Understanding How This Dementia Differs From Alzheimers Can Help Patients Know What To Expect And Feel Less Fearful
En español | Many symptoms of Parkinsons disease shuffling gait, quivering hands, stooped posture are easy to spot. But this disease can also cause problems that are far less visible but no less distressing. Perhaps the most worrisome is cognitive decline, which affects about 50 percent of patients.
This is a scary, confusing and concerning topic for a lot of people, says neurologist Rachel Dolhun, M.D., senior vice president of medical communications at the Michael J. Fox Foundation. While these feelings are natural, common misconceptions can exacerbate patients fears.
For starters, cognitive decline doesnt necessarily equal full-blown dementia, and many people with Parkinsons develop only mild impairment. Another misconception is that even slight memory slippage signals that rapid deterioration is imminent but thats far more common with Alzheimers disease than it is with Parkinsons, says Tsao-Wei Liang, M.D., chief of the movement disorders division at Jefferson Health. Its not always relentlessly progressive, and more often than not, symptoms can be managed with medication, caregiver support and basic organizational strategies, he says.
Its also important to know that many Parkinsons patients with some cognitive impairments are able to form new short-term memories, even if they struggle with attention and multitasking. People with Parkinsons will often remember if you give a clue or prompt them, Dolhun says.
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.;
There Is A Strong Genetic Link To The Disease
“For about 10-15% of all PD cases, we know that there is a strong genetic link to the disease,” says Beck. “There is a lot of research right now studying DNA from people with PD including a major study from the Parkinson’s Foundation, PD GENEration: Mapping the Future of Parkinson’s Disease and scientists have discovered many genetic mutations linked to PD. But even when someone has a genetic mutation associated with PD, that does not necessarily mean they will develop the disease. Scientists are just beginning to understand the full role that genes play in PD. It is possible that certain genes may cause PD while other genes may actually protect people from developing it.”
Treatment Of Behavior And Mood Problems In Lewy Body Dementia
Behavioral and mood problems in people with LBD can arise from hallucinations, delusions, pain, illness, stress, or anxiety. They may also be the result of frustration, fear, or feeling overwhelmed. The person may resist care or lash out verbally or physically.
Medications are appropriate if the behavior interferes with the persons care or the safety of the person or others. If medication is used, then the lowest possible dose for the shortest period of time is recommended.
The first step is to visit a doctor to see if a medical condition unrelated to LBD is causing the problem. Injuries, fever, urinary tract or pulmonary infections, pressure ulcers , and constipation can worsen behavioral problems and increase confusion.
Certain medications, such as anticholinergics and antihistamines may also cause behavioral problems. For example, some medications for sleep problems, pain, bladder control, and LBD-related movement symptoms can cause confusion, agitation, hallucinations, and delusions. Similarly, some anti-anxiety medicines can actually increase anxiety in people with LBD. Review your medications with your doctor to determine if any changes are needed.
The Pathologies Are Different But Many Of The Symptoms Can Be Similar
We do know that the pathology is quite different between Parkinsons and dementia, said Dr. Odinachi Oguh, a neurologist at the Cleveland Clinic Lou Ruvo Center for Brain Health. But the processes in which memory is impacted in both diseases is about the same.
From the pathology standpoint, both diseases are characterized by a neurodegenerative process, Oguh said. The neurodegeneration results in abnormal accumulation of protein, which builds up and becomes toxic to the brain.
Alzheimers, for example, affects memory areas of the brain, which include the temporal lobes, as well as the memory center, or hippocampus. Parkinsons, meanwhile, starts in the basal ganglia part of the brain, and as the disease progresses, it can also affect the memory center, resulting in forgetfulness, an early sign of Alzheimers or other forms of dementia.
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Parkinsons Dementia Vs Alzheimers Dementia
According to experts, Parkinsons dementia can cause impaired physical activity and impacts motor skills. Two neurotransmitters called dopamine and serotonin tend to be damaged by Parkinsons.
