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4.9.4 Management of dementia in Parkinson’s disease

1st choiceNon drug treatment – see Prescribing Notes
2nd choice

Cholinesterase inhibitor [off-label]
See Section 4.11

Prescribing Notes

  • Other causes of cognitive impairment should first be ruled out before considering drug treatment, e.g. infection, dehydration, constipation, electrolyte imbalance or adverse drug reaction. Consider safely reducing or discontinuing (on specialist advice if necessary) any drugs that may be causing or exacerbating cognitive impairment, including:
    • Drugs with an antimuscarinic action, including tricyclic antidepressants, tolterodine, promethazine and oxybutynin
    • H2-receptor antagonists such as ranitidine
    • Benzodiazepines
    • Amantadine
    • Dopamine agonists
  • Cholinesterase inhibitors have been shown to improve cognition, delusions and hallucinations in patients with dementia with Lewy bodies (DLB) (which has similarities to PD). However, motor function may deteriorate.
  • Memantine may be considered if cholinesterase inhibitors are not tolerated or contra-indicated [off-label].