Medications for PD Dementia, Psychological Symptoms

By Karen Hales, Neurology Solutions Contributing Writer

The brain changes caused by Parkinson’s disease begin in a region that plays a key role in movement. The changes spread gradually, but in time they often begin to affect mental functions, including memory and the ability to pay attention, make sound judgments and plan the steps needed to complete a task, known as “executive function.” Resulting secondary symptoms of Parkinson’s disease can include Parkinson’s dementia, psychosis and impaired executive function.

The changes linked to Parkinson’s disease and Parkinson’s disease dementia are abnormal microscopic deposits referred to as “Lewy bodies,” composed chiefly of alpha-synuclein, a protein that’s found widely in the brain. Eventually, PD can lead to dementia in 20-30 percent of patients.

PD medications relieve motor symptoms by increasing dopamine in the brain. However, elevated dopamine levels can trigger hallucinations and delusions. Evaluating patients to balance their dopamine levels to control PD motor symptoms while alleviating hallucinations/delusions can be a complicated process. Prior to introducing anti-psychotic medications, your doctor will first assess and evaluate the level and frequency of these effects before attempting to alleviate psychosis by adjusting your medication regimen.

Medications to treat Secondary Symptoms of Parkinson’s

Following are some of the medications available and considerations in managing secondary symptoms of Parkinson’s disease.

  • Cholinesterase inhibitors are the current mainstay for treating thinking changes in Alzheimer’s. They also may help Parkinson’s disease dementia symptoms.
  • Although physicians sometimes prescribe antipsychotic drugs for behavioral symptoms that can occur in Alzheimer’s, they may cause serious side effects in as many as 50 percent of those with Parkinson’s disease dementia and dementia with Lewy bodies. Three antipsychotic medications that are considered safe for individuals with PD are pimavanersin (NuplazidTM), clozapine (Clozaril®) and quetiapine (Seroquel ®). Though not yet commercially available, pimavanserin was approved by the FDA in 2016 specifically for the treatment of Parkinson’s disease psychosis.
  • L-dopa may be prescribed to treat Parkinson’s motor symptoms. However, it can sometimes aggravate hallucinations and confusion in those with Parkinson’s dementia.
  • Antidepressants may be used to treat depression, which is common in both Parkinson’s disease dementia and dementia with Lewy bodies. The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs).
  • Clonazepam (klonopin) may be prescribed to treat REM sleep disorder; however, while it may control symptoms for many it may have a dulling side effect. Also, klonopin and other anti-anxiety medications in the class of drugs known as benzodiazepines have been increasingly linked to Alzheimer’s disease and other cognitive disorders.

Consider A Medication Review

Choices about medications made early in the course of Parkinson’s disease can have a lasting impact on the course of the illness. Individuals diagnosed with PD and other parkinsonism syndromes should seek the advice of doctors who specialize in treating these complex movement disorders, even when the illness is only suspected. A movement disorder specialist can help tailor your medications to treat both primary symptoms of PD such as tremor, dyskinesia and rigidity and secondary symptoms of Parkinson’s, including depression and cognitive decline.

Request a medication review and talk with your doctor about the possibility of supplementing your regularly prescribed medication, which may help your current medication perform better, and potentially improve your mobility and symptom management.

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