Parkinson’s disease is recognized through tremors, slow body movements and other motor issues. Up to half of the patients develop psychosis during the disease. It often occurs in the later stages of the disease and as a side effect from drugs prescribed to help motor skills.
For decades, physicians have struggled to solve the motor problems, hence non-motor problems remained dormant. Now these psychological issues are becoming a bigger challenge to manage.
Hallucinations or delusions stay mild or happen infrequently that patients can handle them. However, other scary issues become difficult to manage that they consume patients and overwhelm their caregivers.
Patient’s stories:
Julie Torrence clearly remembers the emotional shock she had the day, when her father, Clyde Hill, failed to recognize her at his Kansas care center. For around 3 decades, Parkinson’s disease had affected Hill in many ways ranging from muscle rigidity and walking difficulties that forced him to retire form farming to the more recent hallucinations and delusions that led him to break out of the care center. He thought that his oldest child was his sister. Torrence cried badly. After about 2 months, she met her father at his doctor’s office where he had spent four weeks on a new drug, the 1st approved to treat Parkinson’s psychosis. Now he knew her name, his doctor’s name and names of his grandchildren and great-grandchildren. He seemed to be happy again.
Perhaps a patient has been happily married for 50 years now but believes his/her spouse is having an affair. Or patients may be driven by a fear that strangers or authorities would hurt them. Some are so agitated to flee their homes or accuse family of colluding with bad people.
New Yorkers complain of non-existent rats in their apartments. Kansans are more likely to report non-existent cattle in their backyards. One of Dr. Pahwa’s patients argued with his wife over what he had seen on a tree. The patient took a photo to Pahwa to prove that a girl had been sitting there. Pahwa saw only a tree branch.
The new drug to treat psychosis:
Antipsychotic drugs used for schizophrenia doesn’t help because they block dopamine in the brain, which is like the happenings in Parkinson’s disease.
Researchers searched for a chemical compound that could treat psychosis without damaging the motor skills. Acadia Pharmaceuticals first synthesized a solution, Pimavanserin in 2001. It took a long period of 15 years to get the product to the market under the brand name Nuplazid. This was approved by Food and Drug administration a year ago. Though the drug is expensive, with a one-month wholesale cost of $1,950, insurance often covers most of that. Acadia offers financial assistance for those lacking insurance coverages. Nuplazid does not help every patient. 1 in 4 patients does not improve after taking the drug, however research continues other options. Two other chemical compounds are being developed as said by Pahwa.
From the patients who report benefits of Nuplazid, about half experience a dramatic improvement.
One of the patient includes 78-year-old Hill, who lived most of his life on a farm near Weston. His father also suffered from Parkinson’s disease. As a young child, Torrence watched Hill’s father-her grandfather- struggle with hallucinations and delusions. He would pick things out of the air, call out names, he would be afraid of something and take off running, even though he normally couldn’t run because of the disease. Yet there he was, in his 80’s , running from his farm home with a daughter or grandchild giving chase.
Torrence’s grandfather didn’t live as long with Parkinson’s as her father has. Not as many helpful drugs existed then.
Symptoms started for Hill at the age of 52, when he developed difficulty reaching to get his wallet out of pocket. Drugs helped him for about a decade, however by his early 60’s he mobility was restricted, and he faced higher number of falls, retiring from his works. Deep brain stimulation surgery gave his body a reprieve for several years, but his disease kept progressing and made him wheel chair bound.
One fine evening he asked Torrence if she could see a puppy jumping in and out of the box. Torrence explained him that his Parkinson’s might be causing him to see the puppy. He also had feelings of bad people trying to attack him and he should move out from the place. Torrence sought Pahwa’s help. He has already prescribed Nulpazid to about 25 patients. He counselled with Hill and explained it might not work. Hill agreed to give a chance.
After Hill spent 4 weeks on the new drug, his changes stunned Torrence. Her father noticed the difference too. One recent day, he volunteered to a care center visitor “I’m on a new drug”. Hill still experiences mild delusions. His legs have swollen- a side effect some patients develop due to the drug, but Torrence considers that much better than the psychosis problems.
However more research is needed to help patients in the future.