Prevention of cognitive impairment and dementia in people with Parkinson's disease: A call-to-action.

Mild cognitive impairment and dementia are common symptoms in people with Parkinson's disease (PwPD) that impair the quality of life of those affected. However, PD-specific concepts for the prevention of cognitive decline are rarely incorporated into routine care. Here, we provide key data on cognitive impairment in PwPD and a framework for primary, secondary, and tertiary prevention in this context. The importance of cognitive reserve as a protective buffer for cognitive decline in PwPD is highlighted. Relevant lifestyle and health-related factors, including cognitive aspects, physical and social activity, diet, hearing loss, and cardiovascular factors, are discussed. Evidence on the efficacy of possible cognition-enhancing interventions in PwPD-pharmacological, cognitive, physical, nutritional, and multidomain interventions-is summarized. On this basis, and the recommendations of the European Task Force for Brain Health Services, a proposal is developed outlining options for preventing cognitive impairment in PwPD that could be implemented in routine care, as well as further developments needed to achieve a best-case scenario. The main pillars of a strategic agenda for this purpose include: (i) regular assessment of cognitive state, overall risk, and risk factors for cognitive decline; (ii) risk communication and education concerning modifiable risk factors with standardized procedures; (iii) risk reduction with multi-domain interventions for secondary prevention; and (iv) cognitive enhancement with cognitive and physical training for tertiary prevention. As the proposal makes clear, the prevention of cognitive impairment in PwPD requires interdisciplinary collaboration organized throughout PD care networks.