Caring For Someone With Parkinsons
Caring for someone with Parkinson’s disease or dementia can be a rewarding as well as challenging experience. It will likely involve adapting to new challenges over time as the disease progresses or new symptoms emerge.
Become informed. Learn as much as you can about Parkinsons disease and Parkinsons disease dementia and how it is likely to affect your loved one specifically, given their health history, age, and lifestyle.
Communicate openly and provide reassurance, especially in the early stages following diagnosis, that Parkinsons disease is only slowly progressive in most patients and that your loved one can still live a full life.
Modify tasks to allow for greater independence. Allow your loved one to do things for themselves even if it takes longer. If necessary, break tasks that involve fine motor skills into easier steps and focus on success, not failure.
Help your loved one find alternative means of transport if they have to give up driving. That may involve researching public transportation, ride sharing, or community shuttle services.
Exercise together. Exercising is vital for the health and state of mindof both of you. Take a class together or simply enjoy a walk outside.
Look after yourself. Take regular breaks to avoid caregiver burnout, maintain social ties, and seek out opportunities to relax and have fun. Talking to others in similar situations can be very helpful.
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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 Parkinson Disease Parkinson disease is a slowly progressive, degenerative disorder characterized by resting tremor, stiffness , slow and decreased movement , and eventually gait and/or… read more , 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.
Both dementia with Lewy bodies and Parkinson disease dementia have a progressive course with a poor prognosis.
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:
- a reduction in reasoning, judgement, planning and decision-making abilities
- difficulty learning new things
The person may also show signs of depression or anxiety.
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Dementia Is A Greater Risk Factor In Parkinsons Disease
Overwhelming stress, cardiovascular illness, and negative reactions to the Parkinsons disease medicine levodopa can all raise the chance of dementia. Dementia is uncommon in patients who have Parkinsons disease before the age of 50, regardless of how long they have had the disease.
It is crucial to remember that Parkinsons disease dementia can proceed at different rates in different people. While there are no treatments to slow the rate at which PDD damages brain cells, medicines can assist to alleviate symptoms. Self-help techniques can also help you live a full and meaningful life for as long as feasible.
Improving Diagnosis With Composite Scores
A diagnostic challenge, particularly outside of expert centers, there are long delays in diagnosing LBD leading to significant burden. Although consensus criteria have excellent specificity, there is no standardized way to assess symptoms, reducing sensitivity. We developed the LB Composite Risk Score 21 from autopsy-verified cases to improve the ability to detect LBD in clinic and research populations .
Figure. Diagnostic Tools for Dementia With Lewy Bodies. The Lewy Body Composite Risk Score is a 10-item questionnaire to capture signs and symptoms associated with Lewy body pathology. A score of 3 or greater represents a high probability that Lewy bodies are contributing to cognitive decline . Comparison of MRI in Alzheimers disease and dementia with Lewy bodies demonstrates less cortical and hippocampal atrophy in DLB . Comparison of dopamine transporter single photon emission tomography in AD and DLB shows decreased dopamine uptake in the basal ganglia in DLB vs normal uptake in AD.
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Hospice Eligibility For Parkinsons Disease
Due to the progressive nature of Parkinsons disease, it can be challenging for families to know when their loved one is eligible for the support of hospice care. If a loved one has been diagnosed with six months or less to live or if they have experienced a decline in their ability to move, speak, or participate in the activities of daily living without caregiver assistance, it is time to speak with a hospice professional about next steps.
Dementia In Parkinsons Disease
Dementia is an umbrella term that is defined by a decline in memory and cognitive, or thinking, skills to a level that interferes with normal function. It is normal for older people to have more problems remembering names and faces than they had before, but this does not interfere with normal activities in most cases. People with dementia will misplace things much more than they used to. They will forget appointments, get lost driving, even in relatively familiar places. They may wake up during the night and think they need to go to work even though they retired years ago. They may ask to go home even though they are at home, mistake their wife for their mother, and sometimes get agitated when they are certain there is something wrong and no one else takes this seriously. Patients with dementia often cause problems because they wake up at night and try to go outside, or they may try to cook something and then forget theyve left the burner or oven on. More commonly they ask the same question repeatedly, driving their family crazy.
