Dementia levodopa

Dementia Psychotropic drugs, levodopa, antiepileptic agents Increased confusion, delirium... 

Cognitive impairment, labeled as moderate to marked dementia was first reported in a large number of patients to occur tenfold more commonly than in controls (Lieberman et al., 1979). Demented PD patients in this study responded less well to levodopa therapy and it was suggested that PD with dementia may represent a different disorder from PD without dementia. We distinguish select cognitive impairments from dementia in PD and discuss neurochemical and molecular mechanisms of cognition in PD. 

WiUdnson KD, Lee KM, Deshpande S, Duerksen-Hughes P, Boss JM, Pohl J (1989) The neuron-specific protein PGP 9.5 is a ubiquitin carboxyl-terminal hydrolase. Science 246 670-673 WUhams DR, Hadeed A, al-Din AS, Wreikat AL, Lees AJ (2005) Kufor Rtikeb disease autosomal recessive, levodopa-responsive parkinsonism with pyramidal degeneration, supranuclear gaze palsy, and dementia. Mov Disord 20 1264-1271... 

Memantine, a NMDA receptor blocker that neutralizes the effect of glutamate at striatal and subthalamic levels, has shown beneficial effects in the treatment of some parkinsonian patients chronically treated with levodopa, who demonstrated increased motor deterioration. In addition, it is indicated for treatment of moderate to severe dementia of Alzheimer s disease (AD). 

Amantadine has also been used for the treatment of PD-related dementia (Greulich and Fenger, 1995). Amantadine has been reported to reduce the duration of levodopa-induced dyskinesia and improves motor disability in PD. Although some beneficial effects are noted in patients after amantadine treatment, this drug is known to induce corneal edema that begins few months to several years after institutional therapy (Jeng et al., 2008). 

Memantine is a noncompetitive NMDA receptor antagonist is used for the treatment of moderate to severe Alzheimer s disease. Recent evidence has suggested that memantine might confer some cognitive improvement for individuals with Parkinson s disease dementia and dementia with Lewy bodies. Two cases are report of individuals diagnosed with Parkinson s disease dementia who were started on memantine aimed at cognitive improvement but whose most impressive clinical outcome was the unanticipated improvement in levodopa-induced dyskinesias and on-off phenomenon [74 ]. 

An 86-year-old man who developed Parkinson s disease dementia 8years after the diagnosis of Parkinson s disease. Levodopa had been started early after the diagnosis of Parkinson s disease, and after 6 years, he developed peak-dose choreic levodopa-induced dyskinesias and on-off phenomenon. He did not tolerate the use of rivastig-mine for Parkinson s disease dementia, and memantine was started, aimed at cognitive improvement. Memantine improved the motor fluctuation of this patient [74" ]. 

Vidal El, Fukushima FB, Valle AP, Villas Boas PJ. Unexpected improvement in levodopa-induced dyskinesia and on-off phenomena after introduction of memantine for treatment of parkinson s disease dementia. J Am Geriatr Soc 2013 61(l) 170-2. 

A 79-year-old man underwent colonic resection for bowel obstruction. He had a history of Parkinson s disease and associated dementia, hypertension, type-2 diabetes and occasional constipation. His current medications included carbidopa-levodopa extended release, lisinopril, furosemide, isophane insulin and polyethylene glycol (as needed for constipation). He was treated with metoclopramide (10 mg i.v., every 6 h) for stimulating gastric motility. After receiving the first three doses of metoclopramide, the patient developed mental deterioration until he became xmre-sponsive, and could not be aroused. An electroencephalogram displayed a pattern of diffuse slowing of the background rhythm, which was consistent with acute metabolic encephalopathy. Metoclopramide was discontinued, and... 

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