Treatment for dementia is a complex and specialist area and should be managed by those experienced in treating both Parkinson’s and dementia. There are various trained professionals in the multidisciplinary team who might be involved, including your doctor, a Parkinson’s Disease Nurse Specialist (depending on the country in which you live), and a neurologist or psychiatrist for example. For further information on the various professionals see multidisciplinary team or ask your doctor who else can help you.
There are also many organisations and support groups that offer various kinds of help, such as dementia associations and support groups. Your doctor or a social worker will be able to help you identify such organisations, or you may find contact details in a telephone directory or using an online local directory.
Medication
From what is known about drugs and their effects on dementia and cognitive problems, the following might be helpful:
- in some cases adjusting anti-Parkinsonian medications, for example levodopa, can improve symptoms, although this may mean that symptoms such as tremor and rigidity could be less well controlled. A trial and error approach, balancing out the pros and cons, is often the best way to proceed
- antidepressant drugs sometimes help with the apathy or lack of motivation that is often seen in Parkinson's, and they can also improve depression that is sometimes wrongly diagnosed as dementia.
- Alzheimer's disease medications, so called cholinesterase inhibitors, can be prescribed to people with Parkinson's and dementia. They are relatively safe and their effectiveness is moderate, although
worsening of Parkinson’s symptoms, notably tremor, is seen in rare cases. Another type of medication used in Alzheimer’s disease, memantine, has also been
tested in people with Parkinson’s disease dementia and may have mild
beneficial effects for them. Potential risks and expected benefits must
be considered before starting treatment with this medication
- medication that improves attention and reduces daytime sleepiness might also be helpful - these generally boost energy levels and interest which can improve quality of life
- neuroleptic or antipsychotic medication are sometimes prescribed if psychotic behaviour is a factor, for example: agitation, hallucinations, delusions. Be aware, however, that some older neuroleptics may exacerbate Parkinson’s symptoms and, although newer types tend to be tolerated better, they may be contraindicated for some people, for example those at risk of stroke or with heart disease. Moreover, they can worsen memory problems in older people
- hallucinations may improve by reducing or withdrawing some medications (whilst they are worrying for the carer, often the person experiencing them is not concerned so if treatment worsens other symptoms, hallucinations might be best left untreated).
But, as with all medications, always check with your healthcare professional before altering any of your medications.