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What Can I Expect If A Loved One Or I Have Lewy Body Dementia
Each persons experience with Lewy body dementia is unique to them. How slowly or quickly the disease progresses is impossible to know, but may be influenced by your general health and any existing conditions you may have.
Because LBD is a progressive disease, difficulties with mind and body functions get worse over time. Currently, theres no known way to stop the progression of the disease.
However, theres always hope. Research on dementia with Lewy bodies, Alzheimers disease and Parkinsons disease with dementia are ongoing. New medications are being developed and new treatment approaches are being investigated.
Can Dementia Be Prevented In Any Way For Patients With Parkinsons Disease
Despite various scientific researches there are no known ways of preventing dementia in Parkinsons disease till now. As a precautionary measure patients with Parkinsons disease are urged to exercise and maintain a healthy lifestyle regularly. This may delay or reduce the onset of dementia, though this is not proven scientifically.
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Pdd Signs And Symptoms
The following are some of the most common indications and symptoms of Parkinsons disease dementia:
- Memory and attention problems
- Visual hallucinations are a common occurrence.
It is critical to have yourself or a loved one checked out if you detect any of the following signs and symptoms. But do not make hasty judgments. Anxiety, a lack of desire, and slower thinking are common cognitive impairments in people with Parkinsons disease. These signs do not always indicate dementia.
Tip : Make Additional Healthy Lifestyle Decisions
There are many additional things you can do to control Parkinsons symptoms and reduce your risk of dementia, in addition to regular exercise, a balanced diet, and social interaction.
1. Make an effort to keep your mind active. You may improve your cognitive skills and keep your mind sharp by continuing to study new things and challenging your brain. Learning a new talent, whether it is a musical instrument, a foreign language, a new computer program, or a new game or sport, is another excellent approach to boost brain function. You can learn new skills by enrolling in classes at community centers or institutions.
2. Boost the quality of your nighttime sleep. Toxins must be flushed out of the body, and the brain must be protected. The average adult needs 7 to 9 hours of restful sleep. Create calming night rituals, such as having a bath or doing some mild stretches, and switch off all electronics at least one hour before bedtime.
3. Take care of your tension. Stress that is not managed has a toll on the brain, diminishing a critical memory area, slowing nerve cell growth, and exacerbating many Parkinsons symptoms. Overwhelming stress may raise your chances of developing dementia. Exercise and relaxation techniques such as meditation or deep breathing, in addition to connecting face-to-face with others, can help you reduce stress levels.
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Dementia Outcomes According To Baseline Motor Features
Among motor variables , the proportion of gait involvement at baseline , falls , and freezing predicted dementia. Poor performance on the Purdue Pegboard Test and alternate tap test , but not the UPDRS predicted dementia. Patients developing dementia were more likely to report bilateral onset of motor symptoms . There was no association between dementia status and PD subtype, although the dementia-converted group had slightly more patients with akinetic-rigid Schiess scores than the group without dementia . Baseline UPDRS part III scores, total UPDRS scores, Timed Up and Go, Hoehn and Yahr stage, and axial-limb ratio were not predictive of dementia status.
Dementia And Cognitive Change
Cognition or cognitive function is a term used to describe the thought processes of your brain.
Cognition includes judgement, reasoning, problem-solving and memory. It is thought that the majority of people with Parkinsons experience some changes to their cognition. This is known as cognitive impairment. In people living with Parkinsons the level of cognitive impairment is mild in most cases.
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Memory And Thinking Problems
You may experience forgetfulness, slowed thinking and difficulty concentrating. You might find it harder to follow conversations, and remember some words and names. This can make communication difficult.
You may also find it increasingly difficult to make decisions, plan activities and solve problems. This can make everyday activities harder.
How Is Parkinson Disease Diagnosed
Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinson’s disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.
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How Is Age Related To Pdd
Both PD and PDD are more common with increasing age. Most people with PD start having movement symptoms between ages 50 and 85, although some people have shown signs earlier. Up to 80% of people with PD eventually develop dementia. The average time from onset of movement problems to the development of dementia is about 10 years.
