Impulsive And Compulsive Behaviours In Parkinson’s
Impulsive and compulsive behaviours are a possible side effect of some Parkinsons drugs. This information describes what they are, why they might happen and how to manage them.
In this information we use the term impulsive and compulsive behaviours to include all the different types of behaviour you may experience. But you may also hear the phrase Impulse Control Disorder used to describe some of these behaviours.
Key points:
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Not everyone who takes Parkinsons medication will experience impulsive and compulsive behaviours, so these side effects should not put you off taking your medication to control your symptoms.
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Impulsive and compulsive behaviours can have a serious impact on the person affected and those around them so speak to your healthcare professional as soon you notice any changes.
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Asking your specialist to make changes to your medication regime or adjust the doses that you take is the easiest way to control these behaviours.
People who experience impulsive and compulsive behaviours cant resist the temptation to carry out an activity often one that gives immediate reward or pleasure.
Impulsive and compulsive behaviours happen when a person has an overwhelming urge to behave in a certain way. They will often carry out their behaviour repetitively as a way to reduce the worry or tension they get from their urge. Some people continue to act in this way without thinking and even when they no longer get any pleasure or reward from the activity.
Addictive gambling
Language Dysfunction In Parkinsons
There are several functions within language, including naming objects, generating words, comprehension, and verbal concepts. PD most often affects a persons ability to find a word, although as PD progresses, additional language difficulties may develop, including difficulty naming, difficulty comprehending information, and the use of more simplified and less spontaneous speech.3,4
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
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The Profile Of Memory And Cognitive Changes
Even in the very early stages of Parkinson’s disease people can have difficulty with their thinking processes. Most authorities agree that the primary difficulty lies with the so-called executive cognitive functions.
Executive cognitive functions refer to such thinking processes as memory retrieval, planning, generation of words or concepts, attention, and monitoring and adjustment of non-routine and goal-directed behaviors. The common denominator in all of these executive functions is that they require cognitive control in order to operate smoothly.
The term cognitive refers to processes or operations involved in the processing of all kinds of information. So cognitive control processes are those processes that are used by the mind and brain to regulate the storage, retrieval, and usage of information .
Problems with executive functions are typically mild in early PD. They usually involve a generalized slowing of cognitive processing speed and subtle deficits in attention and working memory. It may be difficult, for example, to hold two different pieces of information in the mind at the same time, or to efficiently generate words and concepts as quickly as one used to. As the disease progresses, these executive cognitive deficits are made more severe by common Parkinson-related mood disorders and Parkinson-related emotional problems such as depression and anxiety.
Memory Difficulties In Parkinsons
The most common difficulty for people with PD is remembering information that has previously been learned. Memory has several different processes and types, and people with PD have trouble recalling information but their long-term memory function generally remains intact. Memory cues or choices can help people with PD to retrieve information from the brains long-term storage.3,4
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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
How Are These Mental Health Problems Treated
Your doctor will first want to check if your hallucinations, delusions, or paranoia are caused by other medical conditions. They’ll check for imbalances in chemicals in your blood that help send nerve signals.
They may also check to see how well your kidney, liver, or lungs are working, as well as test for certain infections. All of these issues could cause mental health problems.
Other medications that you may be using, including over-the-counter drugs, could also play a role in your mental health. Tell your doctor about all the medicines you take, including herbs and supplements.
Often the medications used to treat Parkinson’s disease can cause mental health problems. Your doctor may suggest you switch to a different drug or change your dose. If changing your Parkinson’s medication causes your Parkinson’s symptoms to get worse, your doctor may recommend you stick with it but take antipsychotic drugs at the same time.
There’s a chance that an antipsychotic medicine you take is making your Parkinson’s worse. If that happens, you have alternatives. The medication pimavanserin was approved by the FDA to specifically treat psychosis that goes along with Parkinson’s disease. Other drugs, such as olanzapine , quetiapine , and clozapine can control hallucinations at low doses without making your Parkinson’s symptoms worse.
If you feel depressed or notice any mental health problems, talk to your doctor right away. There’s likely a remedy that will make you feel better.
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How Can We Manage Hallucinations
It may not be necessary to treat all hallucinations of a person with PDD. Hallucinations are often harmless, and it is okay to allow them to happen, as long as they are not disruptive or upsetting to the person or surroundings. Sometimes, recognizing the hallucination and then switching the topic might be an efficient way of handling frustrations that occur because of a hallucination. If hallucinations need medical treatment, your provider may be able to discuss and suggest some options. However, many of the medications used to treat hallucinations may make movement symptoms worse.
What Causes Parkinson Disease
Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.
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Fatigue In Parkinsons Disease
Fatigue is a common but under-recognized problem for people with Parkinsons disease . Fatigue can be defined as an unpleasant sensation of lacking energy, making the performance of routine activities, physical or mental, a strain. People with PD may experience physical fatigue, mental fatigue, or both. Fatigue in PD is not the same as the feeling you might get at the end of a hard days work. It is not necessarily something that goes away with rest. When people with PD are asked about fatigue, they use phrases such as, I feel run down, I am out of energy, I am unable to do anything, I cant get motivated.
