Vascular Dementia And Vascular Cognitive Impairment
The term vascular dementia has been problematic for the same reasons as the term dementia, and the term vascular cognitive impairment is preferable. Impairment of episodic memory is less prominent in vascular dementia than in Alzheimer’s disease, particularly in patients with small vessel disease in whom impairment of executive function and cognitive slowing are more common. White matter changes indicative of small vessel disease and lacunar infarcts are commonly seen on MRI scans in elderly individuals and are particularly common in association with Alzheimer’s disease, often indicating mixed dementia. In younger patients there is usually, but not invariably, an association with vascular risk factors but intensive investigation might identify rarer causes, including mitochondrial disease or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy . Amyloid angiopathy is important to recognise as some patients might have an inflammatory component that could be responsive to steroids lobar microhaemorrhages seen on T2*-weighted MRI might help detection. APP duplications are commonly associated with a prominent amyloid angiopathy with cerebral haemorrhages and seizures. Treatable causes such as cerebral vasculitis are also more commonly found in younger patients than in the elderly.
What Causes Parkinsons Disease Dementia
A chemical messenger in the brain called dopamine helps control and coordinate muscle movement. Over time, Parkinsons disease destroys the nerve cells that make dopamine.
Without this chemical messenger, the nerve cells cant properly relay instructions to the body. This causes a loss of muscle function and coordination. Researchers dont know why these brain cells disappear.
Parkinsons disease also causes dramatic changes in a part of your brain that controls movement.
Those with Parkinsons disease often experience motor symptoms as a preliminary sign of the condition. Tremors are one of the most common first symptoms of Parkinsons disease.
As the disease progresses and spreads in your brain, it can affect the parts of your brain responsible for mental functions, memory, and judgment.
Over time, your brain may not be able to use these areas as efficiently as it once did. As a result, you may begin experiencing symptoms of Parkinsons disease dementia.
You have an increased risk of developing Parkinsons disease dementia if:
- youre a person with a penis
- youre older
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.
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Lewy Bodies: More Than Lbd
LBD is characterized by the presence of Lewy bodies in the nerve cells of the brain, meaning that LBD patients have Lewy bodies in the brain.2 However, Lewy bodies are also common with other conditions, such as Alzheimer’s and Parkinsons disease. In fact, most people with PD also have Lewy bodies in their brain. However, even if they have Lewy bodies, not all Parkinsons patients will also develop LBD.2
Whats The Difference Between Lewy Body Dementia Parkinsons Disease And Alzheimers Disease
Lewy body dementia is an umbrella term for two related clinical diagnoses: dementia with Lewy bodies and Parkinsons disease dementia. These disorders share the same underlying changes in the brain and very similar symptoms, but the symptoms appear in a different order depending on where the Lewy bodies first form.
Dementia with Lewy bodies is a type of dementia that causes problems with memory and thinking abilities that are severe enough to interfere with everyday activities. It specifically affects a persons ability to plan and solve problems, called executive function, and their ability to understand visual information. Dementia always appears first in DLB. The motor symptoms of Parkinsons such as tremor, slowness, stiffness and walking/balance/gait problems usually become more evident as the disease progresses. Visual hallucinations, REM sleep behavior disorder, fluctuating levels of alertness and attention, mood changes and autonomic dysfunction are also characteristic of DLB.
Finally, Alzheimers is characterized by different abnormal clumps called amyloid plaques, and jumbled fiber bundles called tau tangles. These microscopic structural changes in the brain were discovered by Dr. Alois Alzheimer in 1906. These plaques and tangles, together with loss of connections between nerve cells, contribute to loss of coherence and memory, as well as a progressive impairment in conducting normal activities of daily living.
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How Is Age Related To Pdd
Both PD and PDD are more common with increasing age. Most people with PD start having movement symptoms between ages 50 and 85, although some people have shown signs earlier. Up to 80% of people with PD eventually develop dementia. The average time from onset of movement problems to the development of dementia is about 10 years.
Why Is Proper Follow
A person with Parkinsons disease is supposed to go for regular checkups to his health care professional for the following reasons-
Treatment Progress: The check-ups help the health care professionals to check if the treatment procedure is working or not and also provides an insight about the necessary adjustments to be made.
