Treatment of dementia with Lewy bodies and Parkinson's disease dementia.
Cognitive decline and dementia affect approximately 30% to 40% of patients with idiopathic Parkinson's disease during the course of their illness. PD-dementia (PDD) and dementia with Lewy bodies (DLB) are second to Alzheimer's disease in causing degenerative dementia in the elderly. The nosological distinction of the conditions has remained controversial because of broad clinical and pathological overlap. Treatment issues in both clinical settings are virtually identical. Treatment of Parkinsonism is often complicated by drug-induced psychosis and reduced levodopa responsiveness. Cognition, alertness, attention, as well as apathy or aggressive behavior have been shown to respond to treatment with cholinesterase inhibitors in randomized controlled trials both in DLB and PDD. Such treatment may also improve hallucinosis, but many patients will require add-on treatment with atypical neuroleptics to control drug-induced psychotic reactions. Clozapine and quetiapine are the drugs most commonly used and, contrary to classic neuroleptics, risperidone or olanzapine do not seem to cause severe side effects according to published data.
Poewe
Werner
W
Department of Neurology, Medical University of Innsbruck, Austria. werner.poewe@uibk.ac.at
D000544:Alzheimer Disease / Q000628:therapy; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D003376:Counseling; D006801:Humans; D020961:Lewy Body Disease / Q000188:drug therapy / Q000628:therapy*; D010300:Parkinson Disease / Q000188:drug therapy / Q000628:therapy*; D011605:Psychoses, Substance-Induced / Q000188:drug therapy / Q000209:etiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors