Things You Should Know About The Link Between Parkinsons And Dementia
Both Parkinsons disease and dementia were ravaging the brain and behavior of actor Robin Williams before his death, but at the time, he didnt realize he had the latter.
Despite the fact that the signs of this combination can be confusing, the double diagnosis of Parkinsons and dementia impacts a large number of people. Of the one million people who have Parkinsons in the U.S., 50 to 80 percent may have dementiaeither as a result of Parkinsons pathology, or separately.
Robin Williams widow, Susan, wrote an editorial published in Neurology that was addressed to neurologists after his death. In it, she shared what it was like seeing her husband experience both Parkinsons disease and Lewy body dementia firsthand.
My hope is that it will help you understand your patients along with their spouses and caregivers a little more, Susan wrote.
Williams was first diagnosed with Parkinsons disease, which at first seemed to provide some answers for his out-of-character symptoms.
But it wasnt until after his death that an autopsy revealed he had been in the later stages of Lewy body dementiaa common form of dementia characterized by deposits of Lewy body proteins in the brain, which can impact physical movement, mood, memory and behavior.
I will never know the true depth of his suffering, nor just how hard he was fighting, Susan wrote. But from where I stood, I saw the bravest man in the world playing the hardest role of his life.
Lewy Bodies And Parkinsons Disease
A person with Parkinsons disease may develop dementia and have problems with reasoning and thinking. Lewy bodies are a feature of several brain disorders, including Parkinsons disease and Alzheimers disease, and they may cause rigid muscles and problems with movement and posture.
Research suggests that the similarity of the symptoms of Parkinsons disease and Lewy body dementia may be indicative of a shared link to how the brain processes alpha-synuclein.
It is not possible to test for the presence of Lewy bodies, so researchers must try to determine their effects by carrying out postmortem studies.
There is currently no cure for dementia. However, medication can alleviate the symptoms, while a team of medical professionals and therapists may help a person develop strategies to manage their daily activities.
Is Dementia A Symptom Of Both
One of the biggest similarities between PD and LBD is dementia. Some studies have found that approximately 78 percent of PD patients will eventually develop dementia.4 More specifically, almost half of Parkinsons patients will develop a certain type of dementia called Parkinsons Dementia, usually 10-15 years after their initial PD diagnosis.3 People with Parkinsons Dementia commonly experience poor memory and concentration, slowed thinking, confusion, depression, emotional changes, delusions, and visual hallucinations.
Parkinsons dementia is different than LBD, mainly in which symptoms occur first . Patients with Parkinsons Dementia will first show Parkinsons motor symptoms, followed by dementia many years after diagnosis. Conversely, LBD patients will first show dementia symptoms and may show motor symptoms later.3
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See A Doctor If Youre Noticing Symptoms Beyond Parkinsons
Sometimes the mood or memory changes a person experiences cannot entirely be explained just by Parkinsons. If this is the case, the caregiver should explore other diagnoses, because if something cannot be explained by Parkinsons, theres certainly a risk of it being dementia, Oguh said.
She added that some signs to look for include increased memory and behavioral problems, like mood swings, anxiety or depression. Psychiatric behaviors, like hallucinations, delusions or paranoia, cannot just be explained by Parkinsons, and are more likely to be caused by a form of dementia like Lewy body dementia.
Oguh urged caregivers to be aware of changing symptoms like these.
I think sometimes family members are able to realize sooner than the patient, Oguh said. Often the patient might lack insight as to what is happening. I would encourage family members to seek expert opinion and treatment options.
Treating Parkinsons Disease Dementia
A treatment plan for PDD typically includes medications that boost the brains level of certain neurotransmitters and help improve memory and processing speed, Dr. Petrossian says. Exercise is also an important part of the treatment planDr. Petrossian recommends skill-based activities like boxing or dance to boost cognitive function as well as fitness. PDD symptoms should be monitored long-term by a neurologist, and in some cases a psychiatrist, says Dr. Okun. In many cases, physical, occupational, speech, and social work therapy can also be useful since PPD affects all aspects of life.
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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
Dementia With Lewy Bodies And Parkinson Disease Dementia
, MD, PhD, Department of Neurology, University of Mississippi Medical Center
Dementia with Lewy bodiesParkinson disease dementia
Dementia is chronic, global, usually irreversible deterioration of cognition.
Dementia with Lewy bodies is the 3rd most common dementia. Age of onset is typically > 60.
Lewy bodies are spherical, eosinophilic, neuronal cytoplasmic inclusions composed of aggregates of alpha-synuclein, a synaptic protein. They occur in the cortex of some patients who have dementia with Lewy bodies. Neurotransmitter levels and neuronal pathways between the striatum and the neocortex are abnormal.
