Tips For Managing Behavioral Changes In Parkinsons
Guidance from medical professionals is crucial, but advice from other people with Parkinsons can make the difference between living and thriving. Following are suggestions from MyParkinsonsTeam members to manage the behavioral changes in Parkinsons disease.
- Find healthy outlets to channel obsessive behaviors, such as art, woodworking, music, or video games.
- Educate yourself and your loved ones so that others can help you identify and manage behavioral symptoms and mood changes.
- Take your medications on time and with a meal or snack if advised. Make sure you take your medication as prescribed, and tell your medical team if you have any side effects.
- If youre a caregiver or loved one of a person with Parkinsons, be patient and pick your battles. Step away, if possible, to clear your head before engaging.
- If behavioral or personality changes make living arrangements with your spouse too tricky, consider separate living arrangements.
- If you have Parkinsons, be kind to yourself. If your loved one has it, give them grace while also taking care of your needs and well-being.
- Its tough to go it alone, so find in-person and online support groups. MyParkinsonsTeam is an excellent place to start.
Take the quiz: Is Your Parkinsons Causing Behavioral Changes?
Impulsivity And Obsessive Behaviors In Parkinsons Disease
Among the most startling changes for people with Parkinsons are impulse control disorders and obsessive behaviors. Some people start gambling or overspending, for example. One MyParkinsonsTeam member stayed up all night shopping and bought 10 surfboards in a short amount of time.
Many members of MyParkinsonsTeam have also found that their sex drive skyrocketed. One member said their increasing sexual needs were too much for their partner and strained their marriage. Another member, however, was happy with their wonderful postmenopausal sexual awakening.
Some behavioral changes are similar to obsessive-compulsive disorder symptoms and can cause real problems for people living with Parkinsons. For example, a member said their partner started taking things apart and putting them back together, which became a problem when it led to $3,500 in repair bills. Other times, the obsessive behaviors can be productive, like renewed artistic creativity. One member began making wooden flags to sell and donated some earnings to organizations for veterans.
Apomorphine Subcutaneous Injections And Infusion
Apomorphine is an alternative therapy for patients with disabling motor and non-motor fluctuations poorly controlled with conventional treatment. It is a potent dopamine agonist with a short-acting effect that makes it effective in complicated situations such as off dystonia episodes or unpredictable disabling off. Subcutaneous injections are used as a rescue therapy when a rapid on is needed. The effect is quick and lasts 4590min. Patients needing more than three to six injections per day are best treated with a continuous infusion therapy.
Overall, studies report improvement of off time of 50%80%. Its effect on dyskinesias is more controversial. Reductions may occur after a few weeks or months of continuous therapy and mostly if large reduction in levodopa dose can be achieved.
Both apomorphine subcutaneous injections and infusion are safe in terms of procedure but can cause adverse events related to the drug itself. These include nausea, hypotension, excessive somnolence and neuropsychiatric problems, such as confusional state, impulse control disorder and dopamine dysregulation syndrome. Subcutaneous nodules develop in 37% of cases treated with infusions although these are usually not severe and can be managed with non-pharmacological measures, the treatment may need to be stopped.
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Can Parkinsons Dementia Be Reversed
No specific cure has been identified for Parkinsons Disease Dementia. Rather, treatments have been aimed at reducing the symptoms of dementia and helping the patient maintain a high quality of life. Doctors treating patients of PD Dementia generally prescribe medications such as:
- Antidepressants
- Cholinesterase inhibitors
- Clonazepam and L-dopa
Serotonin reuptake inhibitors are known to reduce depression symptoms. The ones widely prescribed by doctors include:
Cholinesterase inhibitors help reduce the effects of cognitive decline in people with dementia whereas Clonazepam helps enhance sleep quality. L-dopa helps reduce movement issues caused by PD but runs the risk of making confusion and dementia symptoms worse.
Doctors treating PD Dementia patients may also prescribe antipsychotic drugs but generally do so with caution, the reason being these reduce psychotic episodes but increase Parkinsons symptoms. The use of these drugs may also cause increased confusion and change in consciousness. For the record, Pimavanserin and Nuplazid have been identified as effective antipsychotic drugs.
Behavioral Changes And Parkinsons
- Parkinsons disease can sometimes prompt changes in behavior, which may include impulsivity, apathy, and irritability.
- Behavioral changes can be treated with a combination of lifestyle changes and interventions from your health care provider.
- Cognitive impairment and dementia may also affect people living with Parkinsons.
People often think of Parkinsons disease as simply a movement disorder, but it also has nonmotor symptoms. Many people living with Parkinsons display behaviors that are troubling to the person and their family. These behavioral changes can be a symptom of Parkinsons, or they may be a side effect of medication.
