Parkinson's dementia; Parkinson's psychosis-dementia complex
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Etiology
- may be same disorder as Lewy body dementia differing in presentation, rather than in etiology or pathology[3]
Epidemiology
- 27% if patients with Parkinson's disease prescribed either cholinesterase inhibitor of memantine[9]
- these prescriptions associated with increasing age & diagnoses of dementia, depression, hip fracture or pelvic fracture, & cerebrovascular events
- black & hispanic patients more frequently prescribed these meds
Clinical manifestations
- subtle dementia (25% of patients with Parkinson's disease)
- occurs > 1 year after diagnosis of Parkinson's disease
- generally reflects subcortical pattern
- psychomotor retardation
- poor memory retrieval
- able to answer multiple choice questions
- responds to cueing
- impaired executive functions
- difficulty with planning, organizing, sequencing & abstracting
- relatively preserved language function
- minor hallucinations[12]
- impaired attention that may fluctuate
- impaired visuospatial skills (difficulties with navigation)
- bradyphrenia with slow response to questions
- apraxia, agnosia & aphasia are NOT features of Parkinson's dementia
Differential diagnosis
- condition is called Parkinson's disease dementia if dementia occurs > 1 year after onset of parkinsonism, orLewy body dementia if both symptoms occur within a year of each other
- distinguish from depression, also common in patients with Parkinson's disease
Management
- treatment may be similar to Lewy body dementia
- the cognitive impairment of Parkinson's dementia does NOT respond to anti-Parkinson medications
- cholinesterase inhibitors may be of benefit
- rivastigmine may have modest benefit in some patients[2]
- beneficial for cognition, behavior, falls & hallucinations[6]
- cognitive benefits of rivastigmine more pronounced when orthostatic hypotension is present[10]
- donepezil improves both cognition & behavior[6]
- no significant benefits in activities of daily living or behavior[8]
- cholinesterase inhibitors improve activities of daily living[6]
- rivastigmine may have modest benefit in some patients[2]
- memantine of no benefit[5]
- no improvement in cognitive function[6]
- beneficial for falls & hallucinations[6]
- rasagiline 1 mg/day of no benefit for mild cognitive impairment associated with Parkinon's disease[7]
- NO effective treatment is known
- cognitive impairment in patients with early Parkinson's disease & the apoE4 allele may be mitigated by exercise[11]
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 2.0 2.1 Journal Watch 25(1):11, 2005 Emre M, Aarsland D, Albanese A, Byrne EJ, Deuschl G, De Deyn PP, Durif F, Kulisevsky J, van Laar T, Lees A, Poewe W, Robillard A, Rosa MM, Wolters E, Quarg P, Tekin S, Lane R. Rivastigmine for dementia associated with Parkinson's disease. N Engl J Med. 2004 Dec 9;351(24):2509-18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15590953
- ↑ 3.0 3.1 McKeith I. Dementia with Lewy bodies and Parkinson's disease with dementia: Where two worlds collide Pract Neurol 2007, 7:374 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18024777
- ↑ Prescriber's Letter 16(4): 2009 Parkinson's Dementia and Lewy Body Dementia Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250407&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 Emre M et al. Memantine for patients with Parkinson's disease dementia or dementia with Lewy bodies: A randomised, double-blind, placebo-controlled trial. Lancet Neurol 2010 Oct; 9:969 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20729148
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Wang HF et al. Efficacy and safety of cholinesterase inhibitors and memantine in cognitive impairment in Parkinson's disease, Parkinson's disease dementia, and dementia with Lewy bodies: Systematic review with meta-analysis and trial sequential analysis. J Neurol Neurosurg Psychiatry 2014 May 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24828899
- ↑ 7.0 7.1 Weintraub D, Hauser RA, Elm JJ et al Rasagiline for mild cognitive impairment in Parkinson's disease: A placebo-controlled trial. Mov Disord. 2016 May;31(5):709-14. Epub 2016 Mar 31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27030249
- ↑ 8.0 8.1 Dubois B, Tolosa E, Katzenschlager R, et al. Donepezil in Parkinson's disease dementia: a randomized, double-blind efficacy and safety study. Mov Disord. 2012;27(10):1230-1238 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2291544
- ↑ 9.0 9.1 Mantri S, Fullard M, Gray SL et al. Patterns of dementia treatment and frank prescribing errors in older adults with Parkinson disease. JAMA Neurol 2018 Oct 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/3028504 https://jamanetwork.com/journals/jamaneurology/fullarticle/2704469
- ↑ 10.0 10.1 Espay AJ et al. Rivastigmine in Parkinson's disease dementia with orthostatic hypotension. Ann Neurol 2020 Oct 5; PMID: https://www.ncbi.nlm.nih.gov/pubmed/33016374 https://onlinelibrary.wiley.com/doi/10.1002/ana.25923
- ↑ 11.0 11.1 Kim R, Park S, Yoo D et al. on Association of physical activity and APOE genotype with longitudinal cognitive change in early PD. Neurology 2021 Mar 31; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/33790041 https://n.neurology.org/content/early/2021/03/31/WNL.0000000000011852
- ↑ 12.0 12.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
Lenka A, Pagonabarraga J, Pal PK et al. Minor hallucinations in Parkinson disease: A subtle symptom with major clinical implications. Neurology. 2019;93(6):259-266 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31289146 PMCID: PMC6709995 Free PMC article https://n.neurology.org/content/93/6/259