Improvement of Cognitive Impairment and Hallucination by Pharmacological and Non-pharmacological Therapies for a Parkinsonism’s Disease with Dementia

We reported a case of 80-years-old man with Parkinsonism Disease Dementia (PDD) who experienced an improvement of hallucination with decreasing dose of madopar and non-pharmacological therapies. The patient was initially diagnosed as Parkinson’s disease (PD) 15 years ago, and was medicated with madopar (dose of 250mg per day). The dose of madopar was gradually increased to 375mg per day during last 15 years because of decreasing curative effect. New symptoms of frequent visual hallucinations and aggressive behavior have emerged. After that, he was hospitalized to our department three months ago with diagnosis of PDD; we adjusted the dose of madopar to 250 mg per day. Selegiline was later added to help managing the subsequent aggravation of his Parkinsonism. Quetiapine fumarate (25mg a day) was used to control his visual hallucinations and aggressive behavior. The frequency of visual hallucinations and attacking behaviours has been decreased gradually after drug treatment. We also prescribed the non-pharmacological therapies for the patient by means of musical therapy and cognitive psychotherapy. Two months later, the severity of his hallucination was alleviated. Furthermore, his NPI evaluating scores deceased from 42 to 12, and MMSE evaluating scores increased from 15 to 22. The pharmacological and non-pharmacological therapies may be good choices for PDD patient suffering from extrapyramidal symptoms and dementia..