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geri:dementia:parkinsons [on September 16, 2018]
geri:dementia:parkinsons [on April 21, 2020]
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 +====== Parkinsons'​s Disease Dementia (PDD) ======
 +===== Primer =====
 +**Parkinson’s Disease Dementia** (PDD) is a form of dementia that develops after the diagnosis of [[geri:​parkinsons|Parkinson'​s Disease]]. Patients with PD have an almost six-fold increased risk of developing dementia. By definition, Parkinson'​s disease dementia is cognitive decline that occurs //after// the onset of Parkinson'​s disease.
 +==== Incidence ====
 +The majority of patients with Parkinson’s will experience some degree of cognitive impairment over time. The time of progression to a Parkinson'​s Disease dementia depends on the length and stage of disease. Some longitudinal studies have shown that the progression to dementia is inevetiable.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​18307261|Hely,​ M. A., Reid, W. G., Adena, M. A., Halliday, G. M., & Morris, J. G. (2008). The Sydney multicenter study of Parkinson'​s disease: the inevitability of dementia at 20 years. Movement disorders, 23(6), 837-844.]])] Parkinson'​s disease is more common in males than in females. Among individuals with Parkinson'​s disease, as many as 75% will develop a major neurocognitive disorder at sometime in the course of their disease.
 +
 +===== Diagnostic Criteria =====
 +<WRAP group>
 +<WRAP half column>
 +== Criterion A ==
 +The criteria are met for [[cl:​2-major-neurocog-disorder|major]] or [[cl:​3-mild-neurocog-disorder|mild neurocognitive disorder]].
 +== Criterion B ==
 +The disturbance occurs in the setting of established Parkinson’s disease.
 +== Criterion C ==
 +There is insidious onset and gradual progression of impairment.
 +</​WRAP>​
 +<WRAP half column>
 +== Criterion D ==
 +The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.
 +
 +Major or mild neurocognitive disorder **probably** due to Parkinson’s disease should be diagnosed if 1 and 2 are both met. Major or miid neurocognitive disorder **possibly** due to Parkinson'​s disease should be diagnosed if 1 //or// 2 is met:
 +  - There is no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease or another neurological,​ mental, or systemic disease or condition likely contributing to cognitive decline).
 +  - The Parkinson’s disease clearly precedes the onset of the neurocognitive disorder.
 +
 +</​WRAP>​
 +</​WRAP>​
 +
 +==== MDS Criteria ====
 +The diagnosis of Parkinson'​s disease dementia (PDD) is most often based on the Movement Disorder Society Task Force 2007 recommendations.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​18098298|Dubois,​ B., Burn, D., Goetz, C., Aarsland, D., Brown, R. G., Broe, G. A., ... & Korczyn, A. (2007). Diagnostic procedures for Parkinson'​s disease dementia: recommendations from the movement disorder society task force. Movement disorders, 22(16), 2314-2324.]])]
 +
 +<panel title="​Diagnostic Criteria"​ subtitle="​Dubois,​ Bruno, et al. Movement disorders 22.16 (2007): 2314-2324."​ no-body="​true">​
 +^ Criterion ​ ^ Description ​                                                ^ Asessment ​                                                                                                            ^
 +^ 1          | A diagnosis of PD                                           | Queen'​s Square Brain Bank Criteria ​                                                                                   |
 +^ 2          | PD developed prior to the onset of dementia ​                | Patient/​caregiver history or ancillary records ​                                                                       |
 +^ 3          | PD associated with a decreased global cognitive efficiency ​ | MMSE < 26                                                                                                             |
 +^ 4          | Cognitive deficiency severe enough to impair daily life     | Caregiver interview or pill questionnaire ​                                                                            |
 +^ 5          | Impairment of more than one cognitive domain ​               | Impairment of at least 2 of the following domains: attention, executive function, visuo-constructive ability, memory ​ |
 +</​panel>​
 +
 +Presence of one of the following behavioural symptoms (apathy, personality changes, hallucinations,​ delusions or excessive daytime sleepiness) may support the diagnosis of probable PDD. 
 +
 +===== Differential Diagnosis =====
 +  * Major or mild neurocognitive disorder with [[geri:​dementia:​lewy-body|Lewy bodies]]. This distinction is based substantially on the timing and sequence of motor and cognitive symptoms. For NCD to be attributed to Parkinson'​s disease, the motor and other symptoms of Parkinson'​s disease must be present well before (by convention, at least 1 year prior) cognitive decline
 +  * Major or mild neurocognitive disorder due to [[geri:​dementia:​alzheimers|]]. The motor features are the key to distinguishing major or mild NCD due to Parkinson'​s disease from major or mild NCD due to Alzheimer'​s disease. However, the two disorders can co-occur.
 +  * Major or mild [[geri:​dementia:​vascular|vascular neurocognitive disorder]]
 +  * Neurocognitive disorder due to another medical condition (e.g., neurodegenerative disorders)
 +  * Neuroleptic-induced [[meds:​antipsychotics:​eps|parkinsonism]]
 +  * Other medical conditions and [[cl:​1-delirium|delirium]]. Delirium and neurocognitive impairments due to side effects of dopamine-blocking drugs and other medical conditions (e.g., sedation or impaired cognition, severe hypothy roidism, Bi2deficiency) must also be ruled out. Sometimes it may be clinically difficult to distinguish between Parkinsons'​s dementia and delirium, and patients must be followed longitudinally.
 +
 +===== Treatment =====
 +==== Acetylcholinesterase Inhibitors ====
 +The currently available evidence supports the use of acetylcholinesterase inhibitors as a class ([[meds:​dementia:​donepezil|donepezil]],​ [[meds:​dementia:​rivastigmine|rivastigmine]],​ and [[meds:​dementia:​galantamine|galantamine]]) in patients with Parkinson'​s disease dementia, with a positive impact on global assessment, cognitive function, behavioural disturbance and activities of daily living rating scales.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3980908/​|Herrmann,​ N., Lanctôt, K. L., & Hogan, D. B. (2013). Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimer'​s research & therapy, 5(1), S5.]])]
 +
 +==== Parkinson'​s Psychosis ====
 +{{page>​geri:​parkinsons#​psychosis&​nouser&​noheader&​nodate&​nofooter}}