Clinical picture of dementia in Parkinsonism - dementia with Lewy bodies (DLB), Parkinson's disease, vascular parkinsonism and normal pressure hydrocephalus

Dementia can be diagnosed in at least 10% and porkinsonion signs in more than 20% of the general population over 75 years of age. The association of dementia and parkinsonism occurs in 75% of patients with classical Parkinson's disease after an eight year course. Parkinsonism occurs in dementia with Lewy bodies (DLB), in progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) less so in other diseases associated with the Pick-complex (frontotemporal dementias). Gait and postural parkinsonian signs predominate in PSP, vascular parkinsonism/dementio and normal pressure hydrocephalus (NPH) (lower body parkinsonism). This review discusses in the first part the different disorders associated with parkinsonism and dementia and in a second part its management. Diagnostic differentiation of the dementia-parkinsonism disorders may help to avoid two common problems: 1. delirium and psychosis are often induced by antiparkinsonion drugs and 2. neuroleptics exacerbate parkinsonian signs and cognitve deficits.