Detecting New Issues- Regular follow-ups help in detection of new problems with cognition, behavior or mood which might need special treatment.
Planning the Care- The follow-ups provide a platform for caregivers to discuss the problems with respect to the patients care.
Presence of Dementia: It can also be known if the patient is susceptible to dementia with the help of regular checkups.
Dementia: It may happen so that the person with Parkinsons disease developing dementia may not be able to take care of himself or take decisions about his healthcare. Thus, caregivers should be extra careful and follow the regular follow-ups with the doctor.
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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.
What Causes Lewy Body Dementia
The causes of LBD are not yet well understood, but research is ongoing in this area. There are probably multiple factors involved, including genetic and environmental risk factors that combine with natural aging processes to make someone susceptible to LBD.
For more information, visit www.lbda.org.
Modified with permission from the Lewy Body Dementia Association
To learn more about motor symptoms related to Parkinsons, visit here.
To learn more about non-motor symptoms related to Parkinsons, visit here.
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Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Disorientation
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
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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Skin And Sweat Glands
The autonomic nervous system also controls the sweat glands of the skin. Both excessive sweating and a decrease in sweating are common Parkinsons symptoms. This may be due to a compensatory reaction to a decline of nervous function in extremities. However, Parkinsons patients with anhidrosis are rare, but it can happen.
Robin Was Very Aware That He Was Losing His Mind And There Was Nothing He Could Do About It
Schneider added: Robin was very aware that he was losing his mind and there was nothing he could do about it.
Jacqueline Cannon said of her fathers condition: He always used to say to me, Im losing my mind. We say to people that LBD is not just about memory. Its about the other symptoms that go with it, especially the hallucinations.
In the spotlight
Like Parkinsons disease there is currently no cure for LBD, and a need to raise awareness the case of Robin Williams will no doubt help. Dedicated research centres do already exist, such as the leading Biomedical Research Unit in Lewy Body Dementia at Newcastle University.
Professor Ian McKeith, president of the Lewy Body Society, believes there is cause for hope however. In a piece published by The Conversation, he wrote: Therapeutic trials have been few and far between in LBD because of a combination of a lack of compounds to test, a pre-occupation with targeting Alzheimers and a reluctance of regulatory bodies to recognise LBD. All of these are now changing and LBD is increasingly viewed as a malleable and commercially-viable target.
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Dementia Outcomes According To Baseline Motor Features
Among motor variables , the proportion of gait involvement at baseline , falls , and freezing predicted dementia. Poor performance on the Purdue Pegboard Test and alternate tap test , but not the UPDRS predicted dementia. Patients developing dementia were more likely to report bilateral onset of motor symptoms . There was no association between dementia status and PD subtype, although the dementia-converted group had slightly more patients with akinetic-rigid Schiess scores than the group without dementia . Baseline UPDRS part III scores, total UPDRS scores, Timed Up and Go, Hoehn and Yahr stage, and axial-limb ratio were not predictive of dementia status.
Do Parkinson’s Patients Get Violent
Parkinson’s disease Dementia or PD Dementia can make a patient very aggressive. Parkinson’s Dementia Aggression germinating from Parkinson’s disease Dementia can lead patients to behave erratically, experience sudden anger outbursts, feel constantly irritated, and always be in a state of restlessness.
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Hospice Eligibility For Parkinsons Disease
Due to the progressive nature of Parkinsons disease, it can be challenging for families to know when their loved one is eligible for the support of hospice care. If a loved one has been diagnosed with six months or less to live or if they have experienced a decline in their ability to move, speak, or participate in the activities of daily living without caregiver assistance, it is time to speak with a hospice professional about next steps.
Not Everyone With Parkinsons Will Develop Dementia
Despite the fact that the pathology of Parkinsons disease can trigger the development of different types of dementia, not everyone with Parkinsons will develop dementia. About 30 percent of people with Parkinsons will actually not develop dementia at all, as stated by the National Parkinson Foundation.
However, the vast majority of people with Parkinsons may experience some form of cognitive impairment over time, the foundation says.
