title: Parkinson's disease (PD) with dementia and falls is improved by AChEI? A preliminary study report.
abstract: OBJECTIVE
  Advanced PD is often associated with cognitive impairment and frequent falls. We describe a suggestive case report of PD associated with mild cognitive impairment (MCI) and falls. The aim of our study was to test alteration in balance potentially related to use of acetylcholinesterase inhibitor (AchEI). We address this hypothesis after keeping the patient in stable dosage of dopamine agonist.
  We describe an initial pharmacological management in a 78-year-old man affected by Parkinson disease (PD) associated with mild cognitive impairment (MCI) and history of falls. The diagnosis of PD was also confirmed by SPECT with DATSCAN, after CT-brain exclusion of potential other causes of the symptoms. Cognitive and motor performances of the patient were initially evaluated by Mini Mental Examination State Examination (MMSE), Short Physical Performance Battery (SPPB) and Romberg test. We also recorded gait parameters using an accelerometer, while balance and stability were assessed by stabilometric platform with open and closed eyes. We repeated cognitive and motor tests and gait and balance evaluation after stable dosage of dopamine agonist before and after introduction of AchEI.
  
  
  RESULTS
  After starting dopamine agonist therapy, there was a significant improvement in gait parameters (speed, stride/min, stride length, swing duration, and decrease in gait cycle duration and rolling duration). When stable dosage of dopamine agonist was reached, AchEI was introduced obtaining not only a significant improvement of cognitive performance, but also a significant positive change in balance.
  
  
  CONCLUSIONS
  We hypothesize that AchEI could improve stability, balance and postural instability in addition to cognitive performance in PD with MCI and balance deficits.
authors: Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy. flauretani@ao.pr.it.|Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy. flauretani@ao.pr.it.
authors: Fulvio
authors: F
authors: Lauretani
authors: Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy.
authors: Laura
authors: L
authors: Galuppo
authors: Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy.
authors: Cosimo
authors: C
authors: Costantino
authors: Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors: Andrea
authors: A
authors: Ticinesi
authors: Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.|Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy.|Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors: Gianpaolo
authors: G
authors: Ceda
authors: Nuclear Medicine Unit, Department of Radiology, Academic Hospital of Parma, Parma, Italy.
authors: Livio
authors: L
authors: Ruffini
authors: Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.
authors: Anna
authors: A
authors: Nardelli
authors: Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.|Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy.|Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors: Marcello
authors: M
authors: Maggio
mesh_terms: D000058:Accidental Falls; D000368:Aged; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D060825:Cognitive Dysfunction / Q000209:etiology; D003704:Dementia / Q000209:etiology*; D005684:Gait; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*
chemical_list: D002800:Cholinesterase Inhibitors
keywords: Accelerometry; Dementia; Donepezil; Falls; Gait; MCI; Parkinson’s disease; Postural instability; Rotigotine; Stabilometry