Parkinsons Disease And Anxiety: Why Does Anxiety Happen
People with Parkinsons disease experience a number of different symptoms. As well as tremor, rigidity and slow movement, many PD patients feel depressed or anxious and struggle with the emotional impact of their illness.
Around 31% of people with Parkinsons disease will experience significant symptoms of anxiety. Those with early-onset Parkinsons are thought to have a higher risk of developing anxiety than older patients. Its unclear whether this occurs due to chemical changes in the brain, Parkinsons medication side-effects or a combination of social, environmental and genetic factors, though scientists are devoting more research to this area.
According to Richard Brown, Professor of Neuropsychology and Clinical Neuroscience at Kings College London:
Anxiety, like all behavior and emotion, is ultimately controlled by our brain. Anxiety is related to a complex set of brain areas and chemicals, many of which are affected in Parkinsons.
There is no cure-all treatment for anxiety stemming from Parkinsons disease because the cause of anxiety in PD is difficult to determine. If you experience anxiety with Parkinsons disease, your doctor will suggest appropriate treatment that takes all of your PD symptoms into account.
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Treatment Of Nonparkinsonian Symptoms
Although motor symptoms are the cardinal features of PD, most if not all patients will also manifest symptoms in other spheres. Depression is particularly common and frequently antedates the motor disorder. Clinical experience shows that tricyclic antidepressants and selective serotonin reuptake inhibitors are very efficacious in this condition, with a dose and adverse event, profile similar to that of other patients. Amitriptyline, which has a marked antimuscarinic action, may adversely affect the constipation, while reducing the severity of parkinsonian tremor.
Cognitive deterioration in PD may start, even before motor symptoms appear , but more frequently characterizes the advanced stages of the disease. The underlying mechanism probably relates to cholinergic loss and is thus similar to AD. It is therefore not surprising that treatment with acetylcholinesterase inhibitors is effective in demented patients with PD. Interestingly, the motor manifestations are not made worse. Although data arc still meager, they seem to favor rivastigmine over donepezil.
The autonomic dysfunction in PD is another frequently problematic area. The most significant, of all is constipation, which commonly antedates the diagnosis and is frequently exacerbated by the antiparkinsonian drugs. Clinical experience again suggests that, the usual therapies arc useful.
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.
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Whats The Difference Between Dementia With Lewy Bodies And Parkinsons
In dementia with Lewy bodies, dementia always appears first. There can also be changes in alertness as well as visual hallucinations. However, because of the presence of Lewy bodies throughout the entire brain, characteristics of this disease not only include cognitive characteristics, but also physical, sleep, and behavioral changes. As the disease progresses, the motor symptoms common to Parkinsons such as tremor, slowness, stiffness, and walking and balance problems will appear.
For more information on dementia with Lewy bodies, visit www.lbda.org.
What To Expect From Your Doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Do you have symptoms all the time or do they come and go?
- Does anything seem to improve your symptoms?
- Does anything seem to make your symptoms worse?
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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.
Speech And Occupational Therapy
Parkinsons disease can lead to slurred speech and difficulty swallowing. A speech and language therapist can provide muscle training techniques that may help overcome some of these problems.
An occupational therapist can help identify everyday tasks that can be challenging and work with the person to find practical solutions.
This may include new strategies for dressing, preparing meals, performing household chores, and shopping. Adaptations to the home environment can also make daily living easier.
For people with Parkinsons disease, deep brain stimulation may help manage:
- tremor
- an electrode inside the part of the brain that controls movement
- a pacemaker-like device, or neurostimulator, under the skin in the upper chest
- a wire under the skin connecting the neurostimulator to the electrode
The neurostimulator sends electrical impulses along the wire and into the brain via the electrode. These impulses can prevent symptoms by interfering with the electrical signals that cause them.
There is a small risk of brain hemorrhage, infection, and headaches. Some people may see no improvement, or their symptoms may worsen. There may also be discomfort during stimulation.
Nevertheless, the AAN considers this treatment safe and effective for specific people and say any adverse effects are usually mild and reversible. Anyone considering this treatment should discuss the pros and cons with a healthcare professional.
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Cerebral Effects Of Chronic Stress In Pd
As outlined earlier, chronic stress influences the brain both at the systems level and at the molecular level . Through these changes, chronic stress may affect PD brains by increasing the susceptibility to depressive and anxiety disorders, while also potentially impacting the already injured dopaminergic nigrostriatal system in patients with PD. Although this remains highly speculative at this stage, the following mechanisms may contribute to these effects.
FIG. 2
Another way in which stress might influence PD disease progression is by depleting compensatory mechanisms. In PD, clinical symptoms usually become apparent when > 50% of dopaminergic cells are lost. This suggests that compensatory mechanisms must take place in the early phase of PD to prevent overt clinical symptoms. These compensatory mechanisms are thought to take place both in the striatal dopamine system and at the level of large-scale brain networks. Under stressful conditions, the residual dopaminergic function is compromised, and attentional resources are depleted, in a similar way as dual tasking does. This may âunmaskâ clinical symptoms that were not seen before or increase the severity of already manifest symptoms.
How Important Is It That I Take My Medication
Parkinsons medications aim to maintain the right level of dopamine in your brain at all times. This means that the dosing schedule of your medication is extremely important. If you miss tablets, or take them late, the symptoms of your Parkinsons disease will come back. In advanced Parkinsons, this can mean that people struggle to move at all, or even swallow.
You could try setting alarms on your phone, or even using a pillbox reminder. Use whatever works to help you with remembering to take your medications at the right times.
