Other Pharmacologic Agents

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Few other pharmacologic strategies for specifically treating dementia in PD have even been reported. Because noradrenergic depletion could contribute to executive dysfunction in PD, Bedard et al. (170) conducted a trial of naphtoxazine (SDZ-NVI-085), a selective noradrenergic alpha 1 agonist, versus placebo in nondemented patients with PD. The results of the study demonstrated improved performance on tasks of set-shifting and cognitive flexibility, such as the Stroop and Odd-Man-Out tests. Furthermore, specific evoked potentials (Nd1 and Nd2 curves), thought to reflect attentional processes and known to be affected in PD, were improved with naphtoxazine. Memantine, an N-methyl-D-aspartate antagonist, has been approved for AD but to date there are no published studies of memantine for PD dementia.

Estrogen replacement therapy (ERT) may be a reasonable protective strategy for the development of dementia in women who have PD. The effect of ERT on the risk of development of dementia was investigated in 87 women with PD without dementia, 80 women with PD with dementia, and 989 nondemented healthy women. ERT did not affect the risk of PD, but appeared to be protective for the development of dementia, arising within the setting of PD (OR 0.22, 95%CI 0.05-1.0) (171). Furthermore, a survey of PD patients residing in nursing homes in five U.S. states demonstrated that female residents on ERT were less cognitively impaired than patients not taking ERT (172).

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