Treatment of dementia in Parkinson’s disease

Dementia is a frequent and debilitating complication of Parkinson’s disease (PD). It typically is gradual in onset and occurs after a number of years of disease. Longitudinal studies indicate that up to 80% of PD patients may develop dementia during their disease course, though this figure varies. Cognitive deficits in PD dementia (PDD) affect more than one cognitive domain, such as attention, working memory, executive function, memory, language, and/or visuospatial functions and are severe enough to impair daily life, independent of motor symptoms. Behavioral symptoms such as depression, apathy, psychosis, and excessive daytime sleepiness can accompany PDD. To date, rivastigmine is the only FDA-approved medication for PDD. There is growing interest in other pharmacological and non-pharmacological treatments for PDD including medications, neuromodulation, and physical and cognitive exercise. Management strategies include avoiding medications that can exacerbate cognitive impairment (such as anticholinergics); treating comorbid neuropsychiatric symptoms; addressing driving, safety, and/or work issues; and providing support to the patient and care partner.