Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies

Weintraub, Daniel; Irwin, David J.

doi:10.1212/con.0000000000001151

Cited by 6 publications

(6 citation statements)

References 68 publications

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“…[8, 9, 14] However, to the best of our knowledge, this is the rst study to report the increased risk of PPH in DLB patients. Considering both DLB-related negative health outcomes, [9,13,21,29] and adverse events and complications related to OH and PPH, as signs of dysautonomia, it is clear that the prevention of such outcomes is indispensable to ensure better management of DLB. [8, 9,14] Although delayed OH was signi cantly higher in DLB patients than in control, this difference between the groups disappeared after the adjustment.…”

Section: Discussionmentioning

confidence: 99%

“…Considering both DLB-related negative health outcomes, [9,13,21,29] and adverse events and complications related to OH and PPH, as signs of dysautonomia, it is clear that the prevention of such outcomes is indispensable to ensure better management of DLB. [8, 9,14] Although delayed OH was signi cantly higher in DLB patients than in control, this difference between the groups disappeared after the adjustment. Indeed, a higher frequency is an expected outcome, as delayed OH is likely to be an early and milder form of OH in such patients.…”

Section: Discussionmentioning

confidence: 99%

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Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Işık

Öntan

Dost

et al. 2023

Preprint

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Purpose Dysautonomia is one of the supportive clinical features in dementia with Lewy bodies (DLB). This study aimed to investigate the prevalence of postural and postprandial blood pressure changes as a sign of dysautonomia in DLB patients. Methods The study group comprised 125 patients with DLB (76 females; mean age 78.4 ± 7.1 years) and 126 controls (89 females; mean age 74.5 ± 6.8 years). Postprandial blood pressure changes were assessed by ambulatory 24-hour blood pressure monitorization. Postural blood pressure changes were assessed via the head-up tilt table test. Results The frequency of postprandial hypotension (PPH), orthostatic hypotension (OH), and delayed OH was higher in patients with DLB compared to controls (89.4% vs 50.8%; p < 0.001, 45.5% vs 28.6%; p = 0.006, and 13.3% vs 5.6%; p = 0.045, respectively); whereas the frequency of supine hypertension (HT), and orthostatic hypertension (OHT) was similar. However, supine HT in non-hypertensive participants was higher in DLB patients than in controls (n = 45, 48.9% vs n = 37, 27%; p = 0.043). PPH and OH were independently associated with DLB (odds ratio [OR]:10.52 confidence interval [CI]%95 3.11–35.61; p < 0.00, and OR:1.96 CI%95 1.05–3.69; p = 0.035, respectively) after adjustment for age, the number of drugs, anti-psychotics, antiparkinsonian drugs, angiotensin receptor blockers, and beta blockers. Conclusion The study demonstrated that PPH was the most common type of dysautonomia, followed by OH and supine HT in older patients with DLB Given the potential complications of postural blood pressure changes and PPH in such patients, autonomic dysfunction should be evaluated in the follow-up of DLB.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Işık

Öntan

Dost

et al. 2023

Preprint

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“…Further, the new MDS-PD criteria recommend that for patients with a diagnosis of DLB made according to consensus criteria, the diagnosis can optionally be qualified as PD (DLB subtype). For more information, refer to the article “Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies” by Daniel Weintraub, MD, and David Irwin, MD, 40 in this issue of Continuum .…”

Section: Diagnosis Of Parkinson Diseasementioning

confidence: 99%

“…A meta-analysis of cholinesterase inhibitors demonstrated improvement in cognitive functions in patients with PD and dementia 95 ; however, this has not been demonstrated for cognitive impairment without dementia in PD 36 . For more information, refer to the article “Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies” by Daniel Weintraub, MD, and David Irwin, MD, 40 in this issue of Continuum .…”

Section: Treatment Of Nonmotor Symptomsmentioning

confidence: 99%

Diagnosis and Medical Management of Parkinson Disease

Thaler¹,

Alcalay²

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: Parkinson disease (PD) is a common neurodegenerative movement disorder, the prevalence of which is rising as the world population ages. It may present with motor and nonmotor symptoms, and symptomatic treatment significantly improves quality of life. This article provides an overview of the workup and differential diagnosis for PD and reviews genetic and environmental risk factors and current treatments.RECENT FINDINGS: Novel treatments for the motor (eg, fluctuations and off times) and nonmotor (eg, hallucinations and orthostatic hypotension) complications of PD have been approved in recent years. In addition, with recent advances in our understanding of the genetics of PD, significant research is focusing on identifying at-risk populations and introducing genetically targeted interventions (precision medicine). SUMMARY: PD is a heterogeneous neurodegenerative movement disorder. Affected individuals may receive substantial symptomatic relief from nonpharmacologic, pharmacologic, and surgical interventions. Although no intervention to modify the progression of PD is currently available, precision medicine and modulation of the immune system are a major focus of ongoing research.

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“…Other neuropsychiatric disorders, including depression and anxiety, are also part of the syndrome of prodromal α-synucleinopathy 2,5,17 . For more information on cognitive and neuropsychiatric manifestations of PD and DLB, refer to the article “Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies” by Daniel Weintraub, MD, and David Irwin, MD, 27 in this issue of Continuum .…”

Section: Cognitive Dysfunction and Other Neuropsychiatric Disordersmentioning

confidence: 99%

Prodromal α-Synucleinopathies

Chahine¹

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: This article describes prodromal α-synucleinopathies.RECENT FINDINGS: The pathology underlying α-synucleinopathies, which include Parkinson disease, multiple system atrophy, and dementia with Lewy bodies, begins years before the presence of the full syndrome that is the basis for the clinical diagnosis of each of these disorders. This "prodromal" phase may manifest with various signs or symptoms. In addition to individuals in the prodromal phase, some individuals are asymptomatic but are at risk for α-synucleinopathies owing to genetic predisposition or other risk factors.SUMMARY: Clinicians are increasingly seeing patients in the clinical setting who are prodromal or at risk for α-synucleinopathies, and this article reviews the approach to these patient populations, which includes identifying clinical features, assessment, and counseling.

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Diagnosis and Treatment of Cognitive and Neuropsychiatric Symptoms in Parkinson Disease and Dementia With Lewy Bodies

Abstract: PURPOSE OF REVIEW: This article summarizes the underlying biology and current diagnostic and treatment strategies for the cognitive and neuropsychiatric features of Parkinson disease (PD) and dementia with Lewy bodies (DLB).

Cited by 6 publications

References 68 publications

Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Diagnosis and Medical Management of Parkinson Disease

Prodromal α-Synucleinopathies

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