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General Advice On Taking Oral Antiparkinsonian Drugs
- Drugs improve most patients quality of life and the activities of daily living, even though they cannot cure Parkinsons disease nor prevent disease progression.
- Long-term use of antiparkinsonian drugs is usually necessary and abrupt withdrawal of the medication without medical supervision should be avoided.
- Good self-care can benefit patients enormously. Self-care includes things that you do to maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions like having a balanced diet with regular exercise and adequate rest.
- Be familiar with the name and dosage of the antiparkinsonian drugs you are taking. Be cautious of their possible side effects.
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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
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How Is Parkinsons Disease Diagnosed
There is no specific test for Parkinsons disease. If your GP thinks you may be suffering with Parkinsons, then they will refer you to a specialist. This may be a neurologist, or a geriatrician who specialises in Parkinsons in older people.
The specialist will do an examination, and if Parkinsons disease is likely, they will prescribe medications to increase the levels of dopamine in the brain. If the symptoms improve, then this confirms the diagnosis.
If investigations are done, they will be done to rule out other conditions which may be causing the symptoms. For example, a brain scan to rule out a tumour, or blood tests to rule out vitamin deficiencies.
What Is The Difference Between Parkinsons Disease And Parkinsonism
Parkinsons disease is a neurodegenerative disorder that leads to movement symptoms and non-movement symptoms. It is sometimes called idiopathic , but the cause is believed to be a combination of genetic and environmental factors.
Parkinsonism is a more general term that encompasses the symptoms of Parkinsons disease. A variety of disorders or syndromes can lead to Parkinsonism, and these syndromes can lead to faster progression of symptoms, increased falling, presence of hallucinations, and can be non-responsive to levodopa .
The majority of people with the symptoms of Parkinsons disease will be diagnosed with idiopathic Parkinsons disease. Between 10% to 15% of these people will be diagnosed with Parkinsonism that is caused by something else.
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Who Are At Risk Of Developing Drug Included Parkinsonism
Some patients may be at a higher risk of developing medication-induced Parkinson
ism than others. Some of the risks include-
Women: Women are seen to be two times as much at risk of having drug inducing Parkinsons disease than men.
AIDS Patients: People with AIDS are at a higher risk.
Family History: Patients having a family history Parkinsons disease are at a higher risk of having drug induced Parkinsonism.
Elderly: Since elder people are usually on multiple medicines, they are at risk of having drug induced Parkinsonism.
Dip Can Easily Be Misdiagnosed As Pd
Both DIP and PD have identical symptoms, which makes certain cases extremely hard to differentiate and can lead to DIP being misdiagnosed by PD. These symptoms can include some or all of the following: tremor, resting tremor, muscle stiffness, impaired speech, slow gait and movements, and problems with posture and balance. Collectively, these symptoms are known as parkinsonism. In some cases, these symptoms have also been called atypical Parkinsons disease, secondary parkinsonism, or Parkinsons plus. Of course parkinsonism can be caused by PD, but it can also occur as a result of DIP. The main difference between parkinsonism associated with DIP and PD is that parkinsonism associated with DIP generally comes on rapidly, while parkinsonism associated with PD tends to develop gradually.
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Whats The Difference Between Vascular Parkinsonism And Parkinsons
As the name implies, vascular parkinsonism is caused by cerebrovascular disease which affects the blood supply to the brain. Vascular parkinsonism is caused by one or more small strokes, while Parkinsons is caused by a gradual loss of nerve cells. One major difference from Parkinsons is that its not progressive, while Parkinsons becomes worse with time. Another difference is that there are no tremors in vascular parkinsonism.
For more information on vascular parkinsonism, read this journal article.
What Is The Treatment For Parkinsons Disease
There is no cure for Parkinsons disease. Medications which are given to you will be aimed at increasing the levels of dopamine in your brain, which helps to reduce tremor and jerky, slow movements.
There are three main types of drug categories which can be used to achieve this, and some people will find certain drugs more useful than others.
It may take a while to achieve a medication regime which works. Medications are started on low doses and increased over time to try to reduce side effects.
Over time, as the natural levels in the brain decrease, medications may need to be increased, changed, or new ones added. You will continue to be followed up by a specialist who will make these changes and discuss the options with you.
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Some Cases Of Parkinsonism Can Be Reversed Others Cannot
In most cases, drug-induced parkinsonism can be reversed once the medication causing the problem is eliminated. However, it can take some time for an individual to return to normal. Depending on the medication and its effects, it can take anywhere from 4-18 months for DIP to resolve itself. In some cases, however, parkinsonism may continue even after the medication has been stopped for more than 18 months. This happens when an individual already has a dopamine deficit that was not caused by the medication. In these cases, that individual was already going to develop PD at some point, however DIP accelerated the process.
Dr. Kashouty, a diplomate of the American Board of Psychiatry and Neurology , practices general neurology with fellowship trained specialization in clinical neurophysiology. Dr. Kashouty finds the form and function of the nerves and muscles the most interesting part of neurology, which is what led him to specialize in neurophysiology with more emphasis on neuromuscular conditions. He treats all neurological diseases, but his main focus is to treat and manage headaches, movement disorders and neuromuscular diseases.
When To Be Suspicious Of Medications
In many cases, symptoms of Parkinsons could be caused by a new medication that was started a few days or a few months ago.
In other cases, it could be caused by medications that start out at one dose and are increased to higher doses. If the dose increases move too quickly, that can also cause these symptoms.
Other factors also make it more likely that someone will develop Parkