Not every person with Parkinson’s disease (PD) will develop psychosis or its symptoms, but it can still be a frightening thought. Hallucinations and delusions can be common in PD, but understanding what it means in Parkinson’s and how a person may experience symptoms can ease the fear and embarrassment that may result. Learn causes, related symptoms and how to address them.
Speaker
Sarah Horn, MD
Assistant Professor of Neurology
Parkinson's Disease and Movement Disorders Program
Director, Movement Disorders Fellowship Program
UT Health San Antonio
There is no charge to attend, but registration is required. This program is open to people with Parkinson's, their family, friends, and the community.
We want to thank this webinar's sponsor, Acadia Pharmaceuticals, for supporting our mission. Acadia has provided support for this educational event but had no influence on the creation of these materials.
This is a virtual program, taking place live, using the online Zoom platform. Instructions on joining the webinar are provided after registering.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Parkinson’s Revolution will take place across the country on February 22, 2025. Join us in-person at your studio location or virtually for a high energy ride that generates funds and awareness for Parkinson’s disease (PD).
Come ride for a reason and then celebrate the power of movement at our post-ride happy hour the Sweat Social! Friends, family, and members of the PD community are welcome to enjoy a short program and light refreshments immediately following the ride.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
New Continuous Pump Medication for Parkinson’s Completes Trials in Europe
PRODUODOPA is a new Parkinson’s drug delivered continuously via a pump, similar to insulin pumps used for people with diabetes. Clinical trials show that it can be an effective option for those whose medications are wearing off or who may have dyskinesia. The pump has the potential to reduce the number of pills a person takes each day.
Parkinson's disease (PD) is a progressive neurological disorder related to the loss of dopamine-producing brain cells. Dopamine, a neurotransmitter, plays a vital role in controlling movement. As dopamine levels decline, people with Parkinson's experience movement symptoms like tremors, stiffness, slowness of movement, along with non-movement symptoms.
The medication levodopa is a key treatment for Parkinson's. This medication works to alleviate movement symptoms by increasing dopamine levels in the brain, significantly improving quality of life for many people living with PD.
Levodopa is usually taken orally, several times a day. The challenge with taking it orally is that the relief it provides doesn’t last long — the half-life of levodopa is only 90 minutes, meaning that symptoms can start to reappear soon after taking it. This can lead to motor fluctuations — commonly referred to as “on” and “off” times. In addition, levodopa may not get properly absorbed because Parkinson’s is related to gastrointestinal issues. As a result, there is a need for PD therapies that can offer more consistently effective treatment for movement symptoms.
Multiple recent clinical trials completed in Europe show the safety and effectiveness of a new formulation of levodopa, called PRODUODOPA (foslevodopa/foscarbidopa), delivered continuously using a small, portable pump that steadily administers the medication under the skin. This technology is commonly used in insulin pumps for people with diabetes.
The pump allows for adjustable infusion rates and the ability to program extra doses. Users can reduce their infusion rate, which can be beneficial during sleep, and increase their rate or provide extra doses to address periods of the day when more medication is needed.
When a 2022 phase III clinical trial compared oral levodopa with continuous PRODUODOPA, the study showed that there was a:
Significant increase in time without movement symptoms (“on” time) with PRODUOPOA; and a
Decrease in time spent with movement symptoms when the medication wears off (“off” time).
The most common adverse effects of the pump were issues with the infusion site — such as swelling, pain or infection. Most of these events were mild and non-serious, however there have been people who have discontinued use of the pump due to adverse events or skin discomfort.
A pump isn’t for everyone — some people with PD may find that they don’t like using a pump because it can restrict their mobility compared to oral medications. The pump may also cause some discomfort.
But for most participants in the clinical trials, the pump was well tolerated. The studies found that continuous 24-hour infusion of PRODUODOPA provides more consistent symptom management than oral medications, leading to reduced motor fluctuations throughout the day and night.
Highlights
Compared to oral levodopa, continuous PRODUODOPA showed an increase in time without Parkinson’s symptoms (“on” time), and a decrease in time with symptoms (“off” time).
The pump allowed for adjustable infusion rates — reduced infusion rate can be beneficial during sleep, while an increased rate can address periods of the day when medication effects diminish.
