems do not arise in a Parkinson's patient, there is a high chance that such problems will not arise in the future either. If there is a fluctuation in psychotic symptoms in a Parkinson's patient, there is a high possibility of developing dementia. In response to the questions, Prof. Rabei said: When a Parkinson's patient also suffers from mental problems, it is not recommended that he undergo brain surgery for the purpose of treating the physical/motor symptoms. The antiparkinsonian drugs are not effective in treating speech problems.