Evidence for cholinesterase-inhibitor therapy for dementia associated with Parkinson's disease

摘要

The management of patients with Parkinson's disease (PD) is challenging, as most patients have some combination of cognitive, neuropsychiatric, motor, sleep, and autonomic symptoms of underlying Lewy-body disease (LBD). The cognitive and neuropsychiatric features are often particularly disturbing to patients as well as their carers.1 The challenge for the clinician is to optimise motor function, to maximise cognition, and to minimise depression, hallucinations, delusions, anxiety, daytime hypersomnolence, and orthostatic hypotension. Levodopa with carbidopa and dopamine agonists are the mainstays of treatment for the motor features, but delusions and hallucinations commonly result from aggressive dosing with dopaminergic drugs, and such therapy can cause or aggravate daytime hypersomnolence and orthostatic hypotension. Anticholinergic therapy can improve motor