When People Talk About Parkinsons They May Mention The Effects It Has On The Substantia Nigra But Did You Know That There Are Other Areas Of The Brain That Are Affected By The Condition
Parkinsons is a condition that causes the gradual loss of the dopamine-producing brain cells of the substantia nigra an area of the brain located just above where the spinal cord meets the midbrain. It is these cells that produce and release the neurotransmitter dopamine, which has a key role in turning thought about movement into action.
While this definition of the condition is useful to briefly explain Parkinsons, the whole story is somewhat more complex. Over the last 30 years, it has become accepted that Parkinsons also causes a number of non-motor symptoms, such as changes in sleep, smell and even the way we think, which likely involve other areas of the brain.
Now scientists are looking at the broader effects of the condition on the brain in an attempt to better understand why people experience different symptoms. The finding could lead us to new treatments that tackle more than just the motor symptoms of the condition.
How People With Parkinson’s Can Beat Apathy
Following an assessment of your symptoms and diagnosis of apathy, your doctor may discuss medications directed at increasing energy or other medications directed at the dopamine, cholinergic, and serotonergic systems . But more importantly, are the behavioral changes that we must make ourselves.
Personality Changes After Deep Brain Stimulation
Deep Brain Stimulation is a well-known and accepted treatment for neurological and psychiatric diseases. It consists of the implantation of electrodes into the brain, which send small electric impulses to specific neurons and pathways.
In Parkinsonâs disease , DBS clearly improves patients symptoms, functionality and quality of life in the long run. Nevertheless, it seems that the electrodes do not have motor-specific functions. DBS influences mental states and personality and in some cases it can even lead to a ânew personalityâ.
One recent study showed that in 45 PD patients submitted to subthalamic nucleus DBS there was a personality change in the direction of increased impulsivity. Surprisingly, relatives were more sensitive to this alteration than patients themselves. The lower sensitivity of the patients to the mood and behavioral changes could be the reason for the complaint: âhe/she is no longer the sameâ.
Yves Agid described that up to 65% of the married PD patients experienced a conjugal crisis after the operation. Different reasons could be found for this, but personality changes could clearly play a role.
Are we changing patients âidentityâ by using DBS? Probably yes: we are making them think differently, take risks in a different way and make decisions in a new manner.
Frank MJ, Seeberger LC, & Oreilly RC . By carrot or by stick: cognitive reinforcement learning in parkinsonism. Science , 306 , 1940-3 PMID: 15528409
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Anxiety And Parkinsons Disease
Anxiety is another common mood disorder of PD and is characterized by excessive nervousness or worry over several months. Patients with generalized anxiety disorder may experience symptoms such as:
- Restlessness, feeling wound-up or on edge
- Difficulty controlling the worry
- Sleep problems, such as difficulty falling or staying asleep, or restless or unsatisfying sleep1,3
Anxiety is not linked with disease progression of PD. It may develop before or after a PD diagnosis. It is often experienced along with depression in people with PD, as the disease process of PD changes the chemistry of the brain. Treatment for anxiety may include anti-anxiety medications, psychological counseling, exercise, relaxation techniques, and/or meditation.1
Flat And Blunted Affect
While flat affect and blunted affect may sometimes appear interchangeable, they are different.
Those with flat affect have no response to emotional stimuli. Blunted affect, however, describes a dulled or constricted response, where a persons emotional response is not as intense as normally expected.
Blunted affect is commonly seen in those with post-traumatic stress disorder or PTSD.
When an event causes a person to experience or witness physical harm or violence, they can go on to develop PTSD. This may cause them to have long-term anxiety and fear, which can be debilitating.
PTSD has many symptoms and often leads to nightmares and flashbacks to the original event. People with PTSD can also experience social detachment and a blunted or numbed affect in response to emotional stimuli.
Again, trauma therapist Deb Smith explains that many clients coming in for treatment of PTSD will initially present with a blunted affect. However, the combination of treatments used to treat PTSD often alleviate that symptom. This in turn returns the client to their pre-trauma affect.
