Clinical management of Parkinson’s disease dementia: pitfalls and progress

Michael Samuel is a consultant neurologist and senior lecturer with East Kent Hospitals NHS Trust, King’s College Hospital London and the University of Kent. He has an interest in the neuropsychiatric aspects of Parkinson’s disease, has been involved in related clinical trials and runs a movement disorder service. Ian Maidment is a specialist mental health pharmacist and is involved in a tertiary service for the psychiatric aspects of Parkinson’s disease. Malaz Boustani is interested in the behavioural aspects of cognitive impairment, is involved in intervention studies and has worked on one of the largest ongoing US studies on the prevention of cognitive decline. Chris Fox is a consultant psychiatrist in Canterbury (East Kent Social Care and Partnership Trust, Canterbury, Kent, England, UK. E-mail: gfox{at}doctors.org.uk). He is involved in intervention studies, a tertiary service for the psychiatric aspects of Parkinson’s disease and a research clinic. He is also conducting research on other dementias and has close collaboration with US groups studying screening programmes for cognitive impairment. Ian Maidment, Malaz Boustani and Chris Fox are all working on the Cochrane Systematic Review of cholinesterase inhibitors in Parkinson’s disease dementia, for which Mr Maidment is lead and Professor Boustani and Dr Fox are co-reviewers.

The non-motor symptoms of Parkinson’s disease, which include cognitive, behavioural and psychological problems, are significant not just in epidemiological terms but also in their impact on patients and carers. Each symptom requires careful evaluation, owing to the potential overlap with comorbid conditions and also to the multiple aetiological pathways in Parkinson’s disease. Such monitoring allows enhanced management. However, the diagnostic difficulties arising from these non-motor symptoms require further research. Here we describe the efficacy and some of the problems of medication used for non-motor symptoms, including antiparkinsonian medication, antipsychotics and acetylcholinesterase inhibitors.