PD dementia
- common - over half of patients by 10 years
- characterised by*:
- fluctuating cognitive symptoms
- hallucinations - visual > tactile > auditory
- daytime somnolence
- disrupted sleep-wake cycle
- (*see PDD diagnostic criteria for more details)
First Steps
- refer to movement disorder team or old age psychiatrist URGENTLY
- rule out infectious precipitant for symptoms
- consider stopping/reducing culprit medications - in this order
- trihexyphenidyl
- amantadine
- selegiline/rasagiline
- dopamine agonist - must be reduced slowly
Non-drug Management
- CPN appointed via mental health team
- carer support instituted
- baseline bloods, lying/standing BP
- in case new treatment is required
- baseline ECG
- if cognitive enhancers or anti-psychotics are to be used
- montreal cognitive assessment (MoCA)
- to document extent of cognitive impairment www.mocatest.org
Drug Management
- if dementia syndrome:
- consider donepezil 5-10 mg nocte
- consider rivastigmine 1.5 mg bd (max 6 mg bd)
- consider rivastigmine patch 4.6 mg per 24 hour (max 13.3 mg) check lying/standing BP and ECG first
- check lying/standing BP and ECG first
- avoid typical anti-psychotic drugs
- haloperidol, chlorpromazine
- consider atypical anti-psychotic agent
- quetiapine 25-50 mg nocte
- aripiprazole 1-5 mg daily
- for treatment failure:
- clozapine 6.25-12.5 mg daily
- requires specialist initiation and monitoring