Parkinsonian dementia

Aluminium is also a possible cause of the high frequency of sclerosis and Parkinsonian dementia among the natives of certain regions of South East Asia, where the soils are high in Al(III) and low in Mg2+ and Ca2+. 

STRIONIGRAL DEGENERATION PARKINSONIAN DEMENTIA VIRUSES " (POST-ENCEPHALITIC)... 

Regarding the cholinergic system, there is evidence that the pathway from the substantia innominata to the cortex degenerates in Parkinsonism, and that the septohippocampal pathway is also functioning suboptimally. As more than 30% of Parkinsonian patients exhibit intellectual deterioration with deficits in cognitive function and memory, it is possible that these cholinergic deficits may account for at least some of the symptoms of parkinsonian dementia. 

Bohnen NI, Kaufer DI, Ivanco LS, Lopresti B, Koeppe RA, Davis JG, Mathis CA, Moore RY, DeKosky ST (2003) Cortical cholinergic function is more severely affected in parkinsonian dementia than in Alzheimer disease an in vivo positron emission tomographic study. Arch Neurol 60 1745-1748... 

Bohnen, N.I., Kaufer, D.I., Hendrickson, R., Constantine, G.M., Mathis, C.A., Moore, R.Y. (2007). Cortical cholinergic denervation is associated with depressive symptoms in Parkinson s disease and parkinsonian dementia. J. Neurol. Neu-... 

Roy-Byrne PP, Uhde TW, Post RM, et al The corticotropin-releasing hormone stimulation test in patients with panic disorder. Am J Psychiatry 143 896-899, 1986 Ruberg M, Ploska F, Javoy-Agid F, et al Muscarinic binding and choline acetyltransferase activity in Parkinsonian subjects with reference to dementia. Brain Res 232 129-139, 1982... 

Schizophrenia is certainly not the only disorder with such impairments in cognition. Autism, poststroke dementia, Alzheimer s disease, and many other organic dementias (parkinsonian/Lewy body dementia, frontotemporal/Pick s dementia, etc.) are also associated with some cognitive dysfunctions similar to those seen in schizophrenia (Fig. 10—4). 

In particular, antihistamines, anti-Parkinsonian drugs, and medications for dementia affect this system, as do numerous medications for general medical conditions. Many psychiatric medications have side effects that occur because of their influence on the acetylcholine receptors. 

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). 

The severity of dementia in PD patients correlates to the severity of Alzheimer s pathology in parkinsonian brains whereby a mild degree of dementia can be ascribed to degeneration of SNC, and a marked degree of cognitive impairment results from additional cortical Alzheimer lesions (Paulus and Jellinger, 1991). The neuropathologi-cal distinction between PD/dementia and PD plus dementia is very difficult. 

An isolated report describes an 87-year-old man with dementia, who started taking haloperidol 5 mg daily for symptoms of agitation and paranoia. Doses of greater than 5 mg were noted to cause extrapyramidal symptoms. After 10 days, tacrine 10 mg four times daily was added. Within 72 hours he developed severe parkinsonian symptoms, which resolved within... 

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