Parkinson's Parkinson's Mental Health and Cognitive Changes 1 — Questions and Answers
Question 1: What percentage of Parkinson's disease patients eventually develop Parkinson's disease dementia (PDD)?
- 10-20%
- 30-50%
- 60-80% (Correct answer)
- 90-100%
Correct answer: 60-80%
Studies consistently show that 60-80% of Parkinson's patients develop dementia over the long course of their disease.
Question 2: Which cognitive domain is MOST commonly affected in the early stages of Parkinson's disease?
- Language and verbal fluency
- Executive function (Correct answer)
- Long-term episodic memory
- Auditory processing
Correct answer: Executive function
Executive function — including planning, problem-solving, and cognitive flexibility — is typically the earliest and most prominently affected domain due to frontostriatal dopamine loss.
Question 3: What term describes mild cognitive impairment in Parkinson's disease that does not yet meet criteria for dementia?
- Parkinson's disease dementia (PDD)
- PD-MCI (Correct answer)
- Dementia with Lewy bodies (DLB)
- Vascular cognitive impairment
Correct answer: PD-MCI
PD-MCI (mild cognitive impairment in Parkinson's disease) describes noticeable cognitive decline that does not significantly interfere with daily functioning.
Question 4: Which neurotransmitter deficiency, beyond dopamine, most significantly contributes to cognitive decline in Parkinson's disease?
- Serotonin
- GABA
- Acetylcholine (Correct answer)
- Glutamate
Correct answer: Acetylcholine
Loss of cholinergic neurons in the nucleus basalis of Meynert reduces acetylcholine levels and plays a major role in cognitive impairment in PD.
Question 5: How is Parkinson's disease dementia (PDD) clinically distinguished from Dementia with Lewy Bodies (DLB)?
- PDD precedes motor symptoms; DLB always follows them
- Dementia occurs more than 1 year after PD motor onset in PDD, within 1 year or before in DLB (Correct answer)
- PDD only affects memory; DLB only affects movement
- There is no clinical distinction between the two
Correct answer: Dementia occurs more than 1 year after PD motor onset in PDD, within 1 year or before in DLB
By the 1-year rule, DLB is diagnosed when dementia precedes or appears within 1 year of parkinsonism, while PDD is diagnosed when dementia follows established PD by more than 1 year.
Question 6: Which medication class is generally AVOIDED in Parkinson's patients with cognitive impairment because it worsens confusion?
- Carbidopa-levodopa
- Anticholinergic medications (Correct answer)
- MAO-B inhibitors
- Amantadine at standard doses
Correct answer: Anticholinergic medications
Anticholinergics worsen the existing cholinergic deficit in PD-related cognitive impairment, significantly increasing confusion and the risk of delirium.
Question 7: Which medication is FDA-approved specifically for treating dementia in Parkinson's disease?
- Memantine
- Donepezil
- Rivastigmine (Correct answer)
- Galantamine
Correct answer: Rivastigmine
Rivastigmine (Exelon) is the only FDA-approved medication for Parkinson's disease dementia, available as a transdermal patch or oral capsule.
Parkinson's Parkinson's Mental Health and Cognitive Changes 1
What percentage of Parkinson's disease patients eventually develop Parkinson's disease dementia (PDD)?