Fatigue in Parkinsons Brochure
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Fatigue is common in PD
Fatigue and Depression
There is a large overlap between fatigue and other problems in PD, especially depression and sleep disorders. People with fatigue are more likely to be depressed and people who are depressed are more likely to be fatigued, but there is nonetheless a large group of PD patients who are fatigued but not depressed. Depression in PD typically responds to antidepressant treatment, and depression-related fatigue may improve with such treatment.
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Fatigue and Sleep disorders
Causes of Fatigue
What Other Things Help
There are various ways to help a person with PDD. Speech therapy may help improve communication between people with PDD and others. Physical therapy may help strengthen and stretch stiff muscles and help to prevent falls.
Research has shown that physical exercise helps to enhance brain health and improves mood and general fitness. A balanced diet, enough sleep and limited alcohol intake are other important ways to promote good brain health. Other illnesses that affect the brain, such as diabetes, high blood pressure and high cholesterol, should also be treated if present.
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What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
What Causes Parkinson’s Disease Dementia
Doctors don’t yet know the exact cause of Parkinson’s disease dementia, but they think it has to do with an accumulation of a protein called alpha-synuclein. When it builds up in the brain, it can create clumps called “Lewy bodies” in nerve cells, causing them to die.
The death of those cells usually results in the motor symptoms typically associated with Parkinson’s disease. As Parkinson’s disease progresses, those Lewy bodies may eventually damage the brain and cause problems with memory and thinking.
While many people with Parkinson’s disease experience cognitive changes, not all of them will go on to develop dementia. It’s estimated that between 50% and 80% of individuals with the disease eventually develop Parkinson’s disease dementia, usually in the later stages of the disease.
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One Of The Most Difficult Neurological Disorder Symptoms Of Parkinsons
Why might this be important to families challenged by PD? Because the biggest source of conflict in families occurs when loved ones fail to recognize that a person with brain changes is not the same person who existed at an earlier time in life. Human beings greatly value continuity in personality but by expecting the person to be the same as they once were, loved ones are unfair to the person with brain insult. This person could no more return to an earlier personality state than he or she can will away tremors or rigidity. Energy expended in any way other than coming to terms with this new person is fruitless. There is actually some fascinating research in this area and it is likely to be a topic for a great deal more discussion in future blogs.
Because of the greater likelihood for executive dysfunction and dementia, personality change is easier to see among individuals with more advanced PD. Motivation is frequently affected, resulting in apathy that diminishes how actively an individual interacts with other people and with the world . Thinking or cognition changes can cause the person to process information more slowly and with less focus and concentration . A previously methodical, consistent individual often becomes increasingly chaotic in their response to their environment . One easily becomes less interested and hopeful about the future .
What Is Parkinsons Disease
Parkinsons is a neurological illness caused by degeneration or breaking down of cells in the nervous system, explained Dr. Shprecher. The nature of Parkinsons Disease is progressive, meaning that it gets worse over time. To comprehend the natural progression of the disease, we should understand its five stages, as explained by the Parkinsons Foundation.
Stage One
Individuals experience mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. They may also experience changes in posture, walking and facial expressions.
Stage Two
Symptoms worsen, including tremor, rigidity and other movement symptoms on both sides of the body. The person is still able to live alone, but daily tasks are more difficult and lengthier.
Stage Three
This is considered mid-stage. Individuals experience loss of balance and slowness of movements. While still fully independent, these symptoms significantly impair activities such as dressing and eating. Falls are also more common by stage three.
Stage Four
Symptoms are severe and limiting. Individuals may stand without help, but movement likely requires a walker. People in stage four require help with daily activities and are unable to live alone.
Stage Five
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Mild Memory And Thinking Problems
Mild memory and thinking problems can be a normal part of getting older. But sometimes, these symptoms are caused by Parkinsons.
This is when you have symptoms such as forgetfulness, problems concentrating and difficulty making decisions, but you can still manage your day-to-day life.
Mild memory and thinking problems are common in Parkinsons and can happen at any stage of the condition, but not everyone with Parkinson’s has these symptoms.
If you do experience these symptoms, your doctor may describe it as mild cognitive impairment .
Its normal to worry if youre experiencing memory and thinking problems, but it doesnt necessarily mean you have dementia, or that you will develop it in the future.
Dementia in Parkinsons is diagnosed when thinking and memory problems are steadily getting worse over time and affect everyday life and daily tasks such as cooking, cleaning and dressing.
When To See A Doctor
If your forgetfulness symptoms are significantly interfering with your day-to-day, schedule an appointment with your doctor. He or she will perform tests to determine the cause and degree of your memory impairment. After the initial evaluation, your doctor may suggest:
- Therapy: Working with a professional is the best way to address underlying problems like depression or anxiety that may be contributing to memory problems.
- Medication: There are currently several medications available for treating some forms of dementia.
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How Do I Prevent Falls From Common Hazards
- Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
- Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
- Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
- Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
- Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
- Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.
Mood And Memory Changes In Parkinson’s Disease
Most people with Parkinsons disease notice some decline in their memory and mental agility, even very early in the course of the disease. Chances are that your PD will also affect your thinking to some extent. But the effects are subtle.
For example, you may notice that it takes you a bit longer to retrieve a memory, come to a decision, calculate a cost or plan a trip. This overall mental sluggishness is influenced by your mood and, in turn, your memory struggles can sometimes negatively influence your mood as well.
The good news is that new research has begun in the area of cognitive rehabilitation that can very effectively reverse this mental sluggishness.
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