The Cognitive Neuropsychiatry of Parkinson's Disease

Patients with Parkinson's disease (PD) suffer most visibly with such motor deficitsas tremor and rigidity and less obviously with a range of nonmotor symptoms, including autonomicdysfunction, mood disorders, and cognitive impairment. The neuropsychiatric disturbances of PD canbe as disabling as its motor disorders; but they have only recently begun to be studied intensivelyby clinicians and scientists. In this book, Patrick McNamara examines the major neuropsychiatricsyndromes of PD in detail and offers a cognitive theory that accounts for both their neurology andtheir phenomenology. McNamara offers an up-to-date review of current knowledge of suchneuropsychiatric manifestations of PD as cognitive deficits, personality changes, speech andlanguage symptoms, sleep disorders, apathy, psychosis, and dementia. He argues that the cognitive,mood, and personality symptoms of PD stem from the weakening or suppression of the agentic aspectsof the self. McNamara's study may well lead to improved treatment for Parkinson's patients. But itsoverarching goal is to arrive at a better understanding of the human mind and its breakdown patternsin patients with PD. The human mind-brain is an elaborate and complex structure patched together toproduce what we call the self. When we observe the disruption of the self structure that occurs withthe various neuropsychiatric disorders associated with PD, McNamara argues, we get a glimpse intothe inner workings of the most spectacular structure of the self: the agentic self, the self thatacts.

Patrick McNamara is Associate Professor of Neurology at Boston University School of Medicine and Boston VA Healthcare System. He is the author of The Neuroscience of Religious Experience and other books.