Deep Brain Stimulation for Parkinson Disease Dementia A New Frontier?

Congratulations Drs. Deeb, Okun and Almedia on the publication of “Deep Brain Stimulation for Parkinson Disease Dementia A New Frontier?”  This article was published in the December issue of JAMA Neurology.

Parkinson disease dementia (PDD) is one of the nonmotor complications of Parkinson disease, characterized by impairment of visuospatial and executive functions.1 The yearly incidence of PDD among patients with Parkinson disease is estimated at approximately 10%, but is widely variable in different reports.1,2 The risk of PDD increases with disease duration and patient age.3 Parkinson disease dementia is often complicated by many neuropsychiatric symptoms such as mood disturbances, apathy, and psychosis. Collectively, these symptoms can lead to major disability.1 In addition to a dopaminergic deficit, a major hallmark of PDD is cholinergic deficit, estimated to be greater than in Alzheimer disease.2,4 The most important source of cholinergic innervation to the neocortex is the nucleus basalis of Meynert (NBM).5 The loss of cholinergic innervation in this region and in other areas has been implicated in the development of several neuropsychiatric complications associated with Parkinson disease, such as poor attention, agitation, and delusions, as well as visual hallucinations.5,6

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