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geri:dementia:parkinsons [on April 21, 2020]
geri:dementia:parkinsons [on February 9, 2022] (current)
psychdb [Differential Diagnosis]
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 ====== Parkinsons'​s Disease Dementia (PDD) ====== ====== Parkinsons'​s Disease Dementia (PDD) ======
 +{{INLINETOC}}
 ===== Primer ===== ===== 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. **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.
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 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. 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 =====+===== DSM-5 Diagnostic Criteria =====
 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
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 ===== Differential Diagnosis ===== ===== 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 with [[geri:​dementia:​lewy-body|Lewy bodies]]** 
-  * 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. +    * 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 [[geri:​dementia:​vascular|vascular neurocognitive disorder]] +  ​* **Major or mild neurocognitive disorder due to [[geri:​dementia:​alzheimers|]]** 
-  * Neurocognitive disorder due to another medical condition (e.g.neurodegenerative disorders) +    * 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. 
-  * Neuroleptic-induced [[meds:​antipsychotics:​eps|parkinsonism]] +  ​* **Major or mild [[geri:​dementia:​vascular|vascular neurocognitive disorder]]** 
-  * 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 roidismBi2deficiency) 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. +  ​* **Neurocognitive disorder due to another medical condition (e.g. neurodegenerative disorders)** 
 +  ​* **Neuroleptic-induced [[meds:​antipsychotics:​eps|parkinsonism]]** (i.e. - extrapyramidal symptoms) 
 +    * In these cases of potential confounding effects from medications such as antipsychotics,​ the clinician should try to elicit a clear history if the Parkinsonian symptoms developed before or after the initiation of antipsychotics. 
 +  ​* **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 ​hypothyroidismB12 deficiency) 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 ===== ===== Treatment =====
 ==== Acetylcholinesterase Inhibitors ==== ==== 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.]])]+  * The currently available evidence supports the use of acetylcholinesterase inhibitors as a class 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.]])]
 +  * [[meds:​dementia:​donepezil|Donepezil]] and [[meds:​dementia:​rivastigmine|rivastigmine]] are typically recommended first, with [[meds:​dementia:​galantamine|galantamine]] having less evidence.
  
 ==== Parkinson'​s Psychosis ==== ==== Parkinson'​s Psychosis ====
 {{page>​geri:​parkinsons#​psychosis&​nouser&​noheader&​nodate&​nofooter}} {{page>​geri:​parkinsons#​psychosis&​nouser&​noheader&​nodate&​nofooter}}