What Is Parkinsons Disease
Parkinsons disease is a condition in which a part of the brain called the substantia nigra loses nerve cells. This loss of nerve cells results in a reduction of a substance called dopamine which is important for the regulation of movement of the body. As the dopamine levels decrease the persons movements become slower. Most people with a diagnosis of Parkinsons do not go on to develop dementia although about a third will, usually in the later stages. This is known as Parkinsons disease with dementia and may also be referred to as Lewy body dementia.
It is estimated that Parkinsons disease affects about 1 in 500 people and it is currently thought that it may be due to a combination of genetic and environmental causes. About one fifth of people diagnosed with Parkinsons disease are under 40 years old but it is more common in the over 50s.
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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
- 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.
Diagnosis: Parkinsons Dementia Or Dementia With Lewy Bodies
During assessment, a specialist may look at when the dementia symptoms first appeared before reaching a diagnosis of Parkinsons dementia or dementia with Lewy bodies.
If there have been motor symptoms for at least one year before dementia symptoms occur, specialists will often give a diagnosis of Parkinsons dementia.
If dementia symptoms occur before or at the same time as motor symptoms, specialists will usually give a diagnosis of dementia with Lewy bodies.
However, it should be noted that in some cases of dementia with Lewy bodies, no motor symptoms develop at all.
Theres no single test diagnosis is made through several different assessments, usually starting with an appointment with your GP or Parkinsons nurse.
Some people find it helps to go to the appointment with someone who knows them well, who can give the GP or Parkinsons nurse information about changes theyve noticed.
Your GP can discuss your symptoms with you and carry out a physical examination, including blood and urine tests, to rule out other potential causes of the symptoms .
Your GP may also review your medication, in case your symptoms are side effects.
If your GP thinks you have dementia, they can refer you to a specialist, such as a neurologist, psychiatrist or geriatrician.
You might be referred to a memory clinic or memory service. In some areas of the country, you can refer yourself to these services.
But if you feel you need to see the specialist again, you can ask to be referred back.
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Dealing With Cognitive Impairments
In some circumstances medications can help to lessen cognitive symptoms. You should speak to your GP or specialist about the options available. There are also various other health professionals who can provide professional support for dealing with cognitive impairments.
Cognitive impairment can be a big challenge for family, friends and carers, as well as those with the symptoms. Some practical tips for dealing with the daily challenges of cognitive impairments include:
- Keep to a daily routine
- Try to use familiar objects and phrases
- Avoid unfamiliar environments
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.
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Not Everyone With Parkinsons Will Develop Dementia
Despite the fact that the pathology of Parkinsons disease can trigger the development of different types of dementia, not everyone with Parkinsons will develop dementia. About 30 percent of people with Parkinsons will actually not develop dementia at all, as stated by the National Parkinson Foundation.
However, the vast majority of people with Parkinsons may experience some form of cognitive impairment over time, the foundation says.
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Managing The Effects Of Parkinsons Disease
Currently there is no cure for Parkinsons disease but UK and international research is ongoing.
With Parkinsons disease the interventions are focused on support, management of the changes, working with the person and their family to ensure they can live as well as possible with the condition. The physical effects of Parkinsons disease can be managed by:
- adapting the home environment so any trip hazards are removed and risks minimised
- a referral to Speech and Language Therapy if there are speech or swallowing problems
- a referral to a physiotherapist if there are movement issues
- a referral to an occupational therapist for aids and devices that may help around the house
If the person with Parkinsons has significant communication or cognitive issues they can be reduced by:
- reviewing the medication given for Parkinsons as this may be worsening the cognitive symptoms
- speaking slowly and clearly if understanding and thought processes are slowed
- reducing distractions
- giving time for communication it may take longer to respond
- asking questions to narrow down the answer, give choices or use yes/no cards or picture cards the person may have word finding difficulties as well as needing longer to respond
- using a mobile phone, tablet or electronic communication aid
- avoid unfamiliar or noisy places as they can cause distress
- providing a routine and activities that the person enjoys and feels comfortable with
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