Effects Of Memory And Cognitive Changes
While it may seem clear to you that emotional states can have a significant impact on your thinking, the reverse is also true: Your thinking can sometimes strongly influence your emotional states. You know the proverbial story of two men who see the same glass of water but one sees it as half full and the other as half empty? The same goes for thinking and emotional states.
Sometimes your assessment of a situation can influence your emotional reaction to that situation. More generally, executive cognitive functions can influence your mood states because those executive functions control all the information you have about the situations you find yourself in. Executive functions control your appraisal of those situations. If you find it difficult to recall happy memories, you may become more sad or depressed. If you find it difficult to plan a vacation, you may put off the vacation and thus influence your mood states and so forth.
Problems with executive functions can also get you into trouble over serious matters like money. If you find it difficult to balance the checkbook, you may get a bit sloppier about your finances. Consider also that the extra jolt of dopamine that comes from taking dopamine medications can sometimes make you temporarily more energized and impulsive. Now when you couple a heightened sense of impulsivity with a lowered capacity for thinking efficiently through decisions, you sometimes get impulsive respondingbad decisions.
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.
Changes In Brain Chemistry
Parkinsons causes a drop in;chemicals in the brain called neurotransmitters especially;dopamine which affect;movement and the brains reward center.
An imbalance of neurotransmitters and low levels of dopamine;are also at work in depression.;This shows why the two are frequently connected.
Parkinsons affects brain chemistry, so thats part of why depression and anxiety symptoms are common in these patients, Dr. Rush says. Their brains are often affected in ways that make it more likely to develop symptoms.
She says the mental;effects;can sometimes make physical symptoms worse. The signs she sees most often include:
- Fatigue
The interplay between physical and emotional symptoms can lead to a downward spiral.
If patients are developing physical symptoms, they may begin to move less, which can lead to more fatigue and a worse physical condition, Dr. Rush says. Then they start feeling even worse. So its a vicious cycle between depression and a sense of helplessness that feeds into some of their physical symptoms.
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Memory Or Thinking Problems
Having issues with thinking and processing things could mean your disease is progressing. Parkinsons is more than a movement disorder. The disease has a cognitive part as well, which means it can cause changes in the way your brain works.
During the final stage of the disease, some people may develop dementia or have hallucinations. However, hallucinations can also be a side effect of certain medications.
If you or your loved ones notice that youre getting unusually forgetful or easily confused, it might be a sign of advanced-stage Parkinsons.
How Parkinsons Disease Affects The Body
Life with Parkinsons is challenging, to say the least. This progressive disease starts slowly, and because theres currently no cure, it gradually worsens how you think and feel.
Giving up may seem like the only solution, but it certainly isnt. Thanks to advanced treatments, many people are able to continue living healthy, productive lives with Parkinsons.
Take a glance at this infographic to get a visual picture of how Parkinsons can affect everything from your memory to your movement.
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Treatment For The Motor Symptoms Of Parkinson’s Disease
There are many ways to deal with Parkinsons disease motor symptoms, including medications, occupational therapy and lifestyle adjustments. You may find that tremors make you more susceptible to accidents such as tripping, falling or spilling hot liquids so you must take care and ask for the help and support you need.
Unlike other Parkinson’s motor symptoms, tremors can be hard to treat with medication. However, medicines can be helpful for treating symptoms such as Parkinson’s disease gait impairments, which can have a major impact on your life. The gait of Parkinson’s disease presents slightly differently in each patient. Some experience the Parkinson’s disease shuffling gate, which can make movement markedly slower and make it look like you are “dragging your feet.” You may also experience reduced arm movement while walking.
In Parkinson’s disease, freezing of gait is characterized by hesitation before stepping forward, or a feeling like your feet have frozen to the floor. Frozen gait usually only lasts for a step or two, but you will need to be careful when crossing busy streets and try to minimize your risk of falling wherever possible.
You can talk to your doctor about medications to try, as well your surgical and homeopathic options. However, there is no cure for Parkinson’s disease and no way to stop the symptoms entirely, but scientists are working to change that.
Foster A Good Relationship
Lastly, maintaining your relationship and communication with the person with Parkinsonâs can be the most challenging and rewarding aspect of caregiving. As Parkinsonâs disease progresses, the roles change and the person with Parkinsonâs may go from being an independent head of the household to a very dependent person requiring a significant level of care. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health. Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern.
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How Is Parkinson Disease Treated
Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
Who Gets Parkinsons Disease
Parkinsonâs disease, documented in 1817 by physician James Parkinson, is the second most common neurodegenerative disease after Alzheimerâs disease. Estimates regarding the number of people in the United States with Parkinsonâs range from 500,000 to 1,500,000, with 50,000 to 60,000 new cases reported annually. No objective test for Parkinsonâs disease exists, so the misdiagnosis rate can be high, especially when a professional who doesnât regularly work with the disease makes the diagnosis.
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Kathy: On Anxiety Going It Alone And Being Kind To Yourself
Anxiety is also the biggest mental health challenge for Kathy , a 72 year old woman with PD diagnosed 4 years ago. Her mental health concerns are deeply influenced by a major external stressor, namely an adult child who is facing an illness of her own. Kathy was always a very active and capable person, and remains so, but PD is starting to cause some physical limitations for her. She wants to help her daughter as much as she can, but has begun to realize that she cant do everything she used to be able to do. This is extremely frustrating, because not only must she accept her limitations, but others around her must do so as well.
She often feels very lonely. She is not married and finds herself shouldering her own physical and mental struggles, as well as those of her daughter, by herself. She is lucky to have some close friends, but they have health challenges of their own to deal with and cant always be there for her. She finds it mildly exasperating to constantly read how important it is for PD patients to surround themselves with supportive family what if you are alone?
