Objective: The intersection of vascular dementia (VaD) and secondary parkinsonism presents a complex therapeutic conundrum, particularly in geriatric populations. This study aims to elucidate the intricacies of managing cognitive impairment intertwined with movement disorders, emphasizing the delicate balance between cognitive preservation and motor function optimization in the context of vascular pathology.

Background: Vascular dementia, the second most prevalent form of dementia, arises from cerebrovascular insufficiency leading to neuronal damage. Concurrently, parkinsonian symptoms in VaD patients are often refractory to traditional dopaminergic therapies. This dual manifestation underscores the necessity for a nuanced approach in managing these overlapping yet distinct neuropathological entities, particularly in the geriatric demographic where polypharmacy and comorbidities further complicate treatment strategies.

Method: A comprehensive review of current literature and a detailed case analysis were conducted, focusing on elderly patients exhibiting both cognitive deficits indicative of VaD and significant parkinsonism symptoms. The study scrutinizes pharmacotherapeutic avenues, including the cautious application of benzodiazepines and the contraindications of atypical antipsychotics, alongside a multidimensional analysis of non-pharmacological interventions.

Results: The results highlight the paradoxical nature of treating parkinsonism with VaD. Benzodiazepines, while effective in transiently ameliorating motor symptoms, exacerbate cognitive decline and pose a heightened risk of dependency and falls in the elderly. Conversely, atypical antipsychotics, commonly employed for behavioral and psychological symptoms in dementia, are often ill-suited due to their propensity to worsen parkinsonian features. This dichotomy demands a personalized treatment regimen that prioritizes maximizing non-pharmacological strategies.

Conclusion: Managing VaD with concomitant parkinsonism requires a delicate interplay between neurocognitive preservation and motor symptom control, particularly in the elderly. This approach demands a holistic, patient-centric methodology, underpinning the importance of individualized care plans. The study advocates for ongoing research into tailored pharmacological strategies and underscores the imperative role of non-pharmacological interventions in this demographic.

References: Parkinson Disease-Associated Cognitive Impairment à common occurrence of cognitive impairment in Parkinson’s disease and its range in severity. It reviews the epidemiology, pathophysiology, diagnosis, and treatment of cognitive impairment in Parkinson’s disease (Aarsland et al., 2021).

Update on the Neurobiology of Vascular Cognitive Impairment à pathophysiology of vascular cognitive impairment (VCI), considered the most common cognitive disorder in the elderly. It discusses the molecular, biochemical, and electrophysiological abnormalities detected in VCI, their correlation with disease progression, and the implications for disease-modifying drugs or non-pharmacological approaches (Vinciguerra et al., 2020).

Pharmacological Treatment of Vascular Dementia à pharmacological treatment for Vascular dementia (VaD) from the perspective of the molecular mechanisms involved, including oxidative stress, the central cholinergic system, neuroinflammation, neuronal apoptosis, and synaptic plasticity (Kuang et al., 2021).

Non-pharmacological Therapy for the Elderly to Prevent Dementia through Cognitive Stimulation Therapy à non-pharmacological therapies, such as cognitive stimulation therapy, that are used to prevent cognitive decline in the elderly with dementia. It emphasizes the significant impact of these therapies in improving cognitive and executive functioning (Siagian et al., 2020).

Cognition Deficits in Parkinson’s Disease: Mechanisms and Treatment à decline in Parkinson’s disease (PD), discussing the pathological mechanisms underlying cognition deficits and reviewing therapeutic strategies, both pharmacological and non-pharmacological, with a focus on their effects on cognitive impairment (Fang et al., 2020).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/managing-cognitive-decline-in-vascular-dementia-with-associated-parkinsonism/