Lewy bodies also occur in the substantia nigra of patients with Parkinson disease, and dementia may develop late in the disease. About 40% of patients with Parkinson disease develop Parkinson disease dementia, usually after age 70 and about 10 to 15 years after Parkinson disease has been diagnosed.
Because Lewy bodies occur in dementia with Lewy bodies and in Parkinson disease dementia, some experts think that the two disorders may be part of a more generalized synucleinopathy affecting the central and peripheral nervous systems. Lewy bodies sometimes occur in patients with Alzheimer disease, and patients with dementia with Lewy bodies may have neuritic plaques and neurofibrillary tangles. Dementia with Lewy bodies, Parkinson disease, and Alzheimer disease overlap considerably. Further research is needed to clarify the relationships among them.
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Do You Die From Pd Dementia
People with Parkinsons-related dementia often want to know how the disease can impact their lifespan. While people with Parkinsons can expect a similar lifespan to the general population, studies show both Parkinsons disease dementia and Lewy body dementia can shorten lifespan, generally due to medical complications from the disease, rather than the disease itself.
What Is The Best Way To Communicate With A Person With Pdd
PD-related mood and motor changes can impact communication cognitive changes and Parkinsons disease dementia can further these difficulties.
- It is not usually helpful to try to reason or argue with someone experiencing a hallucination or delusion. Stay calm and be patient. If the person is frightened by the hallucination or delusion, try to redirect their attention to something else.
- You may find acknowledging what the person is seeing, even if you do not see it, can reduce stress.
- Speak slowly and at eye level. Communicate in simple sentences.
- Ask one question at a time and wait for an answer.
- Limit distractions. Turn off the TV or radio before asking a person with PDD to do something.
- Consider causes behind disruptive behavior: the person may be hungry, thirsty, tired, in pain, frustrated, lonely or bored.
- If the person is stuck on an idea, try agreeing with them, then changing the subject.
- Its OK to use humor to diffuse stressful situations but avoid negative humor or sarcasm these can be misunderstood.
Page reviewed by Dr. Jori Fleisher, MSCE, Assistant Professor, Department of Neurological Sciences at Rush University Medical Center, a Parkinsons Foundation Center of Excellence.
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Lewy Body Dementia Vs Parkinsons Disease Dementia
Diagnoses of Lewy body dementia include dementia with Lewy bodies and Parkinsons disease dementia. Symptoms in both of these diagnoses can be similar.
Lewy body dementia is a progressive dementia caused by abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also seen in Parkinsons disease.
The overlap in symptoms between Lewy body dementia and Parkinsons disease dementia include movement symptoms, rigid muscles, and problems with thinking and reasoning.
This seems to indicate that they could be linked to the same abnormalities, though more research is needed to confirm that.
The later stages of Parkinsons disease have more severe symptoms that may require help moving around, around-the-clock care, or a wheelchair. Quality of life can decline rapidly.
Risks of infection, incontinence, pneumonia, falls, insomnia, and choking increase.
Hospice care, memory care, home health aides, social workers, and support counselors can be a help in later stages.
Parkinsons disease itself isnt fatal, but complications can be.
Research has shown a median survival rate of about
Management Of Dementia In Parkinsonism
There is some evidence that cholinesterase inhibitors may have antipsychotic properties for the management of behavioral symptoms in Parkinsonism. A number of open-label studies have documented the beneficial effects of donepezil and rivastigmine in the management of dementia in Parkinsonism. A large placebo-controlled study of rivastigmine found that the rivastigmine group had significant improvement of the neuropsychiatric symptoms than the control group and were less likely to develop hallucinations. Furthermore, patients who suffered from visual hallucination at the time of initiation of treatment benefited the most.
The management of psychosis in DLB is equally frustrating and only a prospective randomized study in this regard has been reported to date. Rivastigmine led to significant improvement in delusions, hallucinations, depression, and apathy and therefore, cholinesterase inhibitors are now recommended as the first line of management for this condition. Mementine has also been found useful in one small retrospective study. However, cholinesterase inhibitors can increase tremor in Parkinsonism by their procholinergic actions.
One of the major problems of management of psychosis and related problems in Parkinsonism is that stopping drugs often lead to worsening of symptoms. However, some trials show that patients can be switched from clozapine to quetiapine after stability has been earned, provided they responded earlier to the latter agent.
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What Causes Parkinson’s Disease Dementia
Doctors don’t yet know the exact cause of Parkinson’s disease dementia, but they think it has to do with an accumulation of a protein called alpha-synuclein. When it builds up in the brain, it can create clumps called “Lewy bodies” in nerve cells, causing them to die.
The death of those cells usually results in the motor symptoms typically associated with Parkinson’s disease. As Parkinson’s disease progresses, those Lewy bodies may eventually damage the brain and cause problems with memory and thinking.
While many people with Parkinson’s disease experience cognitive changes, not all of them will go on to develop dementia. It’s estimated that between 50% and 80% of individuals with the disease eventually develop Parkinson’s disease dementia, usually in the later stages of the disease.
