Where To Get Help
- Your local community health service
- Your local council
- National Dementia Helpline Dementia Australia Tel. 1800 100 500
- Aged Care Assessment Services Tel. 1300 135 090
- My Aged Care Tel. 1800 200 422
- Cognitive Dementia and Memory Service clinics Tel. 1300 135 090
- Carers Victoria Tel. 1800 242 636
- Commonwealth Respite and Carelink Centres Tel 1800 052 222
- Dementia Behaviour Management Advisory Service Tel. 1800 699 799 for 24-hour telephone advice for carers and care workers
Managing Cognitive Impairments In Parkinsons
After a thorough evaluation to rule out other causes of cognitive impairment, patients with PD may be treated with medication, occupational therapy, and/or speech therapy. The medications used to treat cognitive impairments in people with PD are based on treatments used for Alzheimers disease. Occupational therapy can help a person with PD by providing adaptive strategies for daily activities. Speech therapy can help with language functions, as well as information processing. 3,4
Mood And Memory Changes In Parkinson’s Disease
Most people with Parkinsons disease notice some decline in their memory and mental agility, even very early in the course of the disease. Chances are that your PD will also affect your thinking to some extent. But the effects are subtle.
For example, you may notice that it takes you a bit longer to retrieve a memory, come to a decision, calculate a cost or plan a trip. This overall mental sluggishness is influenced by your mood and, in turn, your memory struggles can sometimes negatively influence your mood as well.
The good news is that new research has begun in the area of cognitive rehabilitation that can very effectively reverse this mental sluggishness.
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Prodromal Pd Phenotypes And Conversion
Recent evidence suggests that individuals with prodromal features of PD, such as hyposmia , REM sleep behaviour disorder and reduced dopamine transporter binding, may present with worse cognitive performance compared with people without any or with only one of these features,,. Interestingly, prodromal PD and DLB may overlap and it is not yet known how to distinguish between those who will develop PD versus those who will develop DLB. Of note, cognitive deficit has been recently defined as a new prodromal marker and has been included in the last update of the research criteria for prodromal PD.
What Are The Complications Of Parkinson Disease
Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.
Parkinson disease dementia can cause problems with:
- Speaking and communicating with others
- Problem solving
- Forgetfulness
- Paying attention
If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.
Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.
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What Is Alzheimer’s Disease
Alzheimer’s disease , the most common form of dementia among older adults, is an irreversible degeneration of the brain that causes disruptions in memory, cognition, personality, and other functions that eventually lead to death from complete brain failure. Genetic and environmental factors including diet, activity, smoking, traumatic brain injury, diabetes, and other medical diseases contribute to the risk of developing this form of the disease. The hallmarks of Alzheimer’s disease are the accumulation of beta-amyloid plaques between nerve cells in the brain and neurofibrillary tangles, which are twisted fibers found inside the brain’s cells). These tangles consist primarily of a protein called tau.
Comparison With Other Dementias
Dementia is the result of physical changes in the brain that can lead to memory loss and an inability to think clearly.
Several types of dementia exist, including:
PD dementia has different symptoms to other types.
Alzheimers dementia, for example, impairs memory and language. PD dementiam on the other hand, affects problem-solving, the speed at which thoughts occur, memory, and mood, alongside other important cognitive functions.
Dementia with Lewy bodies and Parkinsons disease dementia are similar in that the Lewy Bodies might be present in both forms.
However, whether the disease causes Lewy bodies or if Lewy bodies cause the disease symptoms is unclear. Researchers also believe that the way the Lewy bodies form in Parkinsons disease dementia is different from those in Lewy body dementia.
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The Era Of Digital Cognitive Testing
The development of digital cognitive testing and the evolution of self-completed computerized assessments and wearable devices to assess cognitive functioning in daily life, provides an exciting opportunity to both improve clinical management and to obtain more sensitive outcome measures for clinical trials and will likely become a standard procedure in the future, given further technological improvements and increased access to the internet and digital devices. To reach this point, psychometric requirements , documentation and technical problems, as well as their relation to traditional tests, need to be well known.
Is The Dementia Caused By Parkinsons Or Something Else
Indications that dementia may be caused by something other than Parkinsons disease include agitation, delusions , and language difficulties. If the onset of cognitive symptoms is sudden, theyre more likely due to something other than Parkinsons diseaseeven reversible causes such as infection, a vitamin B12 deficiency, or an underactive thyroid gland.
Depression can mimic dementia by causing similar symptoms such as apathy, memory problems, and concentration difficulties. Since depression is very common in Parkinsons patients, its important to recognize the signs and symptoms of depression in older adults.
