The 5 Stages Of Parkinsons Disease
Getting older is underrated by most. Its a joyful experience to sit back, relax and watch the people in your life grow up, have kids of their own and flourish. Age can be a beautiful thing, even as our bodies begin to slow down. We spoke with David Shprecher, DO, movement disorders director at Banner Sun Health Research Institute about a well-known illness which afflicts as many as 2% of people older than 65, Parkinsons Disease.
Parkinson’s Disease Psychosis: The What When Why And How
Psychosis is a psychiatric term used in neurology to refer to a spectrum of abnormalities. Parkinsons disease psychosis is where people experience hallucinations or delusions. Hallucinations is seeing, hearing, or smelling things that dont exist. With tactile hallucinations, one can feel a presence that isnt there. Delusions are believing something that is not true, like that a spouse is being unfaithful or caregivers are stealing. In this one-hour talk, movement disorder specialist Christopher Goetz, MD, focuses on hallucinations and spends a little time on delusions.
Relationship Between Disrupted Neuronal Connectivity And Epileptic Seizures
Epilepsy is considered a disease of network dysfunction.47,48 At a microscopic level, both simple and complex partial seizures involve disruptions in the excitatory interactions between cerebral cortex pyramidal cells.49 From a neurophysiology view, the EEG-graphic representation of an epileptic event is characterized by the paroxysmal onset of hyper-synchronized sharp waves disrupting the neuronal background activity. This activity is often multifocal, reflecting a broader network dysfunction.50,51 Moreover, TMS studies demonstrate similar neurophysiologic features between epilepsy and PD characterized by a state of increased cortical excitability as indicated by reduced intra-cortical inhibition and increased intra-cortical facilitation observed in both patient populations.25,52â55 As mentioned before, in PD, cortical neurons innervating the basal ganglia become hyperexcitable, possibly as a compensatory mechanism following the incremental rise in the output threshold of striatal dopaminergic neurons. As such, it would not be surprising if this putatively maladaptive phenomenon may eventually lead to the generation of epileptiform activity. While epidemiologically, epilepsy-increased comorbidity in patients with PD remains questioned,13,56 our group published the largest case series of patients with PD with concomitant epilepsy57 raising the possibility that epileptic activity in these patients may indeed be under-diagnosed and under-recognized.
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Potential Triggers Of Psychotic Episodes
Psychotic symptoms can have many possible triggers, especially in older patients. A few contributing factors include sleep deprivation, metabolic or electrolyte imbalances, medications, and infections. Overall susceptibility is strongly associated with the patients mental status. These episodes are more likely to arise in situations where there is little stimulation, such as in the evenings or when a patient is alone in a quiet room.
As stated above, medications are often a culprit as well, since many prescribed for PD increase levels of dopamine in the brain. Parkinsons disease is caused by a malfunction and loss of neurons that produce dopamine, a neurotransmitter which functions in relaying messages to the brain that control movement and coordination. Dopamine plays a pivotal role in hallucinations and delusions, but the progression of PD on its own can impair cognition and visual processing, which can lead to Parkinsons disease dementia. According to the Alzheimers Association, 50 to 80 percent of those with Parkinsons will eventually develop PD dementia.
Characteristics Of Pd Tremors
The tremors of PD characteristically occur at rest, stop with voluntary action, and recur again after you hold your new position for a few minutes. PD tremors can affect the hands, arms, face, jaw, legs, and/or feet, and are often slightly more prominent on one side than the other.
The tremor almost always begins in the hand before affecting other parts of the body, and it usually looks like you are rolling a pill between your thumb and index finger. Thats why its called a pill-rolling tremor.
A pill-rolling tremor is the most common type of PD tremor, but shaking tremorswhich may involve the hands or other areas of the bodycan also occur.
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Phenomenology Of The Hallucinations
We grouped together in this category three types of phenomena. The most frequent type was presence hallucinations . The patient had the vivid sensation of the presence of somebody either somewhere in the room or, less often, behind him or her. In all cases, the presence was that of a person, and in one case it was also occasionally the presence of an animal . In seven cases, the presence was that of a relative . In all the other cases the presence was unidentified. The presence hallucinations were commonly as vivid as a hallucinated scene and were described as a `perception’. For instance, one patient said: `the image is behind me’, a second said: `I see someone arriving I turn back but nobody is there’, a third said: `I take a look I don’t see anything, but it is engraved in my mind’, and another said: `I have the impression that my mother is always there, that she is about to come into sight’. The passage hallucinations consisted of brief visions of a person or an animal passing sideways. If an animal was seen, the species was almost invariably specified , and in two instances it was a dog previously owned by the patient. Illusions occurred in nine patients . In five cases the illusion consisted of the transformation of an object into an animal .
Case 1 .
Case 2 .
Formed visual hallucinations
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:
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Visual Hallucinations: Differential Diagnosis And Treatment
Have you ever encountered a patient who reported isolated visual hallucinations but did not have any other symptoms of delirium or psychosis? Have you wondered which medical and neurologic illnesses may present with visual hallucinations? Have you deliberated about how best to work up and treat patients with visual hallucinations?
