Abstract：
OBJECTIVE: Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson\'s disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on \"Parkinson\'s disease\" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders.
METHODS: The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.
RESULTS: Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson\'s disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.
CONCLUSIONS: In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.
METHODS: The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.
RESULTS: Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson\'s disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.
CONCLUSIONS: In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.
摘要：
目的：认知损害和痴呆以及情感障碍是帕金森病（PwPD）患者常见的、使人衰弱的综合征。作者总结了德国神经学会（DGN）2023年更新的德国“帕金森氏病”指南的建议，专注于这些疾病的诊断和治疗。
方法：建议基于文献综述，其他相关准则，和专家意见。
结果：评估认知和情感状态的测量被审查为心理测量属性，在常规临床实践中使用，和可用性在德国。为了改善轻度认知障碍，建议进行认知训练和有氧运动训练。治疗帕金森病（PD）相关性痴呆，认知刺激(作为非药物干预)和乙酰胆碱酯酶抑制剂(AChEIs，即，利伐斯的明）是推荐的。认知行为疗法被推荐用于治疗抑郁症,焦虑,对进步的恐惧。建议采取物理干预措施来治疗抑郁症，疲劳,和冷漠。优化多巴胺能治疗是推荐用于治疗抑郁症的一线药物策略，冷漠,快感缺失,疲劳,和情绪波动。可以使用文拉法辛或地昔帕明另外治疗重度抑郁症，而中度抑郁症可以根据其临床表型（精神运动迟缓或躁动）和合并症（例如，睡眠障碍,疼痛)。文拉法辛和去甲替林可用于治疗快感缺乏症，而西酞普兰可用于焦虑。
结论：除了更新的药物治疗方案，为德国卫生保健系统提供了有关标准化诊断和非药物干预建议的新见解.然而,需要更多的研究来探索非药物干预治疗和预防认知障碍和情感障碍的全部潜力.
方法：建议基于文献综述，其他相关准则，和专家意见。
结果：评估认知和情感状态的测量被审查为心理测量属性，在常规临床实践中使用，和可用性在德国。为了改善轻度认知障碍，建议进行认知训练和有氧运动训练。治疗帕金森病（PD）相关性痴呆，认知刺激(作为非药物干预)和乙酰胆碱酯酶抑制剂(AChEIs，即，利伐斯的明）是推荐的。认知行为疗法被推荐用于治疗抑郁症,焦虑,对进步的恐惧。建议采取物理干预措施来治疗抑郁症，疲劳,和冷漠。优化多巴胺能治疗是推荐用于治疗抑郁症的一线药物策略，冷漠,快感缺失,疲劳,和情绪波动。可以使用文拉法辛或地昔帕明另外治疗重度抑郁症，而中度抑郁症可以根据其临床表型（精神运动迟缓或躁动）和合并症（例如，睡眠障碍,疼痛)。文拉法辛和去甲替林可用于治疗快感缺乏症，而西酞普兰可用于焦虑。
结论：除了更新的药物治疗方案，为德国卫生保健系统提供了有关标准化诊断和非药物干预建议的新见解.然而,需要更多的研究来探索非药物干预治疗和预防认知障碍和情感障碍的全部潜力.