She also finds it irritating to read articles about PD that are relentlessly perky about PD. Yes, exercise can be very helpful and can sometimes help keep symptoms at bay. But there is a down-side to PD as well. You should be allowed to feel that and express that. It is also not your fault if your PD worsens it does not mean that you did not do enough.
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I am a very active person, but deep fatigue must be addressed with rest. Taking a day to rest is not in my nature. It makes me feel like a sloth. Yet, when deep fatigue hits me, the best remedy is to do just that take the day off! I limit myself to one day of physical rest, very rarely two days . I also find that the mind must rest with the body. Getting the mind to a quiet place is the practice of meditation, in whatever form suits the moment. At the height of deep fatigue, meditation can be very difficult, but not impossible. At times, it has taken me four hours to quiet my mind and body to get rejuvenating rest.
But there is a caution here: Be wary of using rest as an excuse to procrastinate. In another column, Ill address the link of scenario looping to set-shifting issues and difficulty initiating new tasks. Basically, getting off the sofa can be problematic if I stay there too long. Perhaps this seems contradictory to my history as a highly active person, but that is the nature of PDs nonmotor effects. Once off the sofa, I make myself shift into a physical task, followed by a short rest and then some type of mental task. There is always some resistance to overcome to do this to get off the sofa but the rest is absolutely necessary to stop the deep fatigue.
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Complex Parkinson’s Disease And Palliative Care
Complex;Parkinson’s disease is defined as the stage when treatment is unable to consistently control symptoms, or the person has developed;uncontrollable jerky movements .
These problems can still be helped by adjustment or addition of some of the medications used to treat Parkinson’s disease,;under the;supervision;of a doctor with a specialist interest in Parkinson’s disease.
As Parkinson’s disease progresses, you’ll be invited to discuss the care you want;with your healthcare team as you near the end of your life. This is known as palliative care.
When there’s no cure for an illness, palliative care tries to alleviate symptoms, and is also aimed at making the end of a person’s life as comfortable as possible.
This is done by attempting to relieve pain and other distressing symptoms, while providing psychological, social and spiritual support for you and your family.
Palliative care can be provided at home or;in a hospice, residential home or hospital.
You may want to consider talking to your family and care team in advance about where you’d like to be treated and what care you wish to receive.
What Causes Parkinson’s Disease
Parkinson’s disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.
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Lean On People You Love
If you have Parkinsons disease and also struggle with frequent depression or anxiety, you dont go it alone. Turn to your family and friends for;a strong support structure to help you cope. Joining a support group is often helpful everyone there knows how you feel.
We know from research that good social support is a protective factor against worsening depression and anxiety symptoms, so its incredibly important for patients to utilize the support they have available from family and friends, Dr. Rush says.
She also has advice for those who are providing this support: In some cases this means being an active listener without trying to fix their frustration or sadness, and doing this can often be an incredibly helpful part of the coping process, she says.
Rem Sleep Behavior Disorder
REM sleep behavior disorder can cause you to act out violent dreams, and also can make it difficult to get a good nights sleep. REM sleep, or rapid eye movement sleep, is the form of deep sleep where you have the most intense dreams. Usually, when you dream during REM sleep, nerve impulses going to your muscles are blocked so that you cannot act out your dreams. In REM behavior disorders, that blocking of the muscle impulses no longer occurs, so you are then free to act out your dreams. While estimates vary dramatically, approximately 50 percent of PD patients are estimated to have partial or complete loss of muscle atonia during REM sleep.
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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.
Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
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Psychiatric Symptoms Associated With Parkinson Disease
Matthew A. Menza, MDPsychiatric Times
Parkinson disease is the second most common neurodegenerative illness in the United States, affecting more than 1 million persons. Disease onset is usually after age 50. In persons older than 70 years, the prevalence is 1.5% to 2.5%.1 While the primary pathology involves degeneration of dopaminergic neurons in the substantia nigra, circuits important in emotion and cognition-such as the serotonergic, adrenergic, cholinergic, and frontal dopaminergic pathways-are also variably disrupted.
Parkinson disease is the second most common neurodegenerative illness in the United States, affecting more than 1 million persons. Disease onset is usually after age 50. In persons older than 70 years, the prevalence is 1.5% to 2.5%.1 While the primary pathology involves degeneration of dopaminergic neurons in the substantia nigra, circuits important in emotion and cognition-such as the serotonergic, adrenergic, cholinergic, and frontal dopaminergic pathways-are also variably disrupted.;
Depression
Many of the symptoms used to make a diagnosis of depression, including poor sleep, decreased energy, psychomotor retardation, and poor concentration, are seen in nearly all patients with PD and are more properly seen as direct manifestations of PD and not of depression. Therefore, while the usual screening instruments are useful, a careful interview, focused on mood, affect, and hedonic capacity, is critical.
Suicidal Behavior In Parkinson’s Disease
Suicidal behavior includes suicidal ideations, suicidal gestures, attempted suicide and completed suicide. Compared to other aspects, little information is available about suicidal behavior in patients with PD. A longitudinal follow-up study of 8 years duration reported the risk of death in patients with PD due to suicide to be 5.3 times higher than expected. Studies that have evaluated suicidal behaviors have reported rates of suicidal ideations/death in patients with PD to vary from 22.7% to 30%. The risk factors for suicidal ideations/death include depression, anxiety, hopelessness, level of education level, age of onset of PD, duration of illness, and history of impulse-control disorder . The odds ratio for suicidal ideation/death in patients with PD for different risk factors are 4.6 to 5.9 , 2.45 to 19.2 , 1.2 , 2.92 and 4.97 to 6.08 in various studies. Other studies have reported increased risk for suicidal ideations with increasing severity of depression with odds ratio of 2.92.
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