If you have, then the following questions and answers should serve to frame the differential diagnosis of visual hallucinations and to explore the available options for diagnostic testing and treatment.
Age And Duration Of Illness
Increased age has been associated with the presence of hallucinations. This might be explained by accerelated sensory loss or age related side effects of medication. One of the main confounders with age is duration of illness when the non-independence of these variables was controlled, Fénelon et alfound that duration of illness was the crucial factor. Grahamet al identified two subgroups of patients with Parkinsons disease experiencing hallucinosis: in those with disease duration of 5 years or less, visual hallucinations were associated with rapid progression of the motor but not the cognitive component of the disease. In the remainder with longer histories, visual hallucinations were associated with postural instability, global cognitive impairment, and the lack of depression. Goetz et al contrasted patients with Parkinsons disease who experienced hallucinations within 3 months of levodopa therapy with those who experienced hallucinations after 1 year of treatment. Diagnoses in the early onset group more often changed to Lewy body or Alzheimers disease. Lewy bodies are present to a greater or lesser degree in all cases of Parkinsons disease and are known to be associated with visual hallucinations.
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What Treatments Are Available For Parkinsons Psychosis
Your doctor may first reduce or change the PD medication youre taking to see whether that reduces psychosis symptoms. This is about finding a balance.
People with PD may need higher doses of dopamine medication to help manage motor symptoms. But dopamine activity shouldnt be increased so much that it results in hallucinations and delusions. Your doctor will work with you to find that balance.
How To Get Back Into A Fitness Routine
Everyone experiences it. Life gets too busy, other commitments pull our focus, or an injury stops the trips to the gym. Regardless of the reason, it is extremely common to fall out of a fitness routine, and it can be difficult to get back into the swing of things.However, while it might take a bit of patience, time, and drive, anybody can increase their activity level once again.
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Pathology Of Neurotransmitter Pathways In Pd Psychosis And Relevance Of Medications
The distribution of pathology in PD involves key components of dopaminergic and other important neurotransmitter pathways implicated in PD psychosis. Dopamine is synthesized in the substantia nigra, with projections to the striatum, limbic system and frontal lobe , and five recognized dopamine receptors with broad distribution throughout the brain and peripheries at varying levels of expression . It is known that dopaminergic medications have differential actions across these receptors, and, similarly, antipsychotic medications display different binding affinities for individual dopamine receptors .
While loss of dopaminergic neurons within the substantia nigra is a central pathological feature of PD , neuronal loss also occurs in multiple other subcortical nuclei with projections to cortical, limbic, and basal ganglia regions. These include the dopaminergic nuclei of the ventral tegmentum, noradrenergic locus coeruleus, serotonergic raphe nuclei, histaminergic tuberomammillary nucleus of the hypothalamus, and cholinergic nucleus basalis of Meynert and the pedunculopontine nucleus . LB deposition and neuronal loss in the locus coeruleus occurs earlier and is more prominent than PD pathology in the substantia nigra, with some evidence that pathology in this region may contribute to subsequent dopaminergic cell loss, because noradrenergic neurons directly innervate the substantia nigra .
Create A Sleep Schedule
Talking to your doctor and reviewing medications is key, but there are also lifestyle changes that may be able to help, Dr. Petrossian says. The biggest is sleep. Even without PD, poor sleep quality can cause challenges with cognitive function, and those who have PD might see worsening physical and mental health, she says. Focusing on a consistent bedtime and wake time schedule is crucial, and its also useful to avoid naps as much as possible in order to get more quality sleep at night.
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Hallucinations According To The Duration Of The Disease
We found that the prevalence of hallucinations of all types and of visual hallucinations in the 3 months preceding inclusion in the study increased with the duration of the disease. Moreover, the duration of Parkinson’s disease was an independent predictor of visual hallucinations in the multivariate analysis. Other studies gave conflicting results on the relationship between hallucinations and disease duration. In a retrospective study of 100 patients, logistic regression analysis also showed an association between `psychosis’ and an increased duration of the disease . An association between the duration of the disease and the occurrence of hallucinations was also found by some investigators but not by others .
Does Epilepsy Affect Sperm Count
Epilepsy may decrease sperm production. But this usually does not affect chances of pregnancy.
Usually, men produce a lot of sperm. Every time a male ejaculates, he releases about 40 million or more sperm!
Epilepsy may produce mild hormonal changes in men, like it does in women. This may reduce sperm production and may cause slightly higher abnormal sperms.
But due to the huge number of sperm produced, the net effect is usually insignificant.
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Parkinsons Sleep Problems: Diagnosis And Treatment
Parkinsons disease is chronic and progressive, meaning it tends to get worse over time. However, there are treatment options that can help manage symptoms and allow patients to get more restful sleep.
