Dementia in Parkinson’s disease: what can we do about it?

It has been around 200 years since James Parkinson first outlined the clinical features of the condition that would later bear his name. While his descriptions of Parkinson’s Disease (‘shaking palsy’) may have focussed largely around the motor manifestations of this condition, recent insights have provided strong evidence that non-motor manifestations contribute significantly to poor quality of life for patients with this neurodegenerative condition (for an excellent review see the reference below by Jankovic).

Depression, cognitive impairment, sexual dysfunction and constipation are just some of the problems that these patients can develop and it is a source of immense frustration for both patients and clinicians that these problems are so hard to treat. Our current approaches to treating Parkinson’s disease are focussed on medications that really only improve motor outcomes, so what is a neurologist to do when a patient describes the effects of non-motor manifestations on his/her quality of life?

In this issue of JNNP, Wang and colleagues provide a thorough overview of the role of cholinesterase inhibitors as treatments for cognitive impairment in Parkinson’s Disease http://jnnp.bmj.com/content/86/2/135.abstract . These are drugs that have been used in the setting of Alzheimer’s Disease for a number of years. In addition to suggesting that these medications have benefits in Parkinson’s Disease as well as an excellent safety profile, the paper also highlight the fact that the treatments have only been assessed in small clinical trials and that larger studies in this population may be required before they can become an established part of treatment for this condition. Nevertheless, their study provides hope for a major problem which currently remains untreatable.

(1) Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008;79:368-376 doi:10.1136/jnnp.2007.131045