In addition to causing issues with movement and coordination, this form of dementia can also cause a slower thought process and memory problems. This is usually less pronounced however, until the later stages of the disease.
With Alzheimers, two types of proteins in the brain, tangles and plaques , accumulate and kill brain cells. This Alzheimers-induced dementia affects memory, clear thinking, language skills, and orientation. It reduces comprehension, learning capacity, and judgement. Storing new information and memory retrieval are impacted more than motor skills.
Distinguishing between these neurodegenerative conditions is important to determine the best treatment approach. Medications for one of condition might create problems when given to a patient with the other condition.
Dementia Progresses At Different Rates For Different People
Dementia is, unfortunately, progressive but, like the motor features of MD, progresses at very different rates in different people. It not only causes poor memory and thinking, but also is frequently associated with depression, sleep disorders, loss of motivation, loss of interest and pleasure in activities that had previously enriched or even defined their life. Patients with dementia are often apathetic, showing reduced happiness and unhappiness. They are more likely to develop problems with sleeping too much or developing challenging sleep habits brings with it an increased sensitivity to the side effects of all the drugs used in treating Parkinsons Disease itself. People with dementia are more likely to develop hallucinations or confusion. Therefore the motor problems of Parkinsons Disease cannot be treated as aggressively in a patient with dementia as compared to the patient without dementia.
Dementia does not kill people. It is not a death sentence. It is true that dementia is associated with a reduced life expectancy, but this is likely due to the greater difficulty involved in treating the motor problems of PD. As noted above, this is because of the increased likelihood of drug side effects in patients with dementia. Unfortunately, more bad things happen to people with dementia. They may forget to use their cane or walker, increasing the risk of falls. They may take their medications unreliably or incorrectly or ignore warning signs of other medical problems.
Why Is It So Important To Know This Information
“If you have PD, it is important to know if you have a genetic component,” says Beck. “The next generation of PD treatments will likely target specific, genetic forms of PD an approach we have seen in some cancer treatments. By equipping yourself with knowledge about the genetics of your disease, you may be eligible for clinical trials that are testing new/experimental treatments specific to your genetic makeup.”
- Trembling of hands, arms, legs, jaw and face
- Stiffness of the arms, legs and trunk
- Slowness of movement
- Poor balance and coordination
The Parkinson’s Foundation offers people with PD genetic testing and counseling at no cost through its ongoing research study, PD GENEration: Mapping the Future of Parkinson’s Disease, says Beck. The Parkinson’s Foundation also has resources available at Parkinson.org, or you can call the Parkinson Foundation Helpline at 1-800-4PD-INFO . And to get through this pandemic at your healthiest, don’t miss these 35 Places You’re Most Likely to Catch COVID.
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Other Causes Of Parkinsonism
Parkinsonism is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.
Parkinsons disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.
These include parkinsonism caused by:
- medication where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped
- other progressive brain conditions such as progressive supranuclear palsy, multiple systems atrophy, and;corticobasal degeneration
- cerebrovascular disease where a series of small strokes cause several parts of the brain to die
You can read more about parkinsonism on the Parkinsons UK website.
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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.
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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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.
Living With Parkinson Disease
These measures can help you live well with Parkinson disease:
- An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
- High protein meals can benefit your brain chemistry
- Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
- If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.
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What Muddles Memory
Parkinson’s is a neurodegenerative condition, so it’s not surprising that memory loss is often part of it. The disease is associated with a decline in acetylcholine, a neurotransmitter that’s important for memory, Liang explains. In patients who have more serious dementia, the buildup of alpha-synuclein proteins in areas of the brain that are important for memory, thinking or language is likely to blame, says Michael Okun, M.D., national medical adviser to the Parkinson’s Foundation and executive director of the Norman Fixel Institute for Neurological Diseases at University of Florida Health.
Research confirms that alpha-synuclein plays a major role, but tau and amyloid beta may also be factors in some patients. A 2019 review of studies, published in the Journal of Neurology, Neurosurgery, & Psychiatry, found that a significant number of deceased Parkinson’s patients who suffered from dementia also had tau and amyloid-beta buildup in their brains.
It’s worth noting that not everyone with Parkinson’s faces an equal risk of memory trouble. Those who develop cognitive impairment tend to be older and living with the disease for longer. Patients who have the most severe motor problems and require high doses of dopamine-promoting medication are also at greatest risk, according to research published in Movement Disorders.
How To Stay Sharp
Several studies aimed at identifying various subtypes of Parkinson’s disease are underway. These projects including the Parkinson’s Outcomes Projects, the Parkinson’s Progression Markers Initiative and the Alzheimer’s Disease Neuroimaging Initiative might one day yield information that could help doctors flag patients at greatest risk of specific complications, including dementia, earlier in the disease process. In the meantime, there are steps you can take to lower the risk of memory problems or catch them as soon as possible.
Preventive strategies are largely aimed at broadly promoting good brain health. Regular exercise is important, and even people who’ve developed substantial motor problems can find classes or activities that work for their level or are specifically for people with Parkinson’s. Dolhun says that maintaining strong social ties and eating a healthy, balanced diet such as the Mediterranean, with its emphasis on anti-inflammatory fatty fish, whole foods and plenty of antioxidant-rich fruits and vegetables are essential, too.
Crossword puzzles are fine, as is mixing things up, Okun says. Do something with your left hand if you’re right-handed, he says. He also encourages patients to listen to audiobooks with a partner or caregiver, stopping after each chapter and having a discussion to ensure that both parties can reiterate what happened .
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Dementia Can Be Treated Through Medication But Its Progression Will Continue
Some of the problems caused by dementia are treatable, but there are no medications that slow the progression of this problem, just as there are no treatments that slow the progression of the rest of the Parkinsons Disease syndrome. We often use the same medications that are used in Alzheimers disease to improve concentration and memory, although only one, rivastigmine, has been approved by the Food and Drug Administration for dementia in PD. Most experts believe that each of the Alzheimer drugs are about as useful in dementia in Parkinsons Disease as they are in Alzheimers, which, unfortunately, is not great. As with all medications used in PD, whether for slowness, stiffness, tremor, depression or sleep disorders, if the medication is not helpful, one should either try a higher dose or stop it. Since the drugs used to treat dementia take several weeks to work, and the dose often requires increases, the family needs to allow a reasonable time period, usually around two months, to decide if it is helpful or not. Obviously this needs to be discussed with the prescribing doctor.
There is a lot of research being done to better understand and better treat dementia in PD.
Where To Get Help
- 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
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What Is Needed For A Parkinsons Disease Dementia Diagnosis
There is no definitive medical test that confirms cognitive decline or dementia in Parkinsons disease. The most accurate way to measure cognitive decline is through neuropsychological testing.
- The testing involves answering questions and performing tasks that have been carefully designed for this purpose. It is carried out by a specialist in this kind of testing.
- Neuropsychological testing addresses the individuals appearance, mood, anxiety level, and experience of delusions or hallucinations.
- It assesses cognitive abilities such as memory, attention, orientation to time and place, use of language, and abilities to carry out various tasks and follow instructions.
- Reasoning, abstract thinking, and problem solving are tested.
- Neuropsychological testing gives a more accurate diagnosis of the problems and thus can help in treatment planning.
- The tests are repeated periodically to see how well treatment is working and check for new problems.
Imaging studies: Generally, brain scans such as CT scan and are of little use in diagnosing dementia in people with Parkinsons disease. Positron emission tomographic scan may help distinguish dementia from depression and similar conditions in Parkinsons disease.
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What Are The Symptoms Of Parkinsons Disease Dementia
Cognitive impairment in Parkinsons 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 Parkinsons 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 Parkinsons 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 Parkinsons 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 Parkinsons disease may become increasingly dependent on spouses or caregivers.
Major mental disorders are common in Parkinsons disease. Two or more of these may appear together in the same person.
The combination of depression, dementia, and Parkinsons 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 Parkinsons disease, this might complicate the diagnosis of Parkinsons dementia.
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