Fluctuations in cognition and alertness in Parkinson's disease and dementia.
Fluctuations in cognition and alertness (FC/FA) are key manifestations of dementia with Lewy bodies (DLB) and also have been recognized recently in patients with Parkinson's disease (PD) with dementia, a condition that shares important clinical, genetic, and neuropathologic characteristics with DLB. A comprehensive assessment of potential episodes of FC/FA is required for adequate clinical management, and several interesting clinical instruments are being developed for that purpose. FC/FA should be differentiated from episodes of excessive daytime sleepiness (EDS). Such diagnostic differentiation appears to be necessary, particularly in the light of the different therapeutic approaches to FA and EDS. Based on the deficit in cholinergic transmission observed in DLB patients, cholinesterase inhibitors, such as rivastigmine, may have a beneficial effect on FC/FA. Other therapies, such as melatonin or modafinil, require further investigation.
Serrano
Carolina
C
Sleep Disorders Unit, Department of Neurology, Jiménez Díaz Foundation, Universidad Autónoma de Madrid, Avda. Reyes Católicos 2, 28040 Madrid, Spain. cserranog@fjd.es
García-Borreguero
Diego
D
D001364:Awareness / Q000502:physiology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D003704:Dementia / Q000523:psychology*; D004311:Double-Blind Method; D006801:Humans; D020961:Lewy Body Disease / Q000188:drug therapy / Q000523:psychology; D008550:Melatonin / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D010300:Parkinson Disease / Q000523:psychology*; D048448:Phenylcarbamates / Q000627:therapeutic use; D010789:Phototherapy; D016032:Randomized Controlled Trials as Topic; D000068836:Rivastigmine
D000697:Central Nervous System Stimulants; D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D008550:Melatonin; D000068836:Rivastigmine