Members of MyParkinsonsTeam have described an array of experiences with behavioral changes. Some people with Parkinsons disease struggle with anger or impulsive behavior that can impact their friends and family members. Others have hallucinations that cause them to act in ways that dont make sense to their caregivers. In addition, attention and motivation problems are common and make everyday tasks harder. These behavioral changes can sometimes impact quality of life and put people with Parkinsons in danger.
Fortunately, there are treatments that can help. With careful monitoring and support from loved ones, people living with Parkinsons disease can manage these behavior symptoms and sometimes even use the symptoms to their advantage.
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Effects Of Low Dopamine On Your Health
The perfect balance of dopamine can help you focus, learn, and stay motivated while dopamine deficiency can make it difficult to concentrate, make you feel less enthusiastic, and can cause movement difficulties.
Neurotransmitters such as dopamine communicate with our brain cells. When the communication is disrupted, the messages are lost. The consequences of this can result in many health conditions including Parkinsons disease, depression, anxiety, etc.
Neurotransmitters are responsible to transport messages and since these neurotransmitters can affect areas of the brain, any kind of miscommunication or error in transmission can trigger moods and behaviors such as anger, aggression, mood swings, anxiety, and so on.
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Role Of Smell In The Pd Pathological Process And Relationship With The Microbiota
According to Braak’s model , the pathological process of PD starts at the same time in two sites, the olfactory bulb/anterior olfactory nucleus, and the enteric nerve cell plexuses. This pathogenic explanation is known as the âdual-hitâ hypothesis. Constipation is actually another well-characterized, early prodromal manifestation of PD.
The alfa-synuclein pathology spreads in a caudal-rostral fashion from the lower brainstem through mid- and forebrain, up to the cerebral cortex in the final stages. Always according to this hypothesis , a yet unknown pathogen could be responsible for this stereotypical sequential damage of the nervous system areas, accessing the Central Nervous System via the olfactory bulb and the myenteric plexus of the enteric nervous system . Those two sites are especially vulnerable due to their lack of a blood brain barrier , that surrounds the CNS . This alleged pathogen could trigger neurodegeneration through a prion-like diffusion of misfolded proteins along neural pathways, or by provoking neuroinflammation leading to degeneration .
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Risk Of Experiencing These Behaviours
It is important that all people with Parkinsons are assessed for any potential risk of impulsive and compulsive behaviour before they start taking their medication. This is an important discussion to have with your specialist.
Research has shown that around 17% of people with Parkinsons who take dopamine agonists experience impulsive and compulsive behaviour. For a small number of people, levodopa, has also been shown to have similar side effects. The research suggests that 7% of people who take these other kinds of medication are affected.
Evidence suggests that you may be more likely to experience impulsive and compulsive behaviour if you are:
- Someone with a history of addictive behaviour
- Someone who has a family history of gambling or alcohol abuse
Its important to emphasise that not everyone will experience this behaviour. It is a possible side effect. It should not put you off taking your medication. Your specialist will assess your risk of impulsive and compulsive behaviours and you can work together to find the most appropriate treatment option for you.
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Personality Changes With Dementia
Dementia, which is caused by illness or injury, is an impairment of at least two cognitive brain functions.
Cognitive brain functions include:
The loss of neurons in the frontal lobe of the brain can cause people with mild dementia to experience personality changes such as becoming more withdrawn or depressed.
People with moderate dementia may experience more significant personality changes, such as becoming agitated and suspicious of others.
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Tips For Living With Hallucinations
It is important for people with PD to talk about hallucinations with their family and care team, because they are manageable and can be troublesome if not treated. Discuss all possible symptoms with your doctor, no matter how minor, rare or bizarre you may think they are.
- Good lighting and stimulating activities in the evening can help keep hallucinations at bay.
- While a hallucination is occurring, caregivers can help their loved one by reassuring them that they will be safe and validating their partners experience. For example, say, Ill take the cat outside instead of arguing that there is no cat.
What Are Parkinsons Delusions
Delusions are thoughts that arent grounded in reality. Theyre not as common as hallucinations, affecting only about 8 percent of people with Parkinsons disease. But they are harder to treat.
The most common delusions involve paranoia for example, the feeling that people are out to get you, or that your partner is cheating on you. Having these thoughts can lead to aggressive or even dangerous behavior.
Youll start with a visit to your doctor for an evaluation. Your doctor may diagnose you with this condition if you:
- have had symptoms like hallucinations and delusions for at least 1 month
- dont have another condition that could be causing these symptoms, like dementia, delirium, major depression, or schizophrenia
Not everyone with Parkinsons disease will develop psychosis. Youre more likely to have this if you:
There are two possible causes of Parkinsons psychosis:
- changes in levels of brain chemicals like serotonin and dopamine from the disease itself
- changes in levels of these chemicals from medications that treat Parkinsons disease
Dopamine is a chemical that helps your body move smoothly. People with Parkinsons disease have lower than normal levels of dopamine, which causes their body to move stiffly.
