Approach to Cognitive Impairment in Parkinson's Disease

Qiang Zhang; Georgina M Aldridge; Nandakumar S Narayanan; Steven W Anderson; Ergun Y Uc

doi:10.1007/s13311-020-00963-x

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Approach to Cognitive Impairment in Parkinson's Disease

Journal article

Open access

Peer reviewed

Approach to Cognitive Impairment in Parkinson's Disease

Qiang Zhang, Georgina M Aldridge, Nandakumar S Narayanan, Steven W Anderson and Ergun Y Uc

Neurotherapeutics, Vol.17(4), pp.1495-1510

10/2020

DOI: 10.1007/s13311-020-00963-x

PMCID: PMC7851260

PMID: 33205381

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https://doi.org/10.1007/s13311-020-00963-xView

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Abstract

Cognitive dysfunction is common in Parkinson's disease (PD) and predicts poor clinical outcomes. It is associated primarily with pathologic involvement of basal forebrain cholinergic and prefrontal dopaminergic systems. Impairments in executive functions, attention, and visuospatial abilities are its hallmark features with eventual involvement of memory and other domains. Subtle symptoms in the premotor and early phases of PD progress to mild cognitive impairment (MCI) which may be present at the time of diagnosis. Eventually, a large majority of PD patients develop dementia with advancing age and longer disease duration, which is usually accompanied by immobility, hallucinations/psychosis, and dysautonomia. Dopaminergic medications and deep brain stimulation help motor dysfunction, but may have potential cognitive side effects. Central acetylcholinesterase inhibitors, and possibly memantine, provide modest and temporary symptomatic relief for dementia, although there is no evidence-based treatment for MCI. There is no proven disease-modifying treatment for cognitive impairment in PD. The symptomatic and disease-modifying role of physical exercise, cognitive training, and neuromodulation on cognitive impairment in PD is under investigation. Multidisciplinary approaches to cognitive impairment with effective treatment of comorbidities, proper rehabilitation, and maintenance of good support systems in addition to pharmaceutical treatment may improve the quality of life of the patients and caregivers.

neuromodulation

neuropsychology

dementia

cholinesterase inhibitors

mild cognitive impairment

Parkinson’s disease

deep brain stimulation

neurorehabilitation

Details

Title: Subtitle: Approach to Cognitive Impairment in Parkinson's Disease
Creators: Qiang Zhang - Neurology Service, Veterans Affairs Medical Center, Iowa City, Iowa, USA
Georgina M Aldridge - Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa, 52242, USA
Nandakumar S Narayanan - Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa, 52242, USA
Steven W Anderson - Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa, 52242, USA
Ergun Y Uc - Neurology Service, Veterans Affairs Medical Center, Iowa City, Iowa, USA. ergun-uc@uiowa.edu
Resource Type: Journal article
Publication Details: Neurotherapeutics, Vol.17(4), pp.1495-1510
DOI: 10.1007/s13311-020-00963-x
PMID: 33205381
PMCID: PMC7851260
NLM abbreviation: Neurotherapeutics
ISSN: 1933-7213
eISSN: 1878-7479
Publisher: United States
Grant note: K08 NS109287 / NINDS NIH HHS R01 NS100849 / NINDS NIH HHS
Language: English
Date published: 10/2020
Academic Unit: Neurology; Iowa Neuroscience Institute
Record Identifier: 9984070867202771

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