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Parkinsons Disease Is A Progressive Disorder
Parkinsons Disease is a slowly progressive neurodegenerative disorder that primarily affects movement and, in some cases, cognition. Individuals with PD may have a slightly shorter life span compared to healthy individuals of the same age group. According to the Michael J. Fox Foundation for Parkinsons Research, patients usually begin developing Parkinsons symptoms around age 60. Many people with PD live between 10 and 20 years after being diagnosed. However, a patients age and general health status factor into the accuracy of this estimate.
While there is no cure for Parkinsons disease, many patients are only mildly affected and need no treatment for several years after their initial diagnosis. However, PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. This progression occurs more quickly in some people than in others.
Pharmaceutical and surgical interventions can help manage some of the symptoms, like bradykinesia , rigidity or tremor , but not much can be done to slow the overall progression of the disease. Over time, shaking, which affects most PD patients, may begin to interfere with daily activities and ones quality of life.
What Are The Primary Motor Symptoms Of Parkinsons Disease
There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.
It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.
Walking or Gait Difficulties
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Beyond The Substantia Nigra
In Parkinsons, other areas of the brain beyond the substantia nigra are involved as the condition progresses. Changes in higher brain areas are linked to non-motor symptoms that can affect people with Parkinsons later on in the condition, and often have a significant impact on quality of life.
For instance, symptoms that affect memory and thinking can be linked to the presence of Lewy bodies in the largest area of the brain the cerebral cortex as well as the limbic system. The limbic system is also believed to be involved in symptoms involving mood and pain, and similar changes in the inferior temporal gyrus, an area of the brain involved in processing what we see, are thought to be the reason for hallucinations.
But research into the spread of Parkinsons through these areas, and how we can stop it , is just one side of the story. There is also ongoing research into where Parkinsons starts, and the effects it is having before it reaches these areas.
The presence of non-motor symptoms many months and maybe even years before the physical symptoms, such as tremor and slowness of movement, points towards the presence of other changes in the body long before the loss of dopamine-producing cells in the substantia nigra. These early symptoms could even help researchers predict those who will go on to be diagnosed with Parkinsons, which would help in the development of new and better treatments.
The Substantia Nigra And Movement
The reason that Parkinsons causes movement symptoms is that the substantia nigra makes up part of the circuitry, called the basal ganglia, that the brain uses to turn thought about movement into action.
The structures of the basal ganglia.
The substantia nigra is the master regulator of the circuit, it mainly communicates using the chemical dopamine, but other chemical transmitters are also used to communicate between other areas of the basal ganglia.
The balance of signals being sent between these structures allows us to control movement. But as Parkinsons progresses, and the dopamine-producing brain cells in the substantia nigra are lost, movement symptoms appear. Without enough dopamine, it becomes harder to start and maintain movements, which leads to symptoms such as slowness of movement, rigidity and freezing. And an imbalance of signals in the basal ganglia means people with Parkinsons can experience what is known as a resting tremor.
But while this is the description of Parkinsons you may find in most textbooks, it is now recognised that changes are not limited to the substantia nigra and basal ganglia.
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Personality Questionnaires And Pet Imaging
Each subject filled out the Temperament and Character Inventory and the Karolinska Scales of Personality questionnaires. In part II, the patients filled out the personality questionnaires either at the PET Centre when the imaging took place or within 1 week after the PET examination.
Electrophilic F2 was produced according to Bergman and Solin . The radiochemical synthesis of 18F-dopa was carried out according to the methods of Namavari and colleagues and Bergman and colleagues . The radiochemical purity exceeded 98% in every case. Dynamic 90-min three-dimensional scans with General Electric Advance PET scanner were performed as described . The mean injected dose of 18F-dopa was 169 MBq. Each subject also underwent a 1.5-T MRI scan . The region of interest analysis was carried out by delineating the head of the caudate nucleus, the putamen, the ventral striatum, the medial frontal cortex , the dorsolateral prefrontal cortex , and the occipital region containing both gray and white matter; we did one ROI on each hemisphere. PET and MRI planes were realigned as described . The investigator who drew the ROIs was not aware of the personality scores. A graphical analysis method was used to calculate the metabolic rate of 18F-dopa, by using radioactivity concentration in the occipital region as the input function .