Drugs that treat Parkinsons improve movement by increasing dopamine levels. Yet they can sometimes cause psychosis as a side effect.
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The Weird Dream Symptom That Made Alan Alda Suspect He Had Parkinsons Disease
Actor Alan Alda has revealed that he was diagnosed with Parkinsons disease over three years ago. In an interview on CBS This Morning on Tuesday, Alda said he decided to speak publicly about his diagnosis because his thumb was twitching in recent TV interviews and he thought people would be curious.
But before his official diagnosis, it was a much weirder symptom that tipped him off.
I was having a dream that someone was attacking me and I threw a sack of potatoes at him, but what I was really doing was throwing a pillow at my wife, Alda, 82, said, noting that he didnt have any other symptoms at the time. It wasnt until months later that he noticed his thumb twitching.
So, Alda asked for a brain scan and was eventually diagnosed with the disease. Although there isnt a specific test that can be used to definitively diagnose Parkinsons, doctors may use brain scans, blood tests, and other exams to rule out other options.
Parkinsons disease is a progressive disorder that affects the nerves and, consequently, movement, the Mayo Clinic explains. Although symptoms may start mildly, they become more severe over time and may include tremors as well as muscle stiffness, slowed movement, impaired balance, and changes in speech and/or writing. The exact cause of the disorder is unknown, but age, genes, and environmental factors may play a role.
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Other Types Of Impulsive And Compulsive Behaviours
Punding
This is when someone does things such as continually handling and sorting objects. They may be fascinated with taking technical equipment apart or collecting a type of object.
This behaviour can mean people dont get enough sleep. It can also cause social problems with family or at work. If someone collects objects or takes machinery apart without knowing how to put it back together, it can also have a big financial impact, as theyll need to spend money to buy new objects or getting equipment repaired.
Some people also experience other behaviours such as compulsive singing, writing, smoking, reckless driving or doing crafts
Hoarding
This happens when someone feels that they must continue to keep items that they dont need. The thought of getting rid of the items may make someone feel upset.
Addiction to Parkinsons medication Some people with Parkinsons have a compulsion to take more medication than they need to control their symptoms because they are addicted to the way it makes them feel.
If a person is taking too much medication and their healthcare professional attempts to reduce it to the levels theyre supposed to take, this may cause unpleasant feelings, anxiety and cravings. It may also cause reduced mobility. A person may refuse to accept this, sometimes resulting in aggression, secret hoarding or requests for repeat prescriptions.
The number of people who may experience impulsive and compulsive behaviours may vary in research because of:
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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
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What Causes Apathy In Parkinsons
The root cause of apathy in Parkinsons is unclear. Apathy is a common symptom of depression, and 35 percent of people with Parkinsons experience depression or depressionlike symptoms. However, many people with Parkinsons who dont have depression do experience apathy, so there isnt a clear cause-and-effect relationship. Apathy may be due to changes in reward centers in the brain.
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Read Messages From Our Community Related To Mental Health In Advanced Pd:
My Dad fights aggressively when his aides try to get him to do something he doesnt want to. He gets so angry and is so strong it can take many people to restrain him.
My Mom lives at home, but constantly thinks that she is somewhere else and wants to go home. She becomes irritated and angry with the family because she says that we are holding her hostage.
My husband is verbally abusive towards me. This is an entirely new aspect to his personality. He was always very loving. Now he is aggressive.
My wife is severely depressed. Although she can get out of bed with help, she would rather stay in bed and do nothing. She also doesnt seem to mind that she is doing nothing all day.
Often, my brother doesnt recognize me when I visit. Last week, I saw my brother in the morning, but when I spoke with him on the phone later on in the evening, he mentioned that he had not seen me in a long while.
These quotes highlight a set of very problematic issues in advanced PD which include cognitive decline/dementia, depression, apathy, anxiety, psychosis , and behavior problems . One person often has a mixture of these symptoms and the symptoms can be inter-related.
How Common Are Impulsivity And Obsessive Behaviors In Parkinsons
About 14 percent of people living with Parkinsons experience obsessive and impulsive behaviors.Impulse control disorders and symptoms of OCD tend to show up after a person begins treatment with dopamine agonist medications such as ropinirole , apomorphine , and pramipexole dihydrochloride . Impulsive behaviors are especially common in people who are taking both a dopamine agonist and levodopa/carbidopa.
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