Parkinson Disease Dementia (cont.)

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Medical Author:

Jose G Merino, MD

Coauthor:

Jose Luchsinger, MD, MPH

Coauthor:

Zhigao Huang, MD, PhD

Medical Editor:

Nestor Galvez-Jimenez, MD

Medical Editor:

Francisco Talavera, PharmD, PhD

Medical Editor:

Helmi L Lutsep, MD

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 that act on the dopamine receptor, and medications that slow down the metabolism of dopamine. In addition, anticholinergic drugs are sometimes used.
Unfortunately, these drugs can 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 medication.

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.