Most side effects of continuous PRODUODOPA were mild, but in a recent phase III clinical trial adverse events caused 23% of participants to discontinue using the pump. The most common reason was due to issues with the infusion site, such as swelling, pain or infection.
What does this mean?
PRODUODOPA delivered via a continuous pump may be a more consistently effective way to reduce Parkinson’s symptoms compared to oral medications. While pumps can effectively deliver treatments, they can also restrict a person's mobility compared to oral medications. Some people may experience some discomfort or other adverse side effects with the pump.
What do these findings mean to the people with PD in the U.S. right now?
On October 17, 2024, the pharmaceutical company Abbvie announced that the U.S. Food and Drug Administration (FDA) approved VYALEV™, the same solution of foslevodopa-foscarbidopa as PRODUODOPA.
In other words, foslevodopa-foscarbidopa is now available in the U.S. under VYALEV, and available in Europe as PRODUODOPA. In the U.S., VYALEV was approved based on the results of the clinical trials mentioned in the above article. Read the full press release from Abbvie here.
If you are interested in VYALEV, talk to your PD doctor about next steps. Medicare coverage is expected in the second half of 2025.
A Note from our National Medical Advisor
“It is always a good day when we have more options for people with Parkinson's. I suspect VYALEV will be a useful approach for select people who have trouble with “off time” or motor fluctuations despite attempts by clinicians to change medication type, dose and frequency. This treatment is less powerful than deep brain stimulation. For those deciding on use of a pump, possible side effects can include skin irritation, hallucinations and dyskinesia. Everyone should understand that there is no reason why you cannot eventually combine therapies, and for example start with a pump and move later to a DBS or use both in combination,” said Michael S. Okun, MD, Parkinson’s Foundation National Medical Advisor and Director at the Norman Fixel Institute for Neurological Diseases.
Learn More
The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about PD and the topics in this article through our below resources, or by calling our free Helpline at 1-800-4PD-INFO (1-800-473-4636) for answers to your Parkinson’s questions.
Abordar la apatía y otros trastornos del estado de ánimo en la enfermedad de Parkinson
La apatía, la sensación de haber perdido las ganas de vivir, es uno de los síntomas más desafiantes de la enfermedad de Parkinson (EP). La apatía puede hacer que resulte difícil relacionarse con los demás, participar en las actividades cotidianas y controlar los síntomas de la EP. Junto con la depresión y la ansiedad, la apatía en la EP a menudo se pasa por alto y no se atiende lo suficiente. Aprender acerca de los síntomas de la apatía, cómo puede interactuar con otros trastornos del estado de ánimo y las estrategias para su manejo puede contribuir a su bienestar mental.
El siguiente artículo se basa en una Charlas con expertos de la Parkinson’s Foundation (Expert Briefings) acerca de la apatía y la salud mental en el Parkinson, con Aaron Malina, neuropsicólogo clínico con doctorado y certificado por el ABPP, quien trabaja en el Northwestern Medicine Lake Forest Hospital, un Centro de Excelencia de la Parkinson’s Foundation.
Cómo afectan el estado de ánimo los cambios cerebrales de la EP
La apatía, junto con la ansiedad, la depresión y los cambios cognitivos, puede ser frecuente en el Parkinson. Los cambios en la química cerebral que causan los síntomas motores en el Parkinson también pueden afectar el estado de ánimo. Algunas personas pueden experimentar trastornos del estado de ánimo incluso antes de que aparezcan los síntomas motores.
El Parkinson impacta en zonas profundas del cerebro, alterando complejas redes de comunicación. Estos cambios están relacionados con una menor producción de:
Dopamina: sustancia química responsable del movimiento y el estado de ánimo
Noradrenalina: sustancia relacionada con el movimiento, el estado de ánimo, la salud cognitiva y más
Serotonina: sustancia química que ayuda a regular las emociones
Acetilcolina: sustancia química que ayuda con las habilidades de pensamiento
Comprender la apatía
La apatía afecta a entre un 16 y un 46% de las personas con Parkinson. La apatía puede aparecer aislada, como componente de otras afecciones psiquiátricas como la depresión, o en enfermedades neurológicas como el Parkinson.
En la EP, la apatía es un trastorno de la motivación debido a la alteración de las redes cerebrales. Aunque hay factores externos que pueden influir en la apatía, ésta no es una reacción emocional y no se debe a dificultades de pensamiento o a sufrimiento emocional.
