From the Research
Sudden aphasia and confusion in a patient with Parkinson's Disease (PD) requires immediate medical attention, as these symptoms may indicate a serious complication such as a medication side effect, stroke, infection, or metabolic disturbance. The cause of these symptoms can be multifactorial, including medication-related issues, such as anticholinergic toxicity from medications like trihexyphenidyl or benztropine, dopamine dysregulation syndrome, or an interaction between Parkinson's medications and other drugs 1. According to a study published in 2011, hospitalized PD patients are at risk of developing acute events such as urinary infection, confusion, and pressure ulcers, and medication errors are also frequent adverse events 2.
Possible Causes
- Medication side effects, particularly from dopaminergic medications like levodopa or dopamine agonists
- Separate neurological events such as a stroke, infection, or metabolic disturbance
- Anticholinergic toxicity from medications like trihexyphenidyl or benztropine
- Dopamine dysregulation syndrome
- Interaction between Parkinson's medications and other drugs
Management
- Thorough neurological examination
- Brain imaging (CT or MRI)
- Blood tests
- Possibly medication adjustment, such as reducing the dose of dopaminergic drugs or switching to alternative formulations
- Temporary discontinuation of certain medications
- Supportive care and treatment of underlying causes
A study published in 2000 highlighted the importance of emergency department presentations of patients with Parkinson's disease, including severe motor "off" periods, involuntary movements, psychosis, acute confusion, panic disorder, and pain 3. Another study published in 1986 reported a rare complication of dopaminergic therapy, where two patients with Parkinson's disease presented with unprovoked, abrupt onset of hallucinations, confusion, and worsening of parkinsonian symptoms, which improved with reduction of Sinemet dosage 4.
Key Considerations
- Prompt intervention is crucial to prevent further complications and potentially reverse the symptoms
- Medication adjustment and supportive care are essential in managing these symptoms
- Hospitalized PD patients require close monitoring and management to prevent acute events and medication errors.