Tip : Make It A Priority To Be Socially Engaged
The more socially active you are, the more you connect face-to-face with others, the stronger your memory and cognition is likely to be. You dont need to be a social butterfly or the life of the party, but you do need to regularly connect with people who care about you.
Connecting with others is the most effective means of relieving stress which left unchecked can exacerbate symptoms of Parkinsons disease. Staying socially engaged also stimulates immune function that may slow the progress of disease. While many of us become more isolated as we get older, its never too late to meet others and develop new friendships.
Tips for meeting new people
- Volunteer
Hotlines and support
In the U.S.: Call the Helpline at 1-800-473-4636 or visit Parkinsons Foundation for resources and support. For Parkinsons Disease Dementia, call the Alzheimers Association helpline at 1-800-272-3900.
UK: Call the helpline at 0808 800 0303 or visit Parkinsons UK to find support
Australia: Call the info line at 1800 644 189 or visit Parkinsons Australia for links to state organizations that provide support and services.
Canada: Call 1 800 565-3000 for information or referrals or visit Parkinson Society of Canada for regional resources and support.
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Tracking Dementia In Parkinson’s Disease
If Dementia Occurs, Mental Abilities Can Fall Like Alzheimer’s Disease
Dec. 13, 2004 — Parkinson’s disease patients with dementia can lose their mental abilities at almost the same rate as people with Alzheimer’s disease, say Norwegian researchers.
Parkinson’s disease belongs to a group of conditions called movement disorders. Symptoms of Parkinson’s disease include tremors, rigidity, and imbalance. Symptoms vary from person to person, and not everyone is affected by all of the symptoms.
Not all people with Parkinson’s disease have dementia. However, dementia isn’t unusual with Parkinson’s disease, although it may take a decade to appear after Parkinson’s begins.
Parkinson’s disease occurs when brain cells that produce the chemical dopamine die. As a result, dopamine levels drop, garbling the brain‘s movement signals to the body.
Parkinson’s is usually diagnosed in people aged 50 or older . Advanced age is also the main risk factor for dementia. Alzheimer’s disease is the most common cause of dementia.
The latest study on Parkinson’s and dementia comes from scientists including Dag Aarsland, MD, PhD, of the geriatric psychiatry department at Norway’s Central Hospital of Roagland. Aarsland and colleagues studied 129 Parkinson’s patients who did not have dementia when they joined the study.
All participants lost at least some of their mental abilities over the years. But those with dementia had a steeper decline.
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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How Is Parkinsons Disease Dementia Diagnosed
No single test can diagnose Parkinsons disease dementia. Instead, doctors rely on a series or combination of tests and indicators.
Your neurologist will likely diagnose you with Parkinsons and then track your progression. They may monitor you for signs of dementia. As you get older, your risk for Parkinsons dementia increases.
Your doctor is more likely to conduct regular testing to monitor your cognitive functions, memory recall, and mental health.
Treatments For Parkinsons Disease Dementia And Dementia With Lewy Bodies
Treatments for DLB are similar to PDD and are aimed at symptom control. The motor symptoms of slowness, stiffness and walking difficulties can be treated with Levodopa. However, Levodopa can cause or exacerbate hallucinations, making it difficult to use it as a treatment for patients who have or are at risk of having hallucinations. Sometimes, clinicians will need to treat the hallucinations more aggressively in order for a patient to tolerate Levodopa given to help the motor symptoms. On the flipside, anti-psychotic medications to control hallucinations can worsen motor symptoms, so treating all the symptoms of LBD simultaneously can be a tricky balancing act.
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What Are The Treatment Options For Parkinsons Psychosis
Because Parkinsons drugs can cause psychosis, your doctor will likely start by taking you off your medications, one at a time, or adjusting the dose. Changing your medication may make your movement symptoms worse.
Your doctor will keep adjusting your medication. The goal is to get you to a dose that improves your movement without causing hallucinations and delusions.
If changing your medication doesnt work, the next step is to go on an antipsychotic medication. These drugs prevent psychosis symptoms by altering levels of chemicals in your brain.
Older antipsychotic drugs can make Parkinsons movement symptoms worse. Newer drugs, called atypical antipsychotics, are less likely to affect your movement. These drugs are off-label, meaning theyre not approved to treat Parkinsons specifically. They include:
- clozapine
- quetiapine
In 2016, the Food and Drug Administration approved pimavanserin . Its the first drug designed specifically to treat Parkinsons disease psychosis. Nuplazid reduces the number of hallucinations and delusions without affecting movement.
Nuplazid and other newer antipsychotic drugs do carry a black box warning. They can increase the risk of death in older people who have psychosis related to dementia. Your doctor will consider this and other risks before prescribing one of these drugs.
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