Cognitive impairment is a frequent non-motorsymptom of Parkinson�s disease\n(PD). In early disease stage, this takes the features of dysexecutive syndrome,\nand is mostly dependent on derangement of frontostriatal circuitries.\nIn advanced stages, worsening of dysexecutive symptoms is accompanied by\ndisorientation and memory deficit leading to dementia in 30% of cases, due to\nmultiple neurotransmitter derangement. Dysexecutive symptoms in the early\nstages of PD may benefit from dopamine replacement therapy (DRT). Conversely,\nsevere cognitive symptoms in more advanced stages are frequently\naggravated by DRT. In particular, pulsatile stimulation of dopaminergic receptors\nby orally administered levodopa (LD) plays a significant negative role\non cognitive and neuropsychiatric symptoms in advanced PD. The introduction\nof a gel of LD-carbidopa for continuous intestinal administration (LCIG)\nallows marked stabilization of plasma LD concentrations and provides benefit\non motor fluctuations and dyskinesia of significantly greater magnitude than\nconventional oral administration in advanced PD patients. The results from\nseveral preliminary studies suggest that efficacy of LCGI on motor symptoms\nmay be accompanied by good tolerability and potential benefit on several\nnon-motor symptoms, including cognitive impairment. Future studies with\nlonger observation period and larger cohorts are advised to confirm these preliminary\nobservations.
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