What Tests Will Be Done To Diagnose This Condition
When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:
- Blood tests .
- Positron emission tomography scan.
New lab tests are possible
Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.
The two tests use the following methods.
- Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
- Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.
Signs And Symptoms Of Pdd
Common signs and symptoms of Parkinsons disease dementia include:
- Poor memory and concentration
- Depression
- Visual hallucinations
If youve noticed some of the above signs and symptoms in yourself or a loved one, its important to get them checked out. But dont jump to conclusions. People with Parkinsons often experience cognitive changes such as anxiety, lack of motivation, and slowed thinking. These symptoms do not automatically mean dementia.
Important Points About The New Medications
With multiple new medications available for the treatment of PD, there is more hope than ever that Parkinsons symptoms can be successfully managed for many years. A few things to consider:
- For people whose symptoms are difficult to control, these new treatments are welcome additions to what was previously available and many people with PD have been using these new medications with significant benefit.
- On the other hand, many of the newly-approved medications have the same mechanisms of action as older medications so they are not breaking new ground in treating symptoms.
- In addition, for some people, the effect on symptoms may be mild or not substantial.
These caveats may mean that your physician has not suggested a medication change for you. It is also important to note that despite all the new medications, carbidopa/levodopa remains the most potent medication to treat the motor symptoms of PD.
If your doctor does choose to try one of the new options, there may be multiple paths that your doctor can take when contemplating a medication adjustment. Often trial and error is the only way to determine the best medication regimen for you, so you may need to practice some patience as you work together with your doctor to determine what works or doesnt work.
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Consider Drug Risks Versus Benefits For The Individual Patient
You have to be very careful, and so its super important that clinicians are aware of the differences between these three drugs , the risks and the benefits, and that these are the ones that are applied rather than the classical dopamine blockers, he adds.
The acetylcholinesterase inhibitors rivastigmine and donepezil can be helpful for psychosis in patients with PD and DLB, and may improve memory as well, according to Dr. Okun. Theres certainly a subset of people with Lewy bodies that do really well with that medication.
Quetiapine can help patients with sleep, and this could account for some of the benefits it provides for patients with psychosis, he adds.
Psychosis in DLB can be more challenging to treat than in PD, Dr. Okun notes, because certain medications can make symptoms worse. Persons with Lewy bodies often have what is called cognitive fluctuations, he explains. They can be very sensitive to many medicines.
Individuals with DLB and PD may also develop a sensitivity to dopamine and dopamine blockers, he adds. Thats more common with Lewy body dementia than it is with Parkinsons disease psychosis, and thats another thing you have to watch out for.
Conceptualization Of The Diseases Needs And Interventions
Both dementia and PD are incurable and progressive diseases with often complex problems and needs, for which tailored interventions are available . For dementia, experts agree that recognizing its eventual terminal nature is the basis for anticipating future problems and an impetus to the provision of adequate palliative care . Some advocate advanced dementia to be a terminal disease to support eligibility for palliative care. However, as about half of dementia patients never reach an advanced stage , it may be a late trigger to initiate palliative care. There is no consensus, however, at which stage palliative care in dementia should start .
Table 2. Conceptualization of the disease, needs of patients and family caregivers, and interventions.
For PD there are no curative treatments either, but the success of dopaminergic replacement therapy and deep brain stimulation has enabled the majority of patients to live independently with a relatively low symptom burden for the first 10 years after diagnosis-when they live up to a decade . This may contribute to PD generally not being recognized as an illness for which a palliative approach may be helpful . A US patient and caregivers council recommends palliative care to be available from diagnosis of PD . This is also the ideal of the European Parkinson’s Disease Association although they emphasize that when to start palliative care is an individual decision.
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Lewy Bodies Dementia And Parkinsons What Does It All Mean
Here are two common scenarios that may sound familiar:
Scenario 1A patient develops a series of neurologic symptoms, is evaluated by a neurologist and is told that she has Parkinsons disease . She then visits another neurologist for a second opinion and is told she has Lewy Body Dementia .
Scenario 2A patient has his first visit with his neurologist and is told that he has PD, at a subsequent visit the diagnosis is changed to Parkinsons disease dementia , and at a follow up visit the diagnosis is changed yet again to Dementia with Lewy Bodies .
Both of these situations understandably cause great uncertainty and frustration.
Number Of People Affected
Parkinsons disease is thought to affect about 2 percent of Americans over 65. Of those, about 50 to 80 percent will go on to develop Parkinsons-related dementia.1 The Parkinsons Foundation estimates that nearly 1 million Americans will be living with Parkinsons by 2020. The disease affects 1.5 times more men than women.7
Approximately 5.8 million Americans are currently living with Alzheimers disease. That number is expected to increase to 14 million by 2050.8 There is little difference between numbers of men and women who develop Alzheimers, but there are more women with the disease, because women tend to live longer than men.3
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What Causes The Condition
Although there are several recognized risk factors for Parkinsons disease, such as exposure to pesticides, for now, the only confirmed causes of Parkinsons disease are genetic. When Parkinsons disease isnt genetic, experts classify it as idiopathic . That means they dont know exactly why it happens.
