Mild Memory And Thinking Problems
Mild memory and thinking problems can be a normal part of getting older. But sometimes, these symptoms are caused by Parkinsons.
This is when you have symptoms such as forgetfulness, problems concentrating and difficulty making decisions, but you can still manage your day-to-day life.
Mild memory and thinking problems are common in Parkinsons and can happen at any stage of the condition, but not everyone with Parkinson’s has these symptoms.
If you do experience these symptoms, your doctor may describe it as mild cognitive impairment .
Its normal to worry if youre experiencing memory and thinking problems, but it doesnt necessarily mean you have dementia, or that you will develop it in the future.
Dementia in Parkinsons is diagnosed when thinking and memory problems are steadily getting worse over time and affect everyday life and daily tasks such as cooking, cleaning and dressing.
Difficulties With Memory And Thinking May Develop In Some People With Parkinson’s
Dear Mayo Clinic:
Does Parkinson’s disease affect memory and thinking? My 70-year-old husband has this condition and is showing signs of cognitive impairment.
Answer:Unfortunately, Parkinson’s disease is not simply a problem of tremor, walking and movement. With advancing age, and the longer a person has the disease, difficulties with memory and thinking may surface. Typically, these problems are subtle at first, but may become progressively worse in some people with Parkinson’s disease.
Parkinson’s disease is a disorder of the nervous system that develops gradually over time. The development of cognitive problems reflects the progressive nature of the disease process. Early in the course of the disease, most symptoms such as tremor, muscle rigidity and difficulty with movement are usually mild and can often be effectively managed with medications.
After many years of Parkinson’s disease, though, symptoms may become less responsive to medication, and new problems can develop. New symptoms can include additional movement problems and cognitive difficulties, as well as bladder and bowel issues and, in some people, low blood pressure.
Physicians should also review patients’ drug lists, as medications for other health problems may sometimes compromise mental clarity. Finally, adequate sleep is important to sound thinking, and occasionally treating sleep disorders, such as sleep apnea, can improve cognition.
Parkinsons Disease May Also Result In Hearing Loss
A study, conducted by a Taiwanese research team, shows that incidences of Parkinsons disease were 1.77 times more likely in a group of patients with hearing loss compared to a non-hearing loss group: 3.11 vs. 1.76 per 1,000 people respectively.
With a comparison group of nearly 20,000 people without hearing loss, the research team investigated the incidence of Parkinsons disease by the end of 2010 in both groups.
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Stages Of Parkinsons Disease
Because Parkinsons disease develops over time, there are various stages that help identify how symptoms have progressed and what should be expected next.
Generally, doctors follow a set of five stages as outlined below:
The beginning stage of Parkinsons disease sometimes doesnt show any signs at all. If symptoms are noticeable, theyre usually tremors and affect one side of the body. The symptoms usually dont affect your daily routine, but they should be taken seriously and brought to the attention of your doctor, if they havent already.
During this stage, the disease starts to affect your whole body. The tremors and stiffness cause routine activities to take a little longer to complete, and your overall movement starts to be affected. Your posture and facial expressions may should start to change, which can impact your ability to walk at a normal pace or communicate like you used to.
This stage features a worsening of all the symptoms that started to progressively deteriorate in stage 2, but you also start to experience a loss of balance and coordination, as well as how quick your reflexes are. As these symptoms start to come into the fold, people with the disease start to fall more, which can cause their own injuries and debilitations. Activities like getting out of bed, eating, and getting dressed start to get more difficult.
What Is Parkinsons Disease Dementia
Parkinsons disease dementia is a brain disorder that occurs in somebut not allpeople living with Parkinsons disease. The brain cell damage caused by the disease can lead to a loss of memory and other cognitive functions such as problem solving and speed of thinking. These changes in thinking and behavior can impact your daily living, independence, and relationships.
In those who do develop Parkinsons disease dementia, there is at least one yearand usually 10 to 15 yearsbetween the Parkinsons diagnosis and the onset of dementia. According to estimates by the Alzheimers Association, 50% or more of people with Parkinsons disease eventually experience dementia, although there are a number of risk factors that impact the likelihood of developing symptoms:
- Parkinsons patients who experience hallucinations, excessive daytime sleepiness, and more severe motor control problems are at higher risk for dementia.
- Dementia is more common in people who are older at onset of Parkinsons.
- Dementia is a bigger risk factor in non-tremor predominant Parkinsons.
- Overwhelming stress, cardiovascular disease, and adverse reactions to the Parkinsons disease drug levodopa can also indicate an increased risk for developing dementia.
- Dementia is relatively rare in people who develop Parkinsons before age 50, no matter how long they have had the disease.
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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.
Executive Dysfunction In Parkinsons
Executive functions in cognition are higher-order mental processes, including the ability to plan, organize, initiate and regulate behavior to meet goals. Executive functioning is present in activities such as multitasking, switching tasks, and solving problems. The prefrontal cortex of the brain and the dopamine system are responsible for executive function. As PD damages these areas, executive dysfunction occurs, and executive dysfunction is one of the most common cognitive impairments found in people with PD.3,4
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What Happens With Memory Problems
Some people with brain injury have a hard time remembering past events such as a telephone message or conversation. It can also be hard to remember future events such as an appointment. People might forget things they need to do during the day. While everyone forgets some things sometimes, people with memory problems forget things more often. They may also forget specific types of information. Most times, long-time memories about family and childhood are not affected.
