- Last edited on February 9, 2022
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geri:dementia:parkinsons [on September 16, 2018] |
geri:dementia:parkinsons [on April 25, 2020] |
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+ | ====== Parkinsons's Disease Dementia (PDD) ====== | ||
+ | {{INLINETOC}} | ||
+ | ===== 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}} | ||