Cognitive Impairment Decreases Function in Parkinson’s Patients

Parkinson’s disease (PD) patients commonly experience cognitive decline. The deterioration in thinking skills and executive functioning is independent of the change or decline in their motor skills. However, patients with severe cognitive deterioration are also likely to experience motor decline as well.

Approximately 70% of patients with PD will

exhibit some degree of dementia.

The treatment of dementia in a PD patient is complicated. Cholinesterase inhibitors (Aricept, Exelon) which are commonly used to treat dementia may be used but the improvements seen are usually modest. These medications also have a significant likelihood of increasing the symptoms of parkinsonism. Memantine is a different type of drug (NMDA antagonist) which may be used to help dementia and does not worsen PD symptoms.

Current recommended treatment for PD patients with cognitive decline includes a trial of cholinesterase inhibitors with careful monitoring of the patient for worsening of PD symptoms and a switch to memantine if worsening occurs. Behavior problems may be managed with the new generation antipsychotics (Geodon, Seroquel, Risperdal, for example). Anticholinergic drugs such as the tricyclic antidepressants and dopamine agonists should be avoided in these patients.

Source: 2006 Annual Meeting Amer Neurol Assn