Abstract and Introduction
Abstract
Originally considered a movement disorder that did not affect cognition, it is now understood that cognitive impairment is widespread among those with Parkinson's disease. Patients present with a variety of cognitive deficits, including executive dysfunction, visuospatial impairment, and memory loss. Neuropsychiatric symptoms are common, particularly psychosis, depression, and anxiety. Rivastigmine and donepezil have both been shown in large, blinded studies to slow the progression of dementia, although rivastigmine is the only medication approved by the United States Food and Drug Administration. Cognitive rehabilitation may be a safe alternative if medications are intolerable. Research is still needed at all levels to gain understanding of this disease process.
Introduction
Parkinson's disease (PD) is a neurodegenerative disorder characterized by tremor, bradykinesia, rigidity, and postural instability. Although all PD patients have some degree of movement impairment, many patients have associated symptoms, including depression, psychosis, and cognitive impairment. Cognitive impairment is pervasive within the PD population. According to the Movement Disorder Society (MDS), an estimated 26.7% of PD patients have mild cognitive impairment, whereas another 30% to 40% live with Parkinson's disease dementia (PDD). One 20-year, longitudinal study suggested that up to 83% of PD patients will develop dementia in their lifetime.
In this study we address much of the recent literature dedicated to the subject of cognitive impairment in PD. As evidenced by epidemiologic studies, knowledge of cognitive impairment in PD is relevant for all primary care providers, including nurse practitioners and physician assistants.