eMedicine Specialties > Psychiatry > Geriatric

Parkinson Disease Dementia: Follow-up

Author: Margaret M Swanberg, DO, Assistant Professor of Neurology, Uniformed Services University; Chief of Neurobehavior Service, Walter Reed Army Medical Center; Assistant Chief, Department of Neurology, Walter Reed Army Medical Center
Coauthor(s): Raj K Kalapatapu, MD, Fellow in Geriatric Psychiatry, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Apr 15, 2009

Follow-up

Further Outpatient Care

Patients with Parkinson disease must have regular follow-up care to ensure adequate treatment of motor and behavioral abnormalities. Once patients are stable on medications, provide follow-up care at least every 3-6 months and periodically adjust medication dosages as necessary.

Inpatient & Outpatient Medications

  • Treatment of patients with Parkinson disease relies on the use of levodopa, dopamine agonists, monoamine oxidase type B (MAO-B) and catechol methyltransferase inhibitors, and anticholinergics.
  • SSRIs and tricyclics are useful for the treatment of patients with depressive symptoms. MAO-B inhibitors contraindicate the use of many of these agents. Before starting any medication, possible interactions must be considered. MAO-B inhibitors contraindicate the use of many of these agents. Before starting any medication, possible interactions must be considered.

Deterrence/Prevention

To date, no strategy, method, treatment, or therapy prevents Parkinson disease and dementia.

Complications

  • Patients with Parkinson disease and dementia with associated hallucinations are at high risk of dying within a few years of placement in care facilities.
  • Psychotic states can develop as adverse effects of treatment with levodopa or, to a lesser extent, dopamine agonists.

Prognosis

Patients with Parkinson disease and dementia have a poorer prognosis than patients with Parkinson disease without dementia.

Patient Education

For excellent patient education resources, visit eMedicine's Dementia Center. Also, see eMedicine's patient education articles Parkinson Disease Dementia, Parkinson Disease, Dementia Medication Overview, and Alzheimer Disease.

Education for patients can include providing information about the disease process, prognosis, pharmacological interventions for symptoms, and nonpharmacological interventions such as psychotherapy for depression. Other educational topics can include driving safety, home safety, medication monitoring, advanced care planning, and possible assisted living or nursing home placement.

Education for caregivers can include a discussion about what may lie ahead for their loved one, respite care agencies, home health support/aid services, support through the American Parkinson Disease Association, advanced care planning, and safety issues.

Some Internet sites for the family education include the following:

Miscellaneous

Medicolegal Pitfalls

  • Driving ability in patients with Parkinson disease must be assessed on an individual basis. Patients with prominent bradykinesia have difficulty moving the foot from the accelerator to the brake.
  • Advise patients taking the non–ergot-derived dopamine agonists pramipexole and ropinirole not to drive or engage in hazardous activities because these medications produce sleep attacks.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Jose G Merino, MD to the development and writing of this article.



More on Parkinson Disease Dementia

Overview: Parkinson Disease Dementia
Differential Diagnoses & Workup: Parkinson Disease Dementia
Treatment & Medication: Parkinson Disease Dementia
Follow-up: Parkinson Disease Dementia
References
Further Reading
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Keywords

Parkinson disease, PD, Parkinson's disease, parkinsonism, Alzheimer disease, AD, Alzheimer's disease, dementia, senility, palsy, cognitive deficits, cognitive impairment, cognitive dysfunction, neurodegenerative disorders

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Contributor Information and Disclosures

Author

Margaret M Swanberg, DO, Assistant Professor of Neurology, Uniformed Services University; Chief of Neurobehavior Service, Walter Reed Army Medical Center; Assistant Chief, Department of Neurology, Walter Reed Army Medical Center
Margaret M Swanberg, DO is a member of the following medical societies: American Academy of Neurology and American Neuropsychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

Raj K Kalapatapu, MD, Fellow in Geriatric Psychiatry, Mount Sinai School of Medicine
Raj K Kalapatapu, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Alan D Schmetzer, MD, Professor, Vice-Chair for Education, and Director of Residency Training in General and Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine
Alan D Schmetzer, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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