Most doctors are familiar with Parkinson's disease, and treatment with levodopa was one of the great and stunning advances of the last century. Much less well understood are associated disorders such as dementia, hallucinations, psychosis and depression, which cause huge morbidity and require active and competent management. Together with cognitive defects, these tend to become more troublesome as the disease progresses. By that stage, management of all aspects of the illness has often passed from the neurologist to a community health team.
I have increasingly felt the need to be expert in the management of Parkinson's disease. Psychiatric and Cognitive Disorders in Parkinson's Disease is an excellent text that should be helpful not only to old-age psychiatrists such as me but also to general practitioners, community health nurses and neurologists. It puts an evidence base behind many of the things I and my colleagues have had to derive from clinical experience. For example, in the treatment of psychosis, it has long been recognized that parkinsonism more commonly develops with olanzapine than with quetiapine or risperidone. With the advent of atypical antipsychotics there has been a great need for information on best use in patients with Parkinson's disease. Seemingly clozapine has advantages, despite the hazard of neutropenia. In the book there are good discussions on the mechanisms of cognitive impairment and how it relates to age, duration of illness and so on. A breakdown of cognitive deficits into types—e.g. bradyphrenia, visuospatial function, executive function, speech and language—offers a better understanding of the complex pictures we encounter in patients. One surprising omission is drugs for Parkinson's disease dementia and Lewy-body dementia—for which the evidence base is strong. By contrast, depression is well handled, with well based advice on the sort of antidepressant to consider. The book points out that electroconvulsive therapy should not be forgotten; as well as improving depression and psychosis it can lessen the motor symptoms of Parkinson's disease.
It is clear to me that primary care and community health services require sufficient understanding of Parkinson's disease to diagnose and treat its psychiatric manifestations. Starkstein and Merello have provided a much needed text and I strongly recommend it.