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How Can We Support The Sleep/wake Cycle Of Pdd
For people with PDD who are confused about the day-night cycle, some daily strategies can be helpful. At night, starting a lights out routine that happens at the same hour every day, where all curtains are closed and lights are turned off, can help the person understand that it is sleep time. During the day, opening the curtains, allowing the person with PDD to spend as much time in the daylight as possible, avoiding naps, and organizing stimulating activities, can be helpful. Having lots of calendars and clocks in every room might also help a person with PDD be less confused about the time of day.
Coping With A Parkinsons Diagnosis
A diagnosis of Parkinsons can be a frightening experience for both you and your loved ones. While there is currently no cure, there are treatments available for Parkinsons symptoms and lifestyle changes you can make to slow the progression of the disease and delay the onset of more debilitating symptoms, including Parkinsons disease dementia. Early diagnosis can prolong independence and help you to live life fully for much longer.
If youve been diagnosed with Parkinsons you may feel anger, deep sadness, or fear about what the future will bring. These feelings are all normal. Its also normal to grieve as you deal with this enormous adjustment.
Give yourself some time to adjust. As with any major change in life, dont expect that you will smoothly snap into this new transition. You may feel alright for a while, and then suddenly feel stressed and overwhelmed again. Take time to adjust to this new transition.
Learn all you can about Parkinsons disease and Parkinsons disease dementia. Educating yourself and making important decisions early can help you feel more in control during this difficult time.
Reach out for support. Living with Parkinsons presents many challenges, but there is help available for this journey. The more you reach out to others and get support, the more youll be able to cope with symptoms while continuing to enrich and find meaning in your life.
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Diagnosis Of Probable Pdd
A diagnosis of probable PDD was made according to the Movement Disorder Society Level 1 criteria., Probable PDD was diagnosed when all the following five criteria were satisfied:
Diagnosis of PD according to United Kingdom Parkinsons Disease Society Brain Bank Criteria.
The development of PD prior to the onset of dementia: This information was gathered by clinicians involved in assessing participants.
PD associated with a decreased global cognitive efficiency: This was defined by a cut of score of 25 on the Mini Mental Status Examination .
Cognitive deficiency severe enough to impair daily life: The foundation of a PDD diagnosis is that the cognitive decline contributes to functional impairments most commonly observed in the activities of daily living . In the UK clinics, this was defined by the Clinical Impression of Severity Index for Parkinsons Disease . The cognitive status scale of this tool assesses the impact of cognitive decline on ADLs. The scale is scored 06, with 4 or higher suggesting that help is needed for ADLs, including help with basic daily activities. As such, any patient scoring 4 or higher met this criterion. In the Australian clinic, item 1.1 of the MDS-UPDRS was used. The scale is scored between 0 and 4 with a score of 2 or higher suggesting help is needed for ADLs, even if only minimal. As such, any patient scoring 2 or higher met this criterion.
Panel : Dementia Plus Syndromes And Associated Diseasessystemic Features
Cataracts
Myotonic dystrophy, cerebrotendinous xanthomatosis, mitochondrial disorders, familial Danish dementia
Splenomegaly
Niemann-Pick disease type C, Gaucher’s disease
Tendon xanthomas
Fabry’s disease, Lesch-Nyhan syndrome, mitochondrial disorders
Hepatic dysfunction
Wilson’s disease, Gaucher’s disease, mitochondrial disorders
Respiratory failure
Frontotemporal lobar degeneration and motor neuron disease, Perry syndrome, mitochondrial disease , anti-NMDA receptor-mediated limbic encephalitis
Gastrointestinal dysfunction
Coeliac disease, Whipple’s disease, porphyria
Anaemia
Vitamin B12 deficiency, neuroacanthocytosis , Wilson’s disease, Gaucher’s disease
Skin lesions
Behcet’s disease, systemic vasculitides and connective tissue disease, Fabry’s disease
Metabolic or infectious crises
Vanishing white matter disease, Alexander’s disease, ornithine transcarbamylase deficiency, alpha mannosidosis, porphyria
Hyponatraemia
VGKC limbic encephalitis
The dementia plus syndromes describe patterns of cognitive impairment plus additional neurological or systemic features that aid investigation and diagnosis of the underlying disease process. This list cannot be comprehensive. Note that vascular disease, structural disorders, and neoplastic disease can be associated with a wide range of presentations. POLG=polymerase , gamma. VGKC=voltage-gated potassium channel.
Neuropsychological signatures of young-onset dementia
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