Episodic Memory And Cognition In Parkinsons Disease
Parkinsons disease is characterized by neuronal Lewy bodies in the substantia nigra of the midbrain with subsequent loss of dopaminergic neurons, which lead to typical motor symptoms of bradykinesia , rigidity, and rest tremors. In addition to these cardinal motor symptoms, patients with PD experience a wide range of non-motor symptoms, most importantly cognitive and memory impairment that in many patients will eventually lead to dementia .
In PD patients, cognitive difficulty can be present in multiple domains, but episodic memory impairment is one of the most common cognitive symptoms reported, which can have a substantial impact on quality of life. One study found over 20% of newly diagnosed patients endorsed a memory complaint and episodic memory was the most commonly impaired domain at baseline in two large cohorts of newly diagnosed patients . Specifically, in the PPMI cohort 17% of de novo PD patients showed impairment on the Hopkins Verbal Learning Test , a test for recognition memory. Furthermore, in the ICICLE-PD cohort 1520% showed impairment on Pattern and Spatial Recognition Memory . Episodic memory impairment is also common later in the disease. One meta-analysis of 1,346 patients from 8 different cohorts of PD patients with mild cognitive impairment found that over 50% of PD-MCI had memory impairment whereas only 39% had executive dysfunction
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What Are The Causes
The cause of Parkinsons is largely unknown. Scientists are currently investigating the role that genetics, environmental factors, and the natural process of aging have on cell death and PD.
There are also secondary forms of PD that are caused by medications such as haloperidol , reserpine , and metoclopramide .
So What Do We Know So Far
Location of the substantia nigra. CC BY-SA 4.0
The substantia nigra is an area of the mid brain located at the top of the spinal cord, which has been the focus of much work into how Parkinsons affects the brain.
There are a right and a left substantia nigra, and often one side is affected before the other. Because of this, people with Parkinsons often experience symptoms primarily on one side of their body, particularly in the early stages. Indeed, this common feature of the condition often helps to distinguish Parkinsons from other similar conditions.
When it comes to confirming a diagnosis, it is the substantia nigra where pathologists look for changes at the end of life in brain tissue that has been donated to research. And the loss of the dopamine-producing cells in this area of the brain, accompanied by the presence of clumps of alpha-synuclein protein , has been the hallmark of Parkinsons for decades.
You can read more about the alpha-synuclein protein, and how it plays a role in the spread of Parkinsons, in a previous blog post:
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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinsons. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
Behaviors Seen In Parkinsons Disease Dementia
As dementia progresses, managing disorientation, confusion, agitation, and impulsivity can be a key component of care.
Some patients experience hallucinations or delusions as a complication of Parkinsons disease. These may be frightening and debilitating. Approximately 50 percent of those with the disease may experience them.
The best thing to do when giving care to someone experiencing hallucinations or delusions from Parkinsons disease dementia is to keep them calm and reduce their stress.
Take note of their symptoms and what they were doing before they exhibited signs of hallucinating and then let their doctor know.
This element of the disease can be particularly challenging for caregivers. Patients may become unable to care for themselves or be left alone.
Some ways to make caregiving easier include:
- sticking to a normal routine whenever possible
- being extra comforting after any medical procedures
- limiting distractions
- using curtains, nightlights, and clocks to help stick to a regular sleep schedule
- remembering that the behaviors are a factor of the disease and not the person
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The Spread Of Parkinsons
Researchers have found that areas of the brain stem below the substantia nigra show cell loss in Parkinsons. And cells in these areas have been found to contain clumps of alpha-synuclein protein, which may form before those in the substantia nigra.
These findings have led some researchers to suggest that . Indeed, there is evidence that, for some, Parkinsons may start in the gut and travel up the vagus nerve, which connects the gut and the brain, to the substantia nigra.
The theory that Parkinsons may spread up the brain stem and progress throughout the brain is the basis of the Braak staging of Parkinsons.
The 6 stages in Braaks theory aim to describe the spread of Parkinsons through the brain:
While there is still some debate over the origin of Parkinsons, and even competing and more complex theories about the spread of Parkinsons, attempts to understand how and why different areas of the brain are involved in the motor and non-motor symptoms are helping in the development of better treatments.
Causes Of Dementia With Lewy Bodies
Lewy bodies are tiny clumps of a protein called alpha-synuclein that can develop inside brain cells.
These clumps damage the way the cells work and communicate with each other, and the brain cells eventually die.
Dementia with Lewy bodies is closely related to Parkinsons disease and often has some of the same symptoms, including difficulty with movement and a higher risk of falls.
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How Is Parkinsons Disease Managed
Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.
While there is no cure for Parkinsons disease, symptoms can be treated with a combination of the following.
Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes difficulty swallowing, chewing, and speaking urinary problems or constipation skin problems and sleep disruptions.
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
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Medicines For Parkinsons Disease
Medicines prescribed for Parkinsons include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinsons is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.
People with Parkinsons should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinsons symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
Treatment Of Parkinsons Disease Dementia
Currently, statistics on cognitive change and dementia in PD come from studying patients who were first diagnosed ten or twenty years ago, prior to widespread recommendations about physical activity and exercise.
While no treatments have been proven to prevent development of Parkinsons and dementia, there is strong reason to believe that physical and cognitive activity could play a powerful role in slowing disease progression in the early stages of Parkinsons disease and throughout the course of disease.
Treatment of PDD involves the use of rivastigmine, an oral or transdermal medication that boosts the brains acetylcholine .
Rivastigmine is the only medication FDA approved for PDD but other medications sometimes used off label include donepezil , also an acetyhlcholine boosting drug, and memantine , an NMDA receptor antagonist.
Medications for dementia help somewhat, and other treatments may play a role for behavior issues in PDD.
Research, including clinical trials, is ongoing to find disease-modifying treatments for PDD.
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