Diagnosis Of Parkinsons Disease Dementia
Diagnosis of PDD typically requires the initial diagnosis of PD, with the signs of Parkinsons disease of rest tremor, bradykinesia , rigidity , and postural instability.
At Pacific Movement Disorders Center we regularly monitor patients for cognitive changes which could signal the beginning of dementia, utilizing evidence-based screening tests. If concern arises, detailed neuropsychological evaluation with clear delineation of cognitive strengths and weakness can be obtained. On occasion, volumetric MRI scanning or PET scanning may play a role.
Differentiating between PDD and Dementia with Lewy Bodies can be challenging, given both conditions pertain to dementia and parkinsonism .
Lewy Bodies in PD patients predominate in the deep part of the brain called the substantia nigra, whereas in DLB they are widespread from onset.
The main differentiating factor is the clinical history:
In PDD, parkinsonism comes first, typically years prior to onset of dementia, whereas in DLB, cognitive changes either precede or coincide with onset of parkinsonism.In PDD, there tends to be clear improvement with levodopa for the motor symptoms at least.
For more on differentiating between PDD and DLB, see this comparison table.
How To Deal With Dementia Behavior Problems
- How to Deal with Dementia Behavior Problems: 19 Dos and Donts
Dementia is a disease that affects millions of people across the globe every year. It is often a highly misunderstood condition that is marred by numerous misconceptions, which make the condition difficult to understand and study.
You should know that dementia is not a name for an illness, rather it is a collective term that describes a broad range of symptoms that relate to declining of thinking, memory, and cognitive skills. These symptoms have deteriorating effects that usually affect how a patient acts and engages in the day-to-day activities.
In advanced dementia stages, affected persons may experience symptoms that bring out a decline in rational thought, intellect, social skills, memory, and normal emotional reactivity. It is something that can make them powerless when it comes to living normal, healthy lives.
Relatives, caregivers, spouses, siblings, children and anyone close to a person who has dementia need to know how to deal with behavioral problems that surface because of the illness. Examples of dementia problems may include aggressiveness, violence and oppositional behaviors. Find out some of the vital Do and Donts when dealing with a dementia patient.
Diagnosis: Parkinson’s Dementia Or Dementia With Lewy Bodies
During assessment, a specialist may look at when the dementia symptoms first appeared before reaching a diagnosis of Parkinson’s dementia or dementia with Lewy bodies.
If there have been motor symptoms for at least one year before dementia symptoms occur, specialists will often give a diagnosis of Parkinson’s dementia.
If dementia symptoms occur before or at the same time as motor symptoms, specialists will usually give a diagnosis of dementia with Lewy bodies.
However, it should be noted that in some cases of dementia with Lewy bodies, no motor symptoms develop at all.
Theres no single test – diagnosis is made through several different assessments, usually starting with an appointment with your GP or Parkinson’s nurse.
Some people find it helps to go to the appointment with someone who knows them well, who can give the GP or Parkinson’s nurse information about changes they’ve noticed.
Your GP can discuss your symptoms with you and carry out a physical examination, including blood and urine tests, to rule out other potential causes of the symptoms .
Your GP may also review your medication, in case your symptoms are side effects.
If your GP thinks you have dementia, they can refer you to a specialist, such as a neurologist, psychiatrist or geriatrician.
You might be referred to a memory clinic or memory service. In some areas of the country, you can refer yourself to these services.
But if you feel you need to see the specialist again, you can ask to be referred back.
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Do Try To Be Pleasant
Caregivers are also humans who are prone to emotions like anger, stress, impatience, and irritation. Even when one goes through caregiver burnout, it is best that the patient does not get wind of it. It is better to step out of the room and try some breathing exercises to calm down before going back to deal with the dementia patient. Where possible, shelve the bad feelings and try and deal with them later. Dementia patients deal with a lot and they do not need more on their plate if they are to lead fulfilling and happy lives.
Pdd Vs Dementia With Lewy Bodies
Another type of dementia is called Dementia with Lewy Bodies , which has similar symptoms to PDD. DLB is associated with abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also found in the brains of people diagnosed with PDD.
However, DLB is diagnosed when cognitive decline happens before the motor symptoms of Parkinsons, or when motor symptoms and cognitive decline occur and progress closely together.
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Do Not Shy Away From Asking For Help
No one may have all the answers especially when it comes to taking care of a person with dementia. Try doing research on how their behavior changes and what needs to be done to help them live their lives without too many complications. Hire help when it becomes too much as it also ensures that you do not become too frustrated or drained. When you have multiple family members who can help, ask everyone to pitch in and look after the patient so that you can get some personal space to breathe and re-energize when it is your time to look after the patient. When you feel like you can no longer look after your loved one at your own home, it may be time to consider assisted living. In such case, look into dementia care homes that can provide specially trained professionals.
