Sharpening the boundaries of Parkinson-associated dementia: recommendation for a neuropsychological diagnostic procedure

Older adults suffering from Parkinson's disease (PD) frequently present with an additional form of severe neurodegenerative and/or vascular pathology. Findings of differential clinical manifestations of cognitive impairment, depending on presence and nature of such coexisting brain pathology, raise the question for neuropsychological procedures that are capable not only of distinguishing between non-demented PD patients and patients with Parkinson-associated dementia (PDD), but also of detecting other types of cognitive decline, most likely Alzheimer's disease (AD) or vascular dementia (VD), superimposing PD. The aim of this article is to review the literature on neuropsychological processes at risk in developing PDD, to introduce comorbid causes of cognitive decline in the presence of PD, to discuss the scope of the "cortical versus subcortical dementia"-concept in view of its capability of differentiating dementias, and to scrutinize existing diagnostic criteria concerning the toleration of comorbidity. Additionally, we derive an evidence-based neuropsychological diagnostic procedure for assessing PDD under special consideration of these comorbid aspects.