Diagnosis, evaluation & management of cognitive disorders in Parkinson’s disease: A systematic review

There is considerable variability in the diagnosis, evaluation and management of cognitive disorders in Parkinson's disease (PD) across clinical services. A review of guidelines and relevant literature will provide recommendations to guide clinical decision-making. The present review aimed to summarise and critically appraise current recommendations for the diagnosis, evaluation and management of cognitive disorders in PD. Five academic databases (PubMed, SCOPUS, Medline, PsycINFO, CINAHL) and five grey literature databases were systematically searched in August 2024 by two independent reviewers following PRISMA guidelines. Guidelines and systematic reviews from 2003-2024 available in English and reporting at least one relevant recommendation for the diagnosis, evaluation or management of cognitive disorders in PD were included. Quality assessment was completed using the AGREE-II tool for guidelines and AMSTAR tool for systematic reviews. In total, 32 guidelines and 24 systematic reviews were included. Guideline quality ranged from moderate to high and systematic review quality from critically low to high. Articles provided recommendations for cognitive impairment in PD in terms of diagnosis, neuropsychological evaluation, treatment and care. However, recommendations for cognitive tools, care considerations, and non-pharmacological interventions were limited, despite relevant evidence from the systematic review literature. Significant gaps identified in processes for neuropsychological evaluations, inconsistent recommendations for non-pharmacological interventions, and limited care considerations calls for future iterations of the clinical practice guidelines for cognitive impairment in PD.