How Is Parkinsons Disease Dementia Different From Alzheimers Disease
Parkinsons disease Dementia must not be confused with Alzheimers disease. Dementia is a hallmark feature of Alzheimers whereas a patient may not necessarily contract Dementia if he happens to contract Parkinsons. Having mentioned that, Dementia does have a greater social and occupational impact on the functioning of people when it affects someone with Parkinsons as compared to Alzheimers.
This is due to the combination of motor and cognitive impairments. Parkinsons directly affects problem-solving functions in a person, besides other aspects such as the speed of thinking, memory, and mood. Parkinsons Dementia Aggression can also be related to Lewy bodies, where sticky clumps of protein are found in the nerve cells of people diagnosed with Parkinsons.
Finally, it must be known to all those associated with Parkinsons in any capacity, whether be it a patient or a caregiver, that majority of people with Parkinsons may experience some of the other forms of cognitive impairment over time. Though cases vary from person to person, the development of Dementia in those diagnosed with Parkinsons cannot be predicted. To put it in numbers, 30 percent of people with Parkinsons never develop dementia as a part of their progression.
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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.
Hard To Face The Truth
I know this shows he still has a hard time accepting his reality and Id never want to rush him or force him to face the truth. I didnt push him to let the doctors speak or stop him from interrupting. He had to say his piece to them and maybe to himself.
It is important to remember this exam is not to give a definitive diagnosis of dementia related to Parkinsons but simply to ascertain the cognitive ability of the patient.
As such, the doctors cannot reveal what type of dementia he has or what stage of Parkinsons this means my father has. They simply are here to test and relay the results.
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Do Not Try To Stop A Person Who Wants To Leave A Room
Staying in one place for long periods may result in behavior problems in the dementia patient. It is essential to have a safe environment where they can enjoy the outdoors without any problem. When someone tries to leave a room, do not force them to stop. Doing this may result in an extreme reaction such as severe distress or injuries.
Instead, it is best to accompany the patient so that they are safe. You can even suggest going for a drive around the block so that they can experience a new environment for a short period. If they do not want company, just let them go but stay close by to make sure that the patient is safe at all times.
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Coping With Cognitive Impairment In People With Parkinsons Disease And Their Carers: A Qualitative Study
Rachael A. Lawson
1Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
2Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
Abstract
1. Introduction
Cognitive impairment in Parkinsons disease is a common nonmotor symptom, with up to 80% of people with PD developing dementia . Previous quantitative studies have shown that cognitive impairment can be detrimental to the quality of life of people with PD and their informal caregivers . However, these studies could not explain the mechanism or what aspects of cognitive impairment affected people with PD and their carers. In-depth qualitative studies may be more suitable to address these questions.
2. Method
This exploratory study used a qualitative design as part of a mixed-methods study. A partially mixed concurrent equal status design was used, where quantitative and qualitative data were collected in parallel to address the same overarching aims and hypotheses . The rational for this approach is that this design is complementary and seeks to gain a deeper, richer, and more complete understanding of a phenomenon by utilising the different methods to investigate either overlapping phenomena or different aspects of a single phenomenon . This paper draws on the findings from the qualitative component of the study.
2.1. Sample
2.2. Data Collection and Analysis
3. Findings
| People with Parkinsons disease | Relationship with carer |
4. Discussion
5. Conclusion
Disclosure
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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New Alzheimer’s Treatment Approved
In June 2021, the U.S. Food and Drug Administration approved Aduhelm for treating patients with Alzheimers disease. Aduhelm is the first new drug approved to treat the disease since 2003 as well as the first to specifically target amyloid-beta – the protein researchers widely believe to play a role in the development of Alzheimer’s.
Is The Dementia Caused By Parkinsons Or Something Else
Indications that dementia may be caused by something other than Parkinsons disease include agitation, delusions , and language difficulties. If the onset of cognitive symptoms is sudden, theyre more likely due to something other than Parkinsons diseaseeven reversible causes such as infection, a vitamin B12 deficiency, or an underactive thyroid gland.
Depression can mimic dementia by causing similar symptoms such as apathy, memory problems, and concentration difficulties. Since depression is very common in Parkinsons patients, its important to recognize the signs and symptoms of depression in older adults.
Parkinsons disease dementia vs. other dementias
Other types of dementia that can be commonly mistaken for Parkinsons disease dementia include:
Lewy Body Dementia is characterized by fluctuations in alertness and attention, recurrent visual hallucinations, and Parkinsonian motor symptoms like rigidity and the loss of spontaneous movement. In this disorder, cognitive problems such as hallucinations tend to occur much earlier in the course of the disease and often precede difficulties with walking and motor control.