Many conditions look like Parkinson’s disease but are instead parkinsonism from a specific cause like some psychiatric medications.
Familial Parkinsons disease
Parkinsons disease can have a familial cause, which means you can inherit it from one or both of your parents. However, this only makes up about 10% of all cases.
Experts have linked at least seven different genes to Parkinson’s disease. They’ve linked three of those to early-onset of the condition . Some genetic mutations also cause unique, distinguishing features.
Idiopathic Parkinsons disease
Experts believe idiopathic Parkinsons disease happens because of problems with how your body uses a protein called -synuclein . Proteins are chemical molecules that have a very specific shape. When some proteins dont have the correct shape a problem known as protein misfolding your body cant use them and can’t break them down.
With nowhere to go, the proteins build up in various places or in certain cells . The buildup of these Lewy bodies causes toxic effects and cell damage.
Induced Parkinsonism
The possible causes are:
What Is Alzheimer’s Disease
Alzheimer’s disease , the most common form of dementia among older adults, is an irreversible degeneration of the brain that causes disruptions in memory, cognition, personality, and other functions that eventually lead to death from complete brain failure. Genetic and environmental factors including diet, activity, smoking, traumatic brain injury, diabetes, and other medical diseases contribute to the risk of developing this form of the disease. The hallmarks of Alzheimer’s disease are the accumulation of beta-amyloid plaques between nerve cells in the brain and neurofibrillary tangles, which are twisted fibers found inside the brain’s cells). These tangles consist primarily of a protein called tau.
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What Medications Are Used To Treat Parkinson’s Symptoms
Since many of the motor symptoms of Parkinsons are the result of a lack of dopamine in the brain, most drugs used to treat Parkinsons are aimed at temporarily replenishing or imitating dopamine. The following list is a guide to medications approved by Health Canada to treat symptoms of Parkinsons1. Speak to your doctor for detailed information regarding effectiveness and side effects of a particular drug.
Levodopa
- Converted into dopamine in the brain and stored in nerve cells to replace depleted dopamine
- Combined with another drug, carbidopa or benzerazide, allows more levodopa to get to the brain and reduces side effects
- Helps improve muscle rigidity and movement
- Side effects include dyskinesias
- Over years of use, may be associated with wearing off
Dopamine Agonists
- Mimics or imitates action of dopamine
- Can be used as initial treatment or with levodopa in advanced stages
- Side effects include sleepiness, hallucinations, leg swelling and obsessions with food, sex and activities such as shopping, gambling and Internet use Amantadine
- Enhances dopamine release and blocks glutamate, a brain transmitter
- Used to treat early symptoms
- Can reduce dyskinesias and improve wearing off
Dopamine Agonist
COMT Inhibitors
Symptoms Of Parkinsons Disease Dementia
Signs and symptoms of Parkinsons disease dementia include:
- Mental inflexibility
- Short-term memory issues and memory loss
- Trouble with decision making
- Executive function difficulty
- Slow processing speed
- Inattention
- Visual processing difficulty
Non-motor symptoms that can be associated with PDD include:
- Psychosis :
- Hallucinations
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Coping With Lewy Body Dementia
Coping with Lewy body dementia involves much more than your treatment plan. Its also essential to have access to social support and a safe home.
In the early stages of this condition, symptoms are typically milder, and people with LBD can function. However, as the disease progresses, there will be a severe decline in cognitive and motor abilities, and assisted care will be necessary.
Taking care of your physical healthy by exercising regularly and eating nutritious meals, is also important. Symptoms of anxiety and depression could develop as a result of this condition. Speaking to a therapist who has experience working with people who have dementia, will help.
Behavioral changes are to be expected with LBD. Keeping a diary to track your triggers and what times of the day you experience changes in your behavior, will help you understand your condition better.
What Happens In Pdd
People with PDD may have trouble focusing, remembering things or making sound judgments. They may develop depression, anxiety or irritability. They may also hallucinate and see people, objects or animals that are not there. Sleep disturbances are common in PDD and can include difficulties with sleep/wake cycle or REM behavior disorder, which involves acting out dreams.
PDD is a disease that changes with time. A person with PDD can live many years with the disease. Research suggests that a person with PDD may live an average of 57 years with the disease, although this can vary from person to person.
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Lewy Body Dementia Vs Parkinsons Disease Dementia
Diagnoses of Lewy body dementia include dementia with Lewy bodies and Parkinsons disease dementia. Symptoms in both of these diagnoses can be similar.
Lewy body dementia is a progressive dementia caused by abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also seen in Parkinsons disease.
