German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson’s disease: new spotlights on diagnostic procedures and non-pharmacological interventions
Copyright policy )German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson’s disease: new spotlights on diagnostic procedures and non-pharmacological interventions
Abstract Background and objective Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson’s disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on “Parkinson’s disease” from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders. Methods The recommendations were based on literature reviews, other relevant guidelines, and expert opinions. Results Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson’s disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety. Conclusions In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.
- German Center for Neurodegenerative Diseases Germany
- IB Hochschule Germany
- University of Cologne Germany
- Deutsche Zentren der Gesundheitsforschung Germany
- Hertie Institute for Clinical Brain Research Germany
therapy [Parkinson Disease], Neurological Update, diagnosis [Mood Disorders], Anxiety, Guideline, etiology [Cognitive Dysfunction], Dementia ; Review Literature as Topic [MeSH] ; Mood Disorders/diagnosis [MeSH] ; Cognitive Dysfunction/diagnosis [MeSH] ; Guideline ; Parkinson Disease/complications [MeSH] ; Humans [MeSH] ; Neurological Update ; Cognitive Dysfunction/etiology [MeSH] ; Mood Disorders/therapy [MeSH] ; Parkinson Disease/therapy [MeSH] ; Practice Guidelines as Topic/standards [MeSH] ; Parkinson Disease/diagnosis [MeSH] ; Neurology/standards [MeSH] ; Cognitive Dysfunction/therapy [MeSH] ; Depression ; Anxiety ; Mood Disorders/etiology [MeSH] ; Societies, Medical/standards [MeSH] ; Germany [MeSH] ; Mild cognitive impairment ; Parkinson’s disease, Germany, standards [Societies, Medical], Humans, therapy [Cognitive Dysfunction], therapy [Mood Disorders], Cognitive Dysfunction, etiology [Mood Disorders], Societies, Medical, Depression, Mood Disorders, Mild cognitive impairment, Parkinson Disease, Review Literature as Topic, diagnosis [Cognitive Dysfunction], Neurology, standards [Neurology], standards [Practice Guidelines as Topic], Practice Guidelines as Topic, Parkinson’s disease, Dementia, complications [Parkinson Disease], diagnosis [Parkinson Disease], ddc: ddc:610
therapy [Parkinson Disease], Neurological Update, diagnosis [Mood Disorders], Anxiety, Guideline, etiology [Cognitive Dysfunction], Dementia ; Review Literature as Topic [MeSH] ; Mood Disorders/diagnosis [MeSH] ; Cognitive Dysfunction/diagnosis [MeSH] ; Guideline ; Parkinson Disease/complications [MeSH] ; Humans [MeSH] ; Neurological Update ; Cognitive Dysfunction/etiology [MeSH] ; Mood Disorders/therapy [MeSH] ; Parkinson Disease/therapy [MeSH] ; Practice Guidelines as Topic/standards [MeSH] ; Parkinson Disease/diagnosis [MeSH] ; Neurology/standards [MeSH] ; Cognitive Dysfunction/therapy [MeSH] ; Depression ; Anxiety ; Mood Disorders/etiology [MeSH] ; Societies, Medical/standards [MeSH] ; Germany [MeSH] ; Mild cognitive impairment ; Parkinson’s disease, Germany, standards [Societies, Medical], Humans, therapy [Cognitive Dysfunction], therapy [Mood Disorders], Cognitive Dysfunction, etiology [Mood Disorders], Societies, Medical, Depression, Mood Disorders, Mild cognitive impairment, Parkinson Disease, Review Literature as Topic, diagnosis [Cognitive Dysfunction], Neurology, standards [Neurology], standards [Practice Guidelines as Topic], Practice Guidelines as Topic, Parkinson’s disease, Dementia, complications [Parkinson Disease], diagnosis [Parkinson Disease], ddc: ddc:610
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