Parkinsons disease dementia vs. other dementias
Other types of dementia that can be commonly mistaken for Parkinsons disease dementia include:
Lewy Body Dementia is characterized by fluctuations in alertness and attention, recurrent visual hallucinations, and Parkinsonian motor symptoms like rigidity and the loss of spontaneous movement. In this disorder, cognitive problems such as hallucinations tend to occur much earlier in the course of the disease and often precede difficulties with walking and motor control.
Alzheimers disease and Parkinsons disease are both common in the elderly, especially in those over 85. Patients with Parkinsons who develop dementia may even develop Alzheimers dementia as well. Therefore, its important to be aware of the signs of Alzheimers Disease and how its treated.
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The Profile Of Memory And Cognitive Changes
Even in the very early stages of Parkinson’s disease people can have difficulty with their thinking processes. Most authorities agree that the primary difficulty lies with the so-called executive cognitive functions.
Executive cognitive functions refer to such thinking processes as memory retrieval, planning, generation of words or concepts, attention, and monitoring and adjustment of non-routine and goal-directed behaviors. The common denominator in all of these executive functions is that they require cognitive control in order to operate smoothly.
The term cognitive refers to processes or operations involved in the processing of all kinds of information. So cognitive control processes are those processes that are used by the mind and brain to regulate the storage, retrieval, and usage of information .
Problems with executive functions are typically mild in early PD. They usually involve a generalized slowing of cognitive processing speed and subtle deficits in attention and working memory. It may be difficult, for example, to hold two different pieces of information in the mind at the same time, or to efficiently generate words and concepts as quickly as one used to. As the disease progresses, these executive cognitive deficits are made more severe by common Parkinson-related mood disorders and Parkinson-related emotional problems such as depression and anxiety.
What Are The Symptoms Of Parkinson Disease
Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:
- Tremors that affect the face and jaw, legs, arms, and hands
- Slow, stiff walking
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Frontotemporal Dementia With Parkinsonism
One form of familial FTD, also known as frontotemporal dementia with Parkinsonism-17 , is caused by genetic changes in the gene for tau protein, located on chromosome 17. No other risk factors for this condition are known.
FTDP-17 is rare and accounts for only three per cent of all cases of dementia. Symptoms progressively get worse over time and usually appear between the ages of 40 and 60. The condition affects both thinking and behavioural skills and movements such as rigidity, lack of facial expression and problems with balance .
It can be distressing to be told that you have a genetic disorder or are at risk of having one. Genetic counselling provides the person and their family with information about a genetic disorder and its likely impact on their lives. This can assist a person with FTDP-17 to make informed medical and personal decisions about how to manage their condition and the challenges it presents to their health and wellbeing. Prenatal genetic counselling is also available for parents to help them decide about a pregnancy that may be at risk of FTDP-17.
Mild Memory And Thinking Problems
Mild memory and thinking problems can be a normal part of getting older. But sometimes, these symptoms are caused by Parkinsons.
This is when you have symptoms such as forgetfulness, problems concentrating and difficulty making decisions, but you can still manage your day-to-day life.
Mild memory and thinking problems are common in Parkinsons and can happen at any stage of the condition, but not everyone with Parkinson’s has these symptoms.
If you do experience these symptoms, your doctor may describe it as mild cognitive impairment .
Its normal to worry if youre experiencing memory and thinking problems, but it doesnt necessarily mean you have dementia, or that you will develop it in the future.
Dementia in Parkinsons is diagnosed when thinking and memory problems are steadily getting worse over time and affect everyday life and daily tasks such as cooking, cleaning and dressing.
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How Common Is Parkinson’s Disease Psychosis
Between 20-40% of people with Parkinsons report the experience of hallucinations or delusions. When followed as the disease progresses over the years, this number increases. The increase does not mean that the hallucinations are persistent across the majority of patients. However, it is important to note that these statistics sometimes include delirium, in which the symptoms are temporary due to medication that needs to be adjusted or infection that needs to be treated, and isolated minor symptoms or minor hallucinations, including illusions, where instead of seeing things that are not there , people misinterpret things that are really there. These are the most common types of psychosis in people with PD, with different studies placing the occurrence between 25-70% of people with Parkinsons. Typically, if the person with PD only has these minor hallucinations, their doctor will not prescribe an antipsychotic medication, though more significant psychosis that requires medication may develop over time. In one study, 10% of those with minor hallucinations had their symptoms resolved within a few years, while 52% saw their symptoms remain the same and 38% saw their psychosis symptoms get worse.
We recommend that people with Parkinsons not use a single percentage to represent the prevalence of hallucinations and PDP. Parkinsons is a complex disease and as it progresses the percentages and risk of symptoms will change.
Treatment Of Parkinsons Disease Dementia
Currently, statistics on cognitive change and dementia in PD come from studying patients who were first diagnosed ten or twenty years ago, prior to widespread recommendations about physical activity and exercise.
While no treatments have been proven to prevent development of Parkinsons and dementia, there is strong reason to believe that physical and cognitive activity could play a powerful role in slowing disease progression in the early stages of Parkinsons disease and throughout the course of disease.
