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In Parkinson disease (PD), apathy and depression often overlap, making it difficult to differentiate between them. This study sought to analyze apathy and depression in patients with PD dementia (PDD). Forty patients were diagnosed with PDD using the Movement Disorder Society criteria. A statistically significant correlation was identified between worsening dementia and an improvement in depression ( r = .3695; r = .1365, 95% confidence interval [CI]: 0.0985 to 05.894, P = .0044) and between worsening dementia and worsening apathy ( r = -.2578, r = .0664, 95% CI: -0.5025 to .0251, P = .036). Depression had a greater correlation with advanced motor symptoms ( r = .4988, r = .2438, 95% CI: 0.2218-0.7013, P = .0005]. In conclusion, depression was associated with less advanced PDD and more intense motor features, while apathy was associated with more advanced cognitive impairment.

Patients with Parkinson disease dementia (PDD) have deficits resulting mainly from frontostriatal dysfunction. The aim of this study was to assess the effectiveness of reality orientation therapy (ROT) combined with drug therapy (acetylcholinesterase inhibitors) in PDD treatment and compare it with that of drug therapy alone. Patients (n ¼ 12) with a diagnosis of PDD were divided into 2 groups: group A-drug therapy and ROT; group B-drug therapy alone. Reality orientation therapy was applied weekly for 6 months, and patients were assessed during the same period. Significant improvements in frontostriatal deficits were observed in the group that received the combined therapy, as shown mainly by the scores in verbal fluency in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (P ¼ .02) and in attention in Scales for outcomes of Parkinson's Disease-Cognition (P ¼ .021) and Clock Drawing Test (P ¼ .037). Patients who received only medication had worse results in constructional praxis recall in the CERAD battery (P ¼ .037). Our results indicate that ROT may help in the treatment of frontostriatal cognitive deficits and can potentially be used to complement drug therapy.

BackgroundApathy is one of the main neuropsychiatric symptoms in patients with Parkinson's disease (PD) and is associated with Parkinson's disease dementia (PDD).ObjectiveTo identify the characteristics of apathy in individuals with PDD according to caregiver perception.MethodsThirty-nine patients with PD according to MDS criteria for PDD were included. The following scales were used: the Hoehn and Yahr, the Unified Parkinson's Disease Rating Scale III, Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA Cog), the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Apathy Evaluation Scale (AES).ResultsA total of 97.4% of the patients showed results consistent with apathy. Analysis of question 14 of the AES revealed no correlation with the total result of all the questions [r=–1293, r2=0.0167, 95%CI (–0.4274 to 0.1940), P=0.2162], however, there was a correlation of responses to the same question with depression data on the MADRS scale [r=–0.5213, r2=0.2718, 95%CI (–0.7186 to –0.2464), P=0.00033].ConclusionApathy is a disorder associated with PDD. However, the scoring scheme of the AES questions can lead to different interpretations of caregiver responses, highlighting limitations of the tool for use in studies of PDD.

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