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PARKINSON'S DISEASE & PARKINSON'S DISEASE DEMENTIA

Parkinson's disease is a progressive neurodegenerative disorder that is common, age-related and chronic.

It is caused by loss or degeneration of dopaminergic neurons in the substantia nigra of the midbrain.

Onset of symptoms and progression of the disease is gradual.

Motor signs and symptoms include resting tremor, rigidity, bradykinesia and postural instability.

Parkinson's disease dementia indicates loss of intellectual functions including memory, significant deterioration in the ability to carry out day-to-day activities and changes in social behavior are often noted.

Management of Parkinson's Disease Complications

Parkinson’s Disease Dementia (PDD)

  • Stop current drug that may aggravate the condition
    • Anticholinergic drugs used for treating motor symptoms of Parkinson’s disease may worsen cognition as well as psychotic symptoms
    • Dementia is a relative contraindication in the use of dopamine agonists
  • Rivastigmine is the only cholinesterase inhibitor approved for Parkinson's disease dementia
    • Acts by inhibiting both acetylcholinesterase and butyrylcholinesterase
    • Has significant effects in cognitive symptoms and global function in patients with Parkinson's disease dementia
    • May improve behavior and activities of daily living
  • Donepezil may be considered in Parkinson's disease dementia
  • Use of cholinesterase inhibitors has a potential risk of exacerbating motor symptoms
  • Memantine, an N-methyl-D-aspartate receptor antagonist, may be given for the treatment of parkinsonism and central spasticity

Psychosis

  • Often drug-induced
    • Reduce the dose or stop offending drug
  • Clozapine may be added to current therapy
  • Quetiapine, but not Olanzapine, may also be considered
  • Pimavanserin has been recently approved for the treatment of hallucinations & delusions associated with Parkinson’s disease psychosis

Depression

  • Optimize current drug therapy
  • Selective serotonin reuptake inhibitors (SSRI) may be added to therapy
  • Pramipexole was found to be an effective treatment of depressive symptoms

Orthostatic Hypotension

  • Avoid factors that may trigger or worsen the condition (eg large meals, alcohol intake, warm environment, diuretics, antihypertensive drugs)
  • In symptomatic patients, increase salt intake
  • Use of elastic stockings, head-up tilt at night may be advised
  • Peripheral alpha-adrenergic agonist may increase the standing blood pressure
  • May consider Fludrocortisone, since it enhances renal sodium reabsorption and has alpha-adrenoreceptor sensitizing properties

Urinary Incontinence

  • Avoid coffee and limit water intake before bedtime
  • Peripherally acting anticholinergic drug may be added to current therapy

Gastrointestinal Motility Problems

  • Patients with Parkinson's disease commonly develop constipation and reduced gastric motility
    • Advise patient on diet, use of laxatives and other measures to improve gastrointestinal motility
  • Patients on dopaminergic therapy frequently experience gastrointestinal adverse effects (eg anorexia, nausea and vomiting)
  • Reduce dose or stop current drugs with anticholinergic effects
  • May add Domperidone to current therapy

Erectile Dysfunction

  • May consider use of Sildenafil
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