Best practice guidelines for the diagnosis, evaluation, and management of cognitive disorders in Parkinson’s disease

Although cognitive impairment is prevalent in people living with Parkinson's disease (PD), the clinical approach to cognitive disorders in PD varies significantly across health services. Here, we present updated best practice guidelines to standardise the diagnosis, evaluation, and management of cognitive disorders in PD across clinical contexts. Guideline development followed a two-phase process incorporating both expert and lived-experience perspectives. In Phase 1, preparatory research (literature reviews and a national survey) generated 58 preliminary recommendations. These were refined through a modified Delphi process with 29 clinician and research experts, resulting in 51 evidence-based and expert-endorsed recommendations. In Phase 2, perspectives of people with lived experience of cognitive disorders in PD (n = 15) were attained through focus groups, which produced 25 recommendations. A subsequent national survey (n = 81) demonstrated consensus on 24 of the 25 recommendations. Overall, the guideline development process yielded 58 unique recommendations, including recommendations for a tailored neuropsychological toolkit sensitive to cognitive decline in PD. These are the first best practice guidelines for the diagnosis, evaluation and management of cognitive disorders in PD informed by empirical evidence, expert consensus, and insights from people with lived experience. Clinical adoption of these guidelines will improve the quality of care, diagnostic accuracy, and early detection of cognitive disorders in PD. Future service models should consider incorporating these guidelines to optimise cognitive care in PD and promote evidence-based and patient-centred standards of practice.