Dementia Associated with Parkinsons Disease

Dementia Associated with Parkinsons Disease

Emre Murat
Published: European Neurological Disease 2007 - Issue II
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The classical perception of Parkinson's disease (PD) heavily emphasises its motor aspects, cognitive features and dementia associated with the disease being largely ignored. Epidemiological studies performed in the last few decades revealed the substantially high incidence and prevalence of cognitive impairment and dementia in PD. Clinical studies using detailed neuropsychological and behavioural assessments have helped to understand its cognitive and behavioural profile, while clinical– pathological correlation studies have revealed the underlying pathology and ascertained the delineation of dementia associated with PD (PD-D) as a distinct entity.

This article provides an update on the epidemiological, clinical and pathological features of PD-D and recent treatment efforts

Epidemiology
Dementia associated with PD has been increasingly better recognised, probably because patients with PD survive for longer than before thanks to modern treatment. Although subtle cognitive deficits can be found in newly diagnosed patients with PD,1 dementia itself is strongly associated with advanced age and severe disease.2 In population-based, cross-sectional studies the prevalence of dementia has been reported to be 28–41%. A meta-analysis of 12 carefully selected studies revealed a cross-sectional prevalence of close to 30%.3 The incidence increases up to six-fold and the cumulative incidence over eight years of follow-up was described to be 78%.4,5 The longitudinal Sydney study revealed that 15 years after the diagnosis 85% of the patients had cognitive impairment, with 50% fulfilling criteria for dementia.6 The main risk factors include old age, severity of motor symptoms, akinetic–rigid form of the disease and subtle deficits in verbal fluency with executive functions and memory performance at baseline.

Clinical Features
The proto-typical dementia syndrome associated with PD (PD-D) has characteristic clinical features, which can be best summarised as a ‘dysexecutive’ syndrome, with prominent impairment of attention, visual–spatial dysfunction, moderately impaired memory and accompanying behavioural symptoms such as apathy and psychosis.8,9

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