The simplest way to start sleeping better with Parkinsons disease is by adopting healthy sleep habits. Sleep hygiene tips for Parkinsons disease sufferers include:
- Sticking to regular bedtimes
- Following a consistent bedtime routine with soothing activities such as listening to music or reading a calming book
- Getting regular exercise, preferably early in the day
- Getting adequate exposure to light, whether outdoors or through light therapy
- Avoiding long naps and naps late in the day
- Creating a cool, dark, and comfortable sleeping environment
- Restricting bedtime activities to sex and sleep only
- Turning off screens an hour before bedtime
- Reducing liquid intake before bedtime
- Avoiding caffeine, alcohol, and tobacco
- Eating a healthy diet and avoiding large meals at night
Light therapy, exercise, and deep brain stimulation have been successfully used to improve overall sleep quality and to treat specific conditions, such as REM sleep behavior disorder, in patients with Parkinsons disease. Cognitive behavioral therapy for insomnia has proven effective at reducing insomnia in healthy adults, although further research is needed on the effects of CBT in patients with Parkinsons disease.
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How Is Myoclonus Diagnosed
Following a review of the persons medical history and physical exam, a physician may order additional tests to confirm the diagnosis of myoclonus:
- Electromyography , which measures electrical activity of muscle, is the commonly used method to diagnose myoclonus as well as nerve and muscle dysfunction
- Electroencephalography uses electrodes attached to the scalp to record the electrical activity of the brain that may trigger the myoclonic jerk
- Evoked potential studies capture the electrical activity in the brain, brain stem, and spinal cord evoked by specific stimuli
- Laboratory urine or blood tests for possible causes and to rule out other conditions that may cause symptoms similar to myoclonus
- Magnetic resonance imaging , using computer-generated radio waves and a magnetic field, to produce three-dimensional images of the brain, spinal cord, nerve, and other tissue .
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Management Of Visual Hallucinations In Pd
Understanding the complex interactions between neurotransmitter systems in the context of neurodegeneration secondary to PD assists in efforts to treat psychotic symptoms as they arise. Management is complex and varies between patients. The first consideration should most obviously be prevention. When these symptoms occur acutely, systemic illness should be considered and treated. When symptoms persist, an increasing array of treatment options are available and can be tailored to the individual patient. A treatment algorithm is presented in .
FIGURE 1. Management flow chart for visual hallucinations in Parkinsons diseasea
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Next Step: Get A Health Screening
If you think you may have had your first hallucination, its important to talk to your health provider about whats going on. Especially if your hallucinations have come on quickly or are dramatically different, there may be something else going on, like a urinary tract infection, which is associated with cognitive changes in older patients, says Melita Petrossian, M.D., a neurologist at Providence Saint Johns Health Center in Santa Monica, CA. You may also be having vision issues, so that should also get checked, as well as your mental health.
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Can A Woman With Epilepsy Have A Baby
Certainly and definetely!
A woman with Epilepsy can get pregnant. A woman with Epilepsy can have a baby. Many women with epilepsy have babies every year.
So no, neither epilepsy nor epilepsy medications decrease fertility in women drastically!
You need to be well informed about pregnancy in epilepsy. Also, there are some extra things to take care of.
These articles cover almost everything you need to know about pregnancy in Epilepsy.
Treatment Options For Pd Psychosis
Treating psychosis is truly a challenge. Unfortunately, only 10 to 20 percent of people with PD psychosis actually inform their doctor of their symptoms. Dr. Dewey speculates that stigma and fear of embarrassment prevent many patients from seeking help.
When new symptoms of any kind arise, it is crucial to make a doctors appointment to discuss the issue. A physician will first try to determine whether there is an underlying illness that could be causing psychotic behaviors. Treating the underlying cause is one of the simplest ways of minimizing these episodes.
When there is no other identifiable source, doctors often turn their attention to the medications that the patient is taking. Gradually decreasing the dosage of dopamine-enhancing medication may reduce psychotic symptoms, but the obvious trade-off is that the persons motor function is likely to deteriorate more rapidly. Balancing risks and benefits is a delicate and complicated process that often involves a three-step approach, including assessment and planning, adjusting or reducing any medications, and initiating antipsychotic therapy.
Medical research produces discoveries continually, so keeping an ongoing dialogue open with your loved ones doctor should be a priority. Finding the best balance of treatment is crucial for optimum care and quality of life.
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Hallucinations And Delusions In Parkinsons Disease
This blog post is based on the latest research and a Parkinsons Foundation Expert Briefing about hallucinations and delusions in Parkinsons. After an explanation of what hallucinations and delusions are, there are tips for what to do, how to minimize these behaviors through lifestyle changes, and medication treatment options.
Medications Used For Treating Psychosis
Antipsychotic agents are designed to balance abnormal chemical levels in the brain. Up until the 1990s, the use of antipsychotics in PD was controversial because the drugs used until that time work by reducing excess dopamine. This alleviated psychosis but caused dramatic worsening of PD motor symptoms.Fortunately, medications that are better tolerated by people with PD are now available. Today, there are three antipsychotic medications considered relatively safe for people with PD. They cause limited worsening of PD while treating hallucinations and delusions.
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