What can we do to enhance cognitive care in Parkinson's disease?

For people living with Parkinson's disease (PD), cognitive impairment is a salient concern. The cumulative risk of mild cognitive impairment and dementia increases as the disease progresses, which contributes to loss of functional independence and increased institutionalization at late stages of PD. Yet, due to scarcity of time and resources, cognition is often an overlooked topic in busy neurology clinics. There are few opportunities for cognitive evaluation during clinical consults, and where it does occur, assessment methods are varied and unstandardized. Diagnostic and post-diagnostic care pathways for cognitive decline vary across clinical services, leaving people with PD falling through the resonant cracks of our healthcare systems. This perspective article highlights current gaps and inconsistencies in the diagnosis, evaluation, and management of cognitive disorders in PD. In doing so, we explore ways in which some of these issues may be rectified through best practice guidelines and critically analyze those that are more difficult to address.