How should I develop a stepwise management plan for a 74‑year‑old man with idiopathic Parkinson disease (9‑year duration) on levodopa/carbidopa 600 mg/150 mg three times daily and rasagiline 1 mg daily, who now has Parkinson disease dementia with visual hallucinations, cognitive fluctuations, mild depression, mild hypertension treated with amlodipine, obstructive sleep apnea treated with CPAP, and intermittent diphenhydramine use, while minimizing impact on motor function?

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Case Study: Complex Management of Parkinson Disease Dementia with Behavioral Symptoms

Patient Presentation

Mr. Thompson is a 74-year-old man with a 9-year history of idiopathic Parkinson disease who presents with worsening cognitive and behavioral symptoms over the past 6 months.

Current Medications:

  • Levodopa/carbidopa 600 mg/150 mg three times daily
  • Rasagiline 1 mg daily
  • Amlodipine 5 mg daily (for hypertension)
  • Diphenhydramine 25 mg PRN for sleep (uses 3-4 times weekly)

Medical History:

  • Parkinson disease (9 years, initially motor-predominant)
  • Mild hypertension (well-controlled)
  • Obstructive sleep apnea (compliant with CPAP)
  • No history of stroke or cardiovascular disease

Current Symptoms:

Cognitive: Progressive memory decline over 6 months, difficulty with executive function, getting lost in familiar places, trouble managing medications independently

Psychiatric: Visual hallucinations (sees children playing in the living room, non-threatening but persistent), mild depressive symptoms with apathy, occasional paranoid ideation that family members are "plotting against him"

Motor: Moderate bradykinesia and rigidity, mild resting tremor, some postural instability, wearing-off phenomena 1-2 hours before next levodopa dose

Sleep: Fragmented sleep despite CPAP, acts out dreams 2-3 nights per week (punching, kicking movements), daytime somnolence

Other: Mild orthostatic hypotension (BP drops from 135/80 to 110/65 on standing), constipation (bowel movement every 3-4 days)

Family Concerns:

His wife reports he is increasingly confused in the evenings, sometimes becomes agitated when she tries to redirect him, and she is exhausted from sleep disruption due to his nocturnal movements. She is concerned about safety given his balance issues and nighttime behaviors.

Physical Examination:

  • Alert but mildly confused about date
  • UPDRS motor score: 32 (moderate impairment)
  • MoCA score: 19/30 (impaired)
  • Mild masked facies, reduced arm swing bilaterally
  • Cogwheel rigidity in upper extremities
  • Postural instability on pull test
  • No focal neurological deficits

Laboratory Results:

  • Basic metabolic panel: Normal
  • CBC: Normal
  • TSH: Normal
  • Vitamin B12: Normal
  • Urinalysis: Negative

Questions for Clinical Decision-Making:

  1. What is the most appropriate diagnostic formulation for this patient's cognitive-behavioral syndrome? 1, 2, 3

  2. Which medication poses the highest risk for worsening his cognitive and psychiatric symptoms and should be discontinued immediately? 2, 3

  3. What is the stepwise approach to managing his visual hallucinations while minimizing motor deterioration? 2, 3, 4

  4. What pharmacological intervention should be initiated first to address both his cognitive decline and potentially help with hallucinations? 2, 3, 4

  5. How should his nocturnal behaviors (likely REM sleep behavior disorder) be managed? 1, 5, 2

  6. What modifications to his Parkinson medications should be considered to reduce psychosis risk while maintaining motor function? 2, 6, 3

  7. What non-pharmacological interventions should be implemented for his sleep-wake cycle disturbances and evening confusion? 7, 5

  8. If his hallucinations persist despite initial interventions and become distressing or dangerous, what is the safest antipsychotic option for this population? 2, 3, 4

  9. What monitoring parameters are essential given his medication regimen and comorbidities? 7, 6

  10. What safety modifications should be recommended at home given his nocturnal behaviors and postural instability? 1


Learning Objectives:

  • Recognize Parkinson disease dementia and distinguish it from delirium
  • Identify medications that worsen cognition in PD patients
  • Understand the unique challenges of managing psychosis in PD (neuroleptic sensitivity)
  • Apply evidence-based treatment algorithms for PD dementia
  • Manage REM sleep behavior disorder in the context of PD
  • Balance motor symptom control with neuropsychiatric side effects
  • Implement appropriate safety measures and caregiver support

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Dementia in Parkinson's disease.

Current treatment options in neurology, 2011

Research

Treatment of psychosis and dementia in Parkinson's disease.

Current treatment options in neurology, 2014

Research

Drug treatment of Parkinson's disease.

Dialogues in clinical neuroscience, 2004

Guideline

Management of Sleep Disturbances and Psychosis in Parkinson's Disease with Early Dementia

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Management of Aggressive Behavior in Geriatric Patients

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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