Mood disorders in Parkinson’s disease

Mood disorders in Parkinson’s Disease (PD) have traditionally been viewed as reactive conditions arising in response to motor deterioration and reduced quality of life. However, emerging evidence indicates that affective disturbances represent a distinct and integral component of the disease, reflecting profound dysregulation of neurotransmitter systems within the central nervous system. Of particular interest is the early manifestation of depression, anxiety, and apathy, which may precede the onset of motor symptoms and thus serve as prodromal markers of the disease. These early affective symptoms are frequently underrecognized by both patients and clinicians, leading to delayed diagnosis and postponement of targeted treatment interventions. The clinical and pathophysiological heterogeneity of affective symptoms in PD has led to the conceptualization of non-motor phenotypes analogous to the established motor subtypes. This article presents a comprehensive review of Russian and international studies published between 2009 and 2024, focusing on the neurochemical and clinical dimensions of depression, anxiety, and apathy in PD. Special attention is given to the roles of the noradrenergic, serotonergic, dopaminergic, and cholinergic systems in the development of mood disturbances. It is emphasized that imbalances among these neurotransmitter networks contribute to the persistence of affective disorders and diminished cognitive flexibility. Contemporary approaches to the phenotypic classification of emotional disturbances are discussed, incorporating data from neuroimaging and neurochemical profiling. Integrating these affective phenotypes into the broader typology of PD holds promise for enhancing diagnostic precision, risk stratification, and the development of personalized therapeutic strategies. The review also explores the interplay between affective and motor symptoms and their combined impact on the clinical trajectory and prognosis of PD. Identifying characteristic patterns of non-motor manifestations, including mood disorders, advances our understanding of the clinical heterogeneity of PD and informs the development of more effective diagnostic and therapeutic frameworks aimed at improving patient quality of life and reducing the risk of social maladaptation.

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