The overlap in symptoms between Lewy body dementia and Parkinsons disease dementia include movement symptoms, rigid muscles, and problems with thinking and reasoning.
This seems to indicate that they could be linked to the same abnormalities, though more research is needed to confirm that.
The later stages of Parkinsons disease have more severe symptoms that may require help moving around, around-the-clock care, or a wheelchair. Quality of life can decline rapidly.
Risks of infection, incontinence, pneumonia, falls, insomnia, and choking increase.
Hospice care, memory care, home health aides, social workers, and support counselors can be a help in later stages.
Parkinsons disease itself isnt fatal, but complications can be.
Research has shown a median survival rate of about
Before Taking This Medicine
You should not take rivastigmine if you are allergic to rivastigmine or similar medicines, such as felbamate, meprobamate, or carisoprodol.
You should not take oral rivastigmine if you have ever had severe redness, itching, or skin irritation caused by wearing a rivastigmine transdermal skin patch.
Tell your doctor if you have ever had:
-
an ulcer or stomach bleeding
Tell your doctor if you are pregnant or plan to become pregnant.
It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.
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Pd Dementia And Safety Concerns
Safety issues should be considered and monitored from the time of diagnosis. As PDD progresses, ensure that your loved one is not left alone and try to:
- Evaluate driving privileges before safety is a concern. Your doctor can make a driving evaluation referral.
- Work out legal and financial issues and safeguard finances. People with dementia are at greater risk of falling victim to scams and fraud.
- Minimize prescription risks. Confirm with the doctor the medication names and doses of the person with PD. If the person is in dementias early stages and capable, fill up their weekly pill box together and monitor use.
- Look into medical alert systems. These systems can be critical in the event of a fall or if your loved one wanders outside of the home. Many types of systems are available, from bracelets and pendants to smartwatches with fall detection and one-button connections to 911.
- Evaluate gun safety. If your loved one owns a firearm or has one in the home, consider bringing it up with their doctor and taking additional safety precautions.
A Step Towards Better Treatments
Dr Arthur Roach, Director of Research at Parkinsons UK, said:
People affected by Parkinsons, their carers, and health and social care professionals have said that preventing falls and improving balance is the biggest unmet need for people living with the condition, outside of finding a cure.
This study shows that there may be drugs already available, being used for other purposes, that can be tested to help treat Parkinsons.
These results take us a step closer to improving the quality of life and finding better treatments for people with Parkinsons. But we still need more information before we recommend that people with Parkinsons are prescribed rivastigmine for falls.
*This article mentions statistics which have since been updated. 2018 data shows that the number of people diagnosed with Parkinsons in the UK is around 145,000.
Watch other research videos on falls and Parkinsons for more from Dr Emily Henderson and people affected by Parkinsons whove taken part in drug trials.
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What Are Parkinson’s Disease Dementia Medical Treatment And Medications
There is no specific therapy for dementia in Parkinson’s disease. Although cognitive symptoms initially may appear to respond to drugs that promote dopamine production, the improvement is mild and transient in contrast to the early responses to motor control improvement with medication in patients with Parkinson’s disease.
Parkinson’s disease dementia medications
Various medications are used to treat the movement disorders of Parkinson’s disease, some may exacerbate symptoms related to dementia.
- These include dopamine given in the form of levodopa medications known as dopamine agonists that act on the dopamine receptor and medications that slow down the metabolism of dopamine. They are often used in conjunction with monoamine oxidase inhibitors such as rasagiline. In addition, anticholinergic drugs are sometimes used.
- Unfortunately, these drugs may affect cognitive symptoms and mood disorders.
- Anticholinergic drugs, for example, help balance levels of dopamine and acetylcholine, another neurotransmitter, in the brain. These drugs can improve movement disorders but often make memory loss worse.
The dementia of Parkinson’s disease may respond to drugs used in patients with Alzheimer’s disease. However, these drugs, called cholinesterase inhibitors , lead to only small and temporary improvements in cognition.
Mood disorders and psychoses are usually treated with other medication.
The Differences Between Parkinsons Dementia And Alzheimers Disease
The advanced cognitive changes that impact daily living in Alzheimers and Parkinsons are both types of dementia.
Parkinsons disease dementia can occur as Parkinsons advances, after several years of motor symptoms. Dementia with Lewy Bodies is diagnosed when cognitive decline happens first, or when Parkinsons motor symptoms and cognitive decline occur and progress closely together.
Alzheimers, a fatal brain disease, causes declines in memory, thinking and reasoning skills. Physicians can diagnose Alzheimers. Visit the Alzheimers Association to learn the 10 signs of Alzheimers disease.
Parkinsons disease dementia tends to be less disabling than Alzheimers disease. People with Alzheimers disease have language difficulties earlier than people with Parkinsons, and they are unable to form new memories unlike in PD.
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