Abstract
Different psychopathological manifestations, such as affective, psychotic, obsessive-compulsive symptoms, and impulse control disturbances, may occur in most central nervous system (CNS) disorders including neurodegenerative and neuroinflammatory diseases. Psychiatric symptoms often represent the clinical onset of such disorders, thus potentially leading to misdiagnosis, delay in treatment, and a worse outcome. In this review, psychiatric symptoms observed along the course of several neurological diseases, namely Alzheimer’s disease, fronto-temporal dementia, Parkinson’s disease, Huntington’s disease, and multiple sclerosis, are discussed, as well as the involved brain circuits and molecular/synaptic alterations. Special attention has been paid to the emerging role of fluid biomarkers in early detection of these neurodegenerative diseases. The frequent occurrence of psychiatric symptoms in neurological diseases, even as the first clinical manifestations, should prompt neurologists and psychiatrists to share a common clinico-biological background and a coordinated diagnostic approach.
Highlights
Psychiatric and neurological diseases often overlap with each other and co-occur [1].Psychiatric symptoms may present along the course of several central nervous system (CNS) disorders, sometimes preceding the onset of typical neurological symptoms and signs [2,3]
This behavioral change is thought to rely on an immune-mediated modulation of synaptic function and could trigger a pathological depressive-like response in disorders characterized by a chronic inflammatory process in the CNS, including neurodegenerative diseases like Alzheimer’s disease (AD) and Parkinson’s disease (PD) [206,207]
In addition to this explanation, α-syn as a biomarker of synucleinopathy could be implicated in the association between psychiatric symptoms and PD, representing a potential biomarker to identify those individuals in which depression is a prodromal manifestation of PD
Summary
Psychiatric and neurological diseases often overlap with each other and co-occur [1]. The onset of neurological diseases with psychiatric symptoms may cause misdiagnosis, hindering the early identification of the underlying CNS disorder and leading to inadequate treatment and worse prognosis [4,5,6]. The occurrence of psychiatric symptoms in neurological diseases may underpin different causes [9]. Psychiatric symptoms occur at any stage of CNS disorders, and clinical pictures may vary along the disease course [27,28,29]. Despite the fact that different neurological conditions share common psychiatric features, psychopathological manifestations can show distinct symptom clusters depending both on disease and individual expression [21,30], which makes the overall clinical picture even more challenging to interpret.
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