Treatment of PDD involves the use of rivastigmine, an oral or transdermal medication that boosts the brains acetylcholine .
Rivastigmine is the only medication FDA approved for PDD but other medications sometimes used off label include donepezil , also an acetyhlcholine boosting drug, and memantine , an NMDA receptor antagonist.
Medications for dementia help somewhat, and other treatments may play a role for behavior issues in PDD.
Research, including clinical trials, is ongoing to find disease-modifying treatments for PDD.
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Changes In Sleeping Patterns
As Parkinsons progresses, you can also develop problems with sleep patterns. These may not happen in the early stages, but can be noticeable later. You might wake up often in the middle of the night or sleep more during the day than you do at night.
Another common sleep disturbance for people with Parkinsons is rapid eye movement sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable if someone is sharing your bed. Dr. Rundle-Gonzalez says many times a bed partner will be the one to notice sleep problems.
REM sleep behavior disorder can also happen in people who dont have Parkinsons. However, if this isnt something youve dealt with before, its likely related to your disease. There are medications your doctor can prescribe to help you sleep comfortably through the night.
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Cognitive impairment can occur due to stress, particularly if the patient feels they are a burden to their caregiver, are experiencing a decline in daily functioning, have a worsening quality of life, are dealing with rising medical costs, or are concerned about their mortality.
According to the National Parkinson Foundation, some of the common cognitive issues people living with Parkinsons disease face include:
- Slowness of thinking
- Struggling to find the right words in conversations
- Lack of reasoning skills
Some Parkinsons disease medications can help with areas such as motivation and concentration, but there are no medications that can improve memory function.
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Parkinsonss News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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How Does Parkinsons Disease Develop
As the disease progresses people who have Parkinsons are increasingly likely to have a tremor, shaking, slowness of movement and rigidity. It can also cause problems with balance, sleep, swallowing, speech and increase the risk of falls. This can cause embarrassment, distress, discomfort and social isolation.
Research has indicated that in Parkinsons disease the persons cognitive processes can also be affected and these may get progressively worse over the years, with some people going onto develop dementia in the later stages of Parkinsons. The cognitive changes could include:
- forgetfulness
- a reduction in reasoning, judgement, planning and decision-making abilities
- difficulty learning new things
The person may also show signs of depression or anxiety.
What Are The Symptoms Of Parkinson’s Disease Dementia
Cognitive impairment in Parkinson’s disease may range from a single isolated symptom to severe dementia.
- The appearance of a single cognitive symptom does not mean that dementia will develop.
- Cognitive symptoms in Parkinson’s disease usually appear years after physical symptoms are noted.
- Cognitive symptoms early in the disease suggest dementia with Parkinsonian features, a somewhat different condition.
Cognitive symptoms in Parkinson’s disease include the following:
- Loss of decision-making ability
- Loss of short- and long-term memory
- Difficulty putting a sequence of events in correct order
- Problems using complex language and comprehending others’ complex language
Persons with Parkinson’s disease, with or without dementia, may often respond slowly to questions and requests. They may become dependent, fearful, indecisive, and passive. As the disease progresses, many people with Parkinson’s disease may become increasingly dependent on spouses or caregivers.
Major mental disorders are common in Parkinson’s disease. Two or more of these may appear together in the same person.
The combination of depression, dementia, and Parkinson’s disease usually means a faster cognitive decline and more severe disability. Hallucinations, delusions, agitation, and manic states can occur as adverse effects of drug treatment of Parkinson’s disease, this might complicate the diagnosis of Parkinson’s dementia.
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Dementia With Lewy Bodies
Initial cognitive deterioration in dementia with Lewy bodies resembles that in other dementias. However, dementia with Lewy bodies often manifests with early and prominent deficits in attention, executive function, and visuoperceptual ability prominent or persistent memory impairment tends to occur as the dementia progresses.
Extrapyramidal symptoms occur. However, in dementia with Lewy bodies , cognitive and extrapyramidal symptoms usually begin within 1 year of each other. Also, the extrapyramidal symptoms differ from those of Parkinson disease in dementia with Lewy bodies, tremor does not occur early, rigidity of axial muscles with gait instability occurs early, and deficits tend to be symmetric. Repeated falls are common.
Fluctuating cognitive function is a relatively specific feature of dementia with Lewy bodies. Periods of being alert, coherent, and oriented may alternate with periods of being confused and unresponsive to questions, usually over a period of days to weeks but sometimes during the same interview.
Memory is impaired, but the impairment appears to result more from deficits in alertness and attention than in memory acquisition thus, short-term recall is affected less than digit span memory .
Patients may stare into space for long periods. Excessive daytime drowsiness is common.
Visuospatial and visuoconstructional abilities are affected more than other cognitive deficits.