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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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There is no specific therapy for dementia in PD. Although cognitive symptoms initially may appear to respond to drugs that promote dopamine production, the improvement is mild and transient in contrast to the early responses to motor control improvement with medication in patients with PD.

Parkinson's disease dementia medications

Various medications are used to treat the movement disorders of PD.

• These include dopamine given in the form of levodopa; medications known as dopamine agonists (for example, a combination of carbidopa and levodopa known as Sinemet) that act on the dopamine receptor; and medications that slow down the metabolism of dopamine. They are often used in conjunction with monoamine oxidase inhibitors (MAO B,) such as rasagiline. In addition, anticholinergic drugs are sometimes used.
• Unfortunately, these drugs may affect cognitive symptoms and mood disorders.
• The anticholinergic drugs, for example, help balance levels of dopamine and acetylcholine, another neurotransmitter, in the brain. These drugs can improve movement disorders but often make memory loss worse.

The dementia of PD may respond to drugs used in patients with Alzheimer's disease. However, these drugs, called cholinesterase inhibitors (such as donepezil [Aricept], rivastigmine [Exelon], galantamine [Reminyl]), lead to only small and temporary improvements in cognition.

Mood disorders and psychoses are usually treated with other medication(s).

• For depression and mood disorders, various antidepressant or mood-stabilizing medications, such as tricyclic agents (such as nortriptyline [Pamelor] or desipramine [Norpramin]) or selective serotonin reuptake inhibitors (SSRIs, such as fluoxetine [Paxil] or citalopram [Celexa]) are used.
• For agitation or psychotic symptoms, atypical antipsychotics are preferred. Clozapine [Clozaril] is often the first choice, but it may have intolerable adverse effects. Quetiapine [Seroquel] may be an alternative. Olanzapine [Zyprexa] and risperidone [Risperdal] tend to worsen motor function.

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