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Management of Parkinson’s Disease Dementia

Practical Considerations

  • Therapy In Practice
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Abstract

Parkinson’s disease dementia (PDD) ultimately develops in about 80% of patients with Parkinson’s disease (PD), and cross-sectional studies have found that some 30% of these patients will experience neuropsychiatric symptoms, such as visual hallucinations and psychosis. The most consistently reported risk factors for dementia in PD are age, severe parkinsonism and mild cognitive impairment.

In PDD, both subcortical cognitive and cortical cognitive profiles are described. Specific disorders of sleep, such as rapid eye movement sleep behaviour disorder, excessive daytime sleepiness and sleep attacks, occur frequently. Alzheimer and Lewy body pathology coexist, but the Lewy body pathology in limbic and cortical areas seems to be the main cause of dementia. Neurochemical changes in the biogenic amines and acetylcholine are common, and magnetic resonance imaging studies have shown cortical atrophy in wide cortical areas, including the hippocampus. All PD patients should be screened for mild cognitive impairment and dementia.

A large randomised clinical trial showed that the cholinesterase inhibitor rivastigmine has desirable effects on cognition and neuropsychiatric symptoms in PDD patients. Atypical antipsychotic agents may improve psychosis in PDD, but the evidence for this is poor and adverse effects from such therapy are common and may be severe. Non-pharmacological interventions can also be effective but require further study.

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Acknowledgements

Arvid Rongve has received funding from Helse-Fonna Regional Health Authorities for preparation of this article and has received honoraria for teaching not related to this article from Lundbeck and Pfizer. Dag Aarsland has acted as a consultant and received honoraria from Pfizer, Novartis, Lundbeck and Janssen-Cilag, and has received grants from Novartis and Lundbeck, none of which were related to this article.

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Authors and Affiliations

  1. Haugesund County Hospital, Haugesund, Norway

    Arvid Rongve

  2. University of Bergen, Bergen, Norway

    Arvid Rongve & Dag Aarsland

  3. Stavanger University Hospital, Stavanger, Norway

    Dag Aarsland

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  1. Arvid Rongve
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  2. Dag Aarsland
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Correspondence to Arvid Rongve.

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Rongve, A., Aarsland, D. Management of Parkinson’s Disease Dementia. Drugs Aging 23, 807–822 (2006). https://doi.org/10.2165/00002512-200623100-00004

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