Cognitive decline is common in Parkinson's disease (PD) and is a leading cause of reduced quality of life. Cognitive difficulty seen early in the course of PD takes the form of mild cognitive impairment (MCI-PD), and Parkinson's disease dementia (PDD) is nearly universal in the late stages of the disease. Although most people with MCI-PD will progress to PDD, the two entities have significant differences in terms of underlying pathophysiology as well as cognitive profiles and management strategies. The most important contributor to MCI-PD is frontostriatal dopamine depletion, whereas the major cause of PDD is Lewy body pathology spreading to the neocortex plus, in many cases, comorbid Alzheimer's pathology. Management strategies for both MCIPD and PDD are limited. The best approach for MCI-PD is a combination of cognitive rehabilitation and appropriate titration of dopaminergic therapy, and the medications used in treatment of Alzheimer's disease appear to have a modest benefit for patients with PDD.
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