MDS 2025 | Recommendations for treating and managing cognitive disorders in Parkinson’s disease

In terms of treatment and management of cognitive disorders in Parkinson’s, I’ll start with pharmacological treatment because that’s the area with the most evidence. Acetylcholinesterase inhibitors are the first-line gold standard treatment for dementia in Parkinson’s, and particularly rivastigmine has the strongest body of evidence behind it. The evidence for MCI is mixed and it’s not common practice to treat MCI with acetylcholinesterase inhibitors and there are other pharmacological options but I want to focus on the non-pharmacological treatment options because this is an area which we kind of found was to be the most emerging or developing field. And compared to, I guess, the other guidelines that are out there, perhaps due to the fact that they are slightly outdated, they weren’t able to, I guess, integrate these new findings into their recommendations. So what we actually found was quite interesting. Tai Chi actually had quite a strong body of evidence to support its use in people with cognitive disorders and Parkinson’s disease in order to improve or at least delay the progression of the cognitive symptoms and improve quality of life. Cognitive rehabilitation is another one with emerging evidence and is something that is continually being looked at in literature and I’m sure soon enough will have strong enough evidence to be able to warrant a strong recommendation. The other thing I wanted to mention was the importance of cautious deprescribing in Parkinson’s disease, particularly when someone has been diagnosed with a cognitive disorder. So we know that polypharmacy is associated with increased risk of falls and poorer quality of life, but it can also exacerbate cognitive symptoms. And so one of our recommendations is to consider a medication review and consider cautious deprescribing of things like benzodiazepines and antipsychotics and anticholinergics. Finally, the last thing I wanted to discuss was the, I guess, body of care considerations that were lacking from other guidelines in the literature. So in terms of guidelines specific to cognitive impairment in Parkinson’s disease, there weren’t really many recommendations on what to do after someone’s been diagnosed in terms of providing basic levels of care. And so some of our recommendations touch on this. I want to talk about two. One of them is the importance of linking people up to support services. This is really important. Once someone’s diagnosed with Parkinson’s disease, oftentimes they are linked up with Parkinson’s support groups and hospital services that are relevant to the Parkinson’s disease. But it’s really important that once they are then identified to have a cognitive disorder, that they’re again considered to be linked up to appropriate services. For example, dementia support groups and allied health services that might be relevant for people living with cognitive disorders. The other thing that was very prominent in our Delphi process that came up is the importance of end-of-life conversations. So a big reason why we do want to identify MCI and cognitive impairments early on in the disease trajectory is so that we have the opportunity to talk about really important topics like end-of-life care before the person loses capacity. And so this is something that came up as quite important is to engage in those discussions as early as possible, of course, with a degree of sensitivity and identifying who is ready for those conversations and who isn’t using that kind of clinical judgment. But it is really important to spark those conversations before it’s too late. So getting an idea of what the patient wants for their end-of-life care to promote their autonomy, to save confusion and stress and burden on both the patient and their care partners and also the clinicians in the future. Yeah, so those are the main kind of findings that we found through the Delphi process in terms of treatment and management. And I’m sure they’re constantly evolving and we hope to update our guidelines in the future.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.