Alzheimers disease and Parkinsons disease are both common in the elderly, especially in those over 85. Patients with Parkinsons who develop dementia may even develop Alzheimers dementia as well. Therefore, its important to be aware of the signs of Alzheimers Disease and how its treated.
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Do Try To Be Forgiving And Patient
Do not forget that dementia is the condition that results in irrational behavior and causes dementia sufferers to act the way they do. The patients demand plenty of patience and forgiveness from the people looking after them. Have the heart to let things go instead of carrying grudges around for something that the patient may not be in control of.
Treating Parkinsons Disease Dementia
A treatment plan for PDD typically includes medications that boost the brains level of certain neurotransmitters and help improve memory and processing speed, Dr. Petrossian says. Exercise is also an important part of the treatment planDr. Petrossian recommends skill-based activities like boxing or dance to boost cognitive function as well as fitness. PDD symptoms should be monitored long-term by a neurologist, and in some cases a psychiatrist, says Dr. Okun. In many cases, physical, occupational, speech, and social work therapy can also be useful since PPD affects all aspects of life.
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What Is Parkinsons Disease
Parkinsonâs disease is a progressive, neurological disease that mainly affects movement but can also affect cognition. Parkinsonâs disease results from the destruction of nerve cells in a part of the brain called the basal ganglia.
Different parts of the brain work together by sending signals to each other to coordinate all of our thoughts, movements, emotions, and senses. When we want to move, a signal is sent from the basal ganglia to the thalamus and then to the cerebral cortex, all different parts of the brain. Nerve cells in the brain communicate by using chemicals. A chemical called dopamine is produced in a group of cells called the substantia nigra and is essential for normal movement. When the cells die, they can no longer produce and send dopamine, so the signal to move doesnât get communicated. By the time a person starts to experience motor symptoms of Parkinsonâs, theyâve already lost approximately 50% of their dopamine producing cells. People may experience non-motor symptoms from loss of other neurotransmitters up to ten years before motor symptoms are noticed.
Dealing With Dementia Parkinsons And Chf
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Related Diagnosis: Lewy Body Dementia
Current research is helping to differentiate dementia related conditions in relationship to Parkinsonâs disease. Doctorâs use a 12-month arbitrary rule to aid in diagnosis. When dementia is present before or within 1 year of Parkinsonâs motor symptoms developing, an individual is diagnosed with DLB. Those who have an existing diagnosis of Parkinsonâs for more than a year, and later develop dementia, are diagnosed with PDD.
In the simplest terms, Lewy bodies are abnormal clumps of proteins that develop in nerve cells. Cholinesterase inhibitors, medications originally developed for Alzheimerâs disease, are the standard treatment today for cognitive DLB and PDD symptoms. Early diagnosis is important, as DLB patients may respond differently than Alzheimerâs disease patients to certain drug, behavioral, and dementia care treatments.
This challenging, multi-system disorder involving movement, cognition, behavior, sleep, and autonomic function requires a comprehensive treatment approach to maximize the quality of life for both the care recipient and their caregiver. It is very important to pay attention to symptoms of dementia and to search for an expert clinician who can diagnose the condition accurately.
What Types Of Help Are Available For Parkinson’s Disease
There are many types of help available for people with Parkinson’s disease. Among them are:
- Support groups: Support groups are very useful for sharing experiences. They provide an environment where you can learn new ways of dealing with your illness. You may want to share approaches you have discovered with others. You will also gain strength in knowing that you are not facing hardships alone.
- Individual counseling: Sometimes people have problems that are better addressed in a one-on-one atmosphere. By participating in individual counseling, you may more effectively express sensitive or private feelings you have about your illness and its impact on your lifestyle and relationships.
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Parkinsons And Lewy Body Disease
Lewy body disease occurs when there is an abnormal build up of a protein called alphasynuclein in the brain. Depending on where the proteins accumulate, Lewy body disease can lead to impairments in movement, thinking and behaviour.
Lewy body disease includes three overlapping disorders:
- Dementia with Lewy bodies
- Parkinsons disease dementia
This overlap results in the disease being called a spectrum disease.
In people with Parkinsons a large number of Lewy bodies appear in an area of the brain known as the substantia nigra. This area of the brain is responsible for movement, so the Lewy bodies are likely to cause impairments in movement.
Some people may go on to develop dementia with Lewy bodies. In this form of the disease, the clumps of protein occur in the cortex . This part of the brain is responsible for many cognitive processes, so the Lewy bodies are likely to result in cognitive impairments like those described under the heading above. It can result in symptoms similar to those seen in Alzheimers.