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. 2024 Nov;271(11):7330-7357.
doi: 10.1007/s00415-024-12503-0. Epub 2024 Aug 9.

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions

Elke Kalbe  1 , Ann-Kristin Folkerts  2 , Karsten Witt  3   4   5 , Carsten Buhmann  6 , Inga Liepelt-Scarfone  7   8   9 ; German Parkinson’s Guidelines Group
Affiliations

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions

Elke Kalbe et al. J Neurol. 2024 Nov.

Abstract

Background and objective: Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders.

Methods: The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.

Results: Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.

Conclusions: In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.

Keywords: Anxiety; Dementia; Depression; Guideline; Mild cognitive impairment; Parkinson’s disease.

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Conflict of interest statement

Declarations Conflicts of interest EK has received grants from the German Ministry of Education and Research, General Joint Committee, Germany, the German Parkinson Society, and STADAPHARM GmbH; honoraria from AbbVie GmbH Germany; memodio GmbH Germany; license fees from Prolog GmbH, Germany. EK is one of the authors of the cognitive intervention series “NEUROvitalis” but receives no corresponding honoraria. AKF has received grants from the German Parkinson Society, the German Alzheimer’s Society, the German Parkinson Foundation, STADAPHARM GmbH and the General Joint Committee Germany as well as honoraria from Springer Medizin Verlag GmbH, Heidelberg, Germany; Springer-Verlag GmbH, Berlin; ProLog Wissen GmbH, Cologne, Germany; Seminar- und Fortbildungszentrum Rheine, Germany; LOGOMANIA, Fendt & Sax GbR, Munich, Germany; LOGUAN, Ulm, Germany; dbs e.V., Moers, Germany; STADAPHARM GmbH, Bad Vilbel, Germany; NEUROPSY, St. Konrad, Austria; Multiple Sclerosis Society Vienna, Vienna, Austria; and Gossweiler Foundation, Bern, Switzerland. AKF is one of the authors of the cognitive intervention series “NEUROvitalis” but receives no corresponding honoraria. CB reports fees for lectures and/or honour boards from AbbVie, Bial, Desitin, Kyowa Kirin, Merz, STADA Pharma, TAD Pharma, UCB, Zambon. He has received royalties from Thieme Press and Kohlhammer Press and reports funding from Hilde-Ulrichs-Stiftung für Parkinsonforschung. KW has received funding from the Deutsche Forschungsgemeinschaft (German Research Association) and STADAPHARM GmbH outside the present study. He has received honoraria for presentations/advisory boards/consultations from BIAL, Indorsia, Boston Scientific and STADAPHARM GmbH outside the present study. He has received royalties from Thieme Press and Elsevier Press. He serves as an editorial board member of Wileys “Parkinson’s Disease”, “Behavioural Neurology” and PLOSone. ILS reports funding from Bayer AG and travel grants from and travel grants from Desitin and the German Neurological Society outside the submitted work. Ethics approval and consent to participate Not applicable

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