Las personas con apatía tienen dificultades para procesar, identificar y diferenciar entre resultados buenos y malos. Esto les dificulta responder en consecuencia. La apatía puede complicar el asistir a las citas médicas, tomar medicamentos o cuidar de sí mismo. En casos extremos, alguien con apatía puede no moverse ni hablar.
La persona que experimenta apatía puede mostrar poca expresión emocional o parecer indiferente, desinteresada o remota. Esto puede verse agravado por los síntomas de la EP como la cara de máscara (hipomimia) que dificultan la comunicación de las emociones.
Tipos de apatía y tratamientos
Los síntomas de la apatía son causados por una disfunción profunda en el mesencéfalo y los lóbulos frontales del cerebro, que procesan la información emocional, el impulso, el movimiento y el comportamiento. Las personas con la EP de mayor edad, con menos educación sanitaria, que experimentan depresión, deterioro cognitivo o trastornos del sueño MOR (por movimientos oculares rápidos), así como aquellas con Parkinson avanzado, corren un mayor riesgo de desarrollar apatía.
Es posible que su médico le pida que responda un cuestionario o le haga una entrevista para entender cómo afecta su vida la apatía e identificar la terapia más adecuada.
La apatía puede manifestarse de cuatro maneras:
Síntomas conductuales: incluyendo falta de iniciativa y productividad. Hace que la persona se vuelva más dependiente de los demás. Los agonistas de la dopamina pueden ayudar. Sin embargo, estos medicamentos se asocian a trastornos del control de impulsos.
Síntomas emocionales: provocan una falta de respuesta a los acontecimientos positivos y negativos, menos interés por lo que les ocurre a los demás, menos afecto e indiferencia general. Además de los agonistas de la dopamina, pueden recetarse metilfenidato o agentes serotoninérgicos.
Síntomas cognitivos: afectan el interés de la persona por aprender cosas nuevas y su capacidad para planificar, organizar o participar en actividades. Pueden recetarse inhibidores de la colinesterasa.
Interacción social: disminuye con la apatía. La falta de interés por participar en las relaciones puede afectar a la pareja, los familiares y los amigos.
Además de los medicamentos, el ejercicio, la interacción social, la atención plena y la terapia cognitiva desempeñan un papel importante en el tratamiento de la apatía. La terapia no invasiva de estimulación magnética transcraneal (EMT), que estimula las células del cerebro, podría mejorar los síntomas. La estimulación cerebral profunda (ECP), una cirugía neurológica para tratar algunos síntomas del Parkinson, a veces también puede mejorar la apatía.
Apatía y cambios cognitivos
La apatía puede ser un factor predictivo del cambio cognitivo en el Parkinson. Muchas personas con la EP experimentan un deterioro cognitivo leve, que puede afectar la función ejecutiva; es decir, la capacidad de la persona para planificar, organizar y resolver problemas. Las personas con cambios cognitivos importantes pueden experimentar una mayor apatía.
Separar la apatía de la depresión
Aunque la apatía y la depresión se producen en diferentes partes de los lóbulos frontales, ambas pueden traslaparse. Los síntomas que se observan tanto en la apatía como en la depresión incluyen:
Movimiento lento
Incapacidad para experimentar alegría
Falta de energía física
Disminución del entusiasmo
La depresión afecta a un 50% de las personas con Parkinson. Aunque la depresión puede causar tristeza o irritabilidad, su aparición no depende de un acontecimiento triste o traumático. La depresión puede provocar cambios en el peso, el apetito y el sueño. Alguien con depresión puede experimentar falta de autoestima, culpabilidad o pensamientos de autolesión o suicidio.
Las personas con más síntomas motores y las mujeres presentan un mayor riesgo de depresión en la EP. Las personas con Parkinson avanzado, ciertos subtipos genéticos de la EP o con deterioro cognitivo también son más propensas a la depresión.
Ansiedad y cognición
La ansiedad, una preocupación excesiva que es difícil de controlar, puede presentarse hasta en un tercio de las personas con Parkinson y puede afectar la cognición y la función física. Alguien con ansiedad puede sentirse triste, irritable, nervioso o inquieto, puede cansarse o fatigarse con facilidad, tener problemas de concentración o para dormir, o presentar un aumento de los dolores o molestias musculares. A algunas personas con Parkinson se les diagnostica ansiedad junto con depresión.
