Parkinson Disease Dementia Management: an Update of Current Evidence and Future Directions

Purpose of ReviewParkinson disease dementia (PDD) is a multisystem disorder involving motor and nonmotor symptoms. Therapeutic options for management of cognitive and neuropsychiatric symptoms are relatively limited when compared to motor symptoms and have been an active area of study. We present the reader with a critical appraisal of evidence for approved and recently investigated therapies in the management of PDD, particularly highlighting recent findings in the management of cognitive impairment and psychotic symptoms.Recent Findings.Several disappointing trials for treatment of cognitive impairment in PDD leave rivastigmine as the only on-label treatment option; evidence supporting possible benefit of other therapies is reviewed. Several clinical trials are currently ongoing and studying novel treatment options for cognitive impairment in PDD. Pimavanserin has demonstrated efficacy for management of Parkinson disease psychosis. In a randomized clinical trial, integrated outpatient palliative care, in addition to standard care, improved multiple aspects of care in this patient population compared to standard care alone.Rivastigmine, in particular transdermal administration due to greater tolerability, has the best evidence for treatment of cognitive impairment in PDD. Evidence for other acetylcholinesterase inhibitors and memantine is mostly supportive but less conclusive. Research is ongoing to overcome this unmet need for treatment options for cognitive symptoms of PDD. Psychotic symptoms of PDD are best managed with pimavanserin, which was recently investigated and approved in the USA. Caution is needed in prescribing practices, including treatment of motor symptoms, to avoid iatrogenic worsening of nonmotor symptoms.Palliative care should be integrated into the management of PDD.