1st February 2024

Management

General principles 

• There are no specific treatments as such. These treatment options can provide symptomatic treatment. 
• It is pertinent to get the diagnosis accurately so the right symptomatic treatment and support can be offered. Hence, the importance of detailed collateral history and investigations.
• Medications used for visual hallucinations can worsen Parkinson’s, and treatment offered for Parkinson’s symptoms can worsen psychosis. Moreover, neuroleptic sensitivity can add to the difficulty of offering limited medications.
• Non-pharmacological treatment should be used in the first instance.

Bio

• Acetylcholinesterase inhibitors are used as the first choice for hallucinations and behavioural problems like agitation. They also can help with cognitive problems. The aim is to lead a better quality of life and manage activities of daily living.
• Should a need arise to offer antipsychotics, atypical neuroleptics/ antipsychotics are preferred (Quetiapine, Aripiprazole, Clozapine), especially if there is a poor response to cholinesterase inhibitors.
• For motor symptoms, anti-Parkinson medications such as levodopa and carbidopa are helpful in a few individuals.
• For the REM sleep disorder, Clonazepam and Melatonin (especially at lower doses) have been helpful.
• Consider antipsychotics, prn Benzodiazepine for behavioural and psychological symptoms of dementia, weighing the pros and cons of antipsychotics and the physical health.

Psycho

• Apart from the ones mentioned in Alzheimer’s dementia, CBT is used for anxiety and depression.
• Cognitive stimulation therapy

Social

• Apart from the ones mentioned in Alzheimer’s dementia, education regarding a healthy lifestyle (smoking cessation, reducing alcohol excess, exercise and a healthy diet)
• Physiotherapy and Occupational therapy input- adaptations at home for independent living
• Speech and Language therapy
• Carer support, Respite care
• Reminiscence therapy- sharing life experiences and memories
• Positive interactions and activities that interest and distract them
• Basic sleep hygiene