When Parkinson's disease is complicated by cognitive impairment and psychotic symptoms, standard motor-focused management alone is insufficient. These neuropsychiatric features require a structured, stepwise approach that is distinct from routine Parkinson's care.
This protocol is indicated for patients with Parkinson's disease in whom cognitive impairment and psychotic symptoms are present concurrently. Both features directly influence the choice and sequence of interventions.
The initial strategy centres on non-pharmacological measures — environmental and behavioural interventions aimed at stabilising the patient's condition — alongside attention to any correctable medical factors. Following this, a careful, systematic review of the patient's current medication is undertaken. The complete stepwise protocol — including how adjustments are prioritised and sequenced, and what to consider specifically in the context of cognitive impairment — is available in full via the link below.
DOI: 10.1186/s42466-024-00325-4
If the symptomatology allows, the treatment should start with implementation of general non-pharmacological measures (e.g. stimulus shielding, reorienting measures, re-establishment of a circadian rhythm).
Implementation of general therapeutic measures such as fluid supplementation for exsiccosis and treatment of an infection should be started, followed by reduction/adjustment of triggering medication in general (anticholinergic, antiglutamatergic, or sedative drugs) followed by PD medication, especially amantadine, MAO-B inhibitors, dopamine agonists and COMT inhibitors, or combination treatments.
In case of cognitive impairment and failure of the general measures, a switch to an acetylcholinesterase inhibitor can be offered.
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