La fobia social (miedo o ansiedad ante las situaciones sociales) es un trastorno de ansiedad frecuente en la EP. Alguien que experimenta fobia social teme ser percibido negativamente por los demás y evita las situaciones sociales o las soporta con un miedo intenso.
Las personas que desarrollan Parkinson a una edad más temprana son más propensas a la ansiedad. La ansiedad también tiende a empeorar en las personas con la EP durante los periodos en "off", cuando el efecto de la levodopa desaparece.
En busca de tratamiento
Las revisiones periódicas para detectar cambios cognitivos y del estado de ánimo son un aspecto importante de la atención de la EP. Sin embargo, no todos los médicos especialistas en Parkinson preguntan por la salud mental o detectan cambios en el estado de ánimo. Si experimenta cualquier signo de apatía, depresión, ansiedad o cambios cognitivos, hable con su médico.
La terapia farmacológica se utiliza a menudo en combinación con la terapia de conversación (cognitivo-conductual) para controlar el bienestar mental en la EP. Los medicamentos más utilizados para tratar la depresión y la ansiedad son los ISRS (inhibidores selectivos de la recaptación de serotonina) y los IRSN (inhibidores de la recaptación de serotonina y norepinefrina). La terapia cognitivo-conductual ayuda a la persona a comprender cómo influyen los síntomas de su estado de ánimo en su forma de pensar y sentir y le proporciona herramientas para hacer frente a los síntomas.
El ejercicio o movimiento habitual también es esencial para el control del Parkinson y el bienestar mental.
Aprenda más
Descubra más acerca de la salud emocional en el Parkinson con estos recursos:
The Parkinson's Foundation hopes to be an official charity partner for the 2026 Life Time Miami Marathon Weekend. By signing up to run as a Parkinson's Champion you commit to raising funds and awareness for the Parkinson's Foundation, and in return you get access to a free entry (bib) to the race in addition to tons of other fun benefits and perks. You can learn more about our program and join our interest list at Run4PD.org.
The Life Time Miami Marathon has evolved to become one of the fastest-growing annual marathons that hosts tens of thousands from around the world. Known for its scenic, USTAF-certified, flat, single-loop and Boston-qualifying course, the event attracts first timers and elite distance runners alike. With tropical views and sounds of the city it has a finish line alongside the water at Bayfront Park in the beautiful South Beach.
NOTE: The Tropical 5k usually occurs the Saturday of race weekend, while the Marathon & Half are usually on Sunday.
Are you looking for a fun way to volunteer for the Parkinson's Foundation & raise your voice while raising awareness? Come out and cheer on our incredible athletes! Learn more and apply at Parkinson.org/ChampionsCheer.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Exercise and Slowing the Progression of Parkinson’s Disease: An Informational and Interactive Seminar
Hosted by the Parkinson’s Foundation Georgia Chapter in partnership with The Marcus JCC of Atlanta.
Featuring Dr. Madeleine Hackney
Free with advanced registration
Host Co-Chairs: Lisa and Ron Brill
Join us for an informative evening featuring one of the leading voices in Parkinson’s research, renowned mobility expert, Dr. Madeleine Hackney. Dr. Hackney will lead a discussion on the latest research surrounding exercise and Parkinson’s disease (PD), sharing invaluable insights into how movement can enhance the quality of life for those living with PD.
In addition to this in-depth presentation, this session will feature an interactive component, offering participants the chance to experience exercises specifically designed for Parkinson’s care. This event is perfect for individuals with Parkinson’s, caregivers, healthcare professionals, and anyone interested in learning how exercise can play a vital role in managing Parkinson’s Disease.
Dr. Madeleine Hackney is co-founder of MDT Education Solutions, a Parkinson's Foundation Accredited Continuing Education Provider.
Dr. Madeleine E. Hackney
Dr. Madeleine E. Hackney is an Associate Professor in the Emory School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology and a Research Scientist with the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA. She graduated from New York University, Tisch School of the Arts with a Bachelor of Fine Arts in Dance Performance and completed pre-medical curriculum at Hunter College, City University of New York. She received her PhD in Movement Science at Washington University in St. Louis and then completed post-doctoral work at Emory University and the Atlanta VA in geriatric sensorimotor rehabilitation.