Mild Cognitive Impairment And Dementia
Cognitive impairment and the development of dementia are increasingly being considered part of the course of Parkinsons disease. Of particular importance, nearly 90% of PD patients with dementia exhibit at least one neuropsychiatric symptom, and 77% have two or more neuropsychiatric symptoms. Risk factors for the development of mild cognitive impairment include older age at disease onset, male gender, depression, severity of motor symptoms, and advanced disease stage .
The prevalence of dementia in PD is estimated at 26% to 44%, with over 80% developing dementia within 20 years of diagnosis. Mild cognitive impairment in people with PD is associated with the development of dementia within 4 years . Depression can exacerbate cognitive impairments in PD, and the frequency of depression in PD is estimated at 25% to 33% .
In a study that examined clusters of neuropsychiatric symptoms and cognitive status in PD, it was found that in people suffering from hallucinations nearly 80% had dementia; in those with mixed neuropsychiatric symptoms nearly 58% had dementia; and in those with mild depression 31% had dementia. Patients experiencing hallucinations tended to have longer disease duration, more severe motor symptoms, and older age .
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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.
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.
One Of The Most Difficult Neurological Disorder Symptoms Of Parkinsons
Why might this be important to families challenged by PD? Because the biggest source of conflict in families occurs when loved ones fail to recognize that a person with brain changes is not the same person who existed at an earlier time in life. Human beings greatly value continuity in personality but by expecting the person to be the same as they once were, loved ones are unfair to the person with brain insult. This person could no more return to an earlier personality state than he or she can will away tremors or rigidity. Energy expended in any way other than coming to terms with this new person is fruitless. There is actually some fascinating research in this area and it is likely to be a topic for a great deal more discussion in future blogs.
Because of the greater likelihood for executive dysfunction and dementia, personality change is easier to see among individuals with more advanced PD. Motivation is frequently affected, resulting in apathy that diminishes how actively an individual interacts with other people and with the world . Thinking or cognition changes can cause the person to process information more slowly and with less focus and concentration . A previously methodical, consistent individual often becomes increasingly chaotic in their response to their environment . One easily becomes less interested and hopeful about the future .
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Part I Personality Questionnaires
The Parkinson’s disease patients scored lower than controls on the TCI novelty-seeking scale . The patient group scored higher than controls on the TCI harm avoidance scale and on the KSP muscular-tension scale . The other differences between patients and controls did not reach statistical significance after correction for multiple comparisons . The TCI harm-avoidance scale correlated positively with the KSP muscular-tension scale both in the Parkinson’s disease group and in the control group . The motor UPDRS score did not significantly correlate with any of the personality scales .
Mean scores of 61 unmedicated Parkinson’s disease patients and 45 healthy controls on the TCI and theKSP
Living With Parkinsons Disease
Depending on severity, life can look very different for a person coping with Parkinsons Disease. As a loved one, your top priority will be their comfort, peace of mind and safety. Dr. Shprecher offered some advice, regardless of the diseases progression. Besides movement issues Parkinsons Disease can cause a wide variety of symptoms including drooling, constipation, low blood pressure when standing up, voice problems, depression, anxiety, sleep problems, hallucinations and dementia.; Therefore, regular visits with a neurologist;experienced with Parkinsons are important to make sure the diagnosis is on target, and the symptoms are monitored and addressed.; Because changes in your other medications can affect your Parkinsons symptoms, you should remind each member of your healthcare team to send a copy of your clinic note after every appointment.
Dr. Shprecher also added that maintaining a healthy diet and getting regular exercise can help improve quality of life.;Physical and speech therapists;are welcome additions to any caregiving team.
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Personality And Addictive Behaviours In Early Parkinson’s Disease And Rem Sleep Behaviour Disorder
A similar pattern of personality change is seen in PD and RBD compared to controls.
The similar pattern found suggests these personality changes occur before motor symptoms.
Extraversion, linked with reward sensitivity, is associated with smoking and alcohol.
Lower addictive behaviours before and after motor symptoms are not explained by personality alone.
This suggests that inherent factors other than simple dopamine dysfunction drive these differences.