Dr. Hackney uses laboratory and clinical measures to characterize mobility and gait under simple and challenging conditions (e.g., backward walking). She also investigates aspects pertaining to improved quality of life and goal-attainment as a result of rehabilitative physical activity approaches. She has presented her work nationally and internationally as an invited speaker, including at the Karolinska institute in Sweden, and in Tel Aviv, Israel.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Parkinson’s Revolution will take place across the country on February 22, 2025. Join us in-person at your studio location or virtually for a high energy ride that generates funds and awareness for Parkinson’s disease (PD).
New in 2025: This year, we will be hosting an in-person team for Pedaling for Parkinson’s Augusta. If you're wanting to participate in Revolution in Augusta, GA, join the team here. Use that Revolution page to fundraise and earn rewards for the in-person ride on March 1, 2025.
Come ride for a reason and then celebrate the power of movement at our post-ride happy hour the Sweat Social! Friends, family, and members of the PD community are welcome to enjoy a short program and light refreshments immediately following the ride.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Care needs in Parkinson’s change as symptoms progress. This program will provide you with tools to help you decide when it’s time to ask for outside help. Learn what you need to know to find the right kind of caregiver to meet your needs and discuss next steps to consider for care as Parkinson’s advances.
Presenter
Joan Miravite, DNP, RN, FNP-BC, FAAN, FAANP
Assistant Professor, Icahn School of Medicine at Mount Sinai
Director of Interdisciplinary Clinical Care for Movement Disorders
Mount Sinai Beth Israel, Department of Neurology
Strauss Movement Disorder Center
Parkinson Foundation Center of Excellence
Educational Events
Care Partners of Veterans with Parkinson's Disease
This program offers essential support and practical guidance for care partners of veterans living with Parkinson’s disease. Discover effective strategies for managing the evolving responsibilities of caregiving and learn how to access a range of valuable resources designed to enhance your caregiving journey.
Join us to deepen your understanding of the comprehensive care services and dedicated support available through the VA and the Parkinson’s Foundation, empowering you to provide the best care possible while prioritizing your own well-being.
Speaker
Corlynn Hullfish, LCSW
Caregiver Support Coordinator
Parkinson’s Disease Coordinator
Program of General Caregiver Support Services (PGCSS)
Respite Subject Matter Expert
Corporal Michael J. Crescenz VA Medical Center
(She/Her/Hers)
* While this webinar is designed for care partners, we welcome those living with Parkinson's disease to join us. Please note that the focus of this program is on supporting those who identify as care partners.
There is no charge to attend, but registration is required. This program is open to people with Parkinson's, their family, friends, and the community.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Exercise is an essential part of overall Parkinson’s management. In addition to helping with movement symptoms, exercise can have a positive impact on non-motor symptoms in Parkinson’s. This program focuses on how exercise supports brain health and can lead to improved emotional and cognitive well-being.
This program is open to people with Parkinson's, their family, friends and the community. There is no charge to attend, but registration is required as in-person seating is limited
Attendance is free. Lunch will be served.
Featured Speaker:
Karen D. Sullivan, PhD, ABPP
Pinehurst Neuropsychology
Karen D. Sullivan, PhD, ABPP founded Pinehurst Neuropsychology in November 2013. She is a Clinical Psychologist with specialty training in Clinical Neuropsychology, licensed in the state of North Carolina. Prior to coming to Pinehurst, Dr. Sullivan was an Assistant Professor at the University of North Carolina at Chapel Hill’s School of Medicine in the Physical Medicine and Rehabilitation Department. Dr. Sullivan received her doctoral degree at Boston University in 2009 and then completed her internship and post-doctoral fellowship in Clinical Neuropsychology and Rehabilitation Psychology at the VA Boston Healthcare System, through Harvard Medical School and the Boston University School of Medicine. Dr. Sullivan is Board Certified in Clinical Neuropsychology by the American Board of Professional Psychology.
Her goal is to help people understand the impact of their condition on everyday functioning and provide genuinely helpful recommendations that address the cognitive, behavioral and emotional concerns of the patient, family and referring provider. Although Dr. Sullivan’s practice includes adults throughout the lifespan (18 and over), she has extensive training in clinical issues unique to older adults.
She created the I CARE FOR YOUR BRAIN with Dr. Sullivan program and won the 2017 LeadingAge North Carolina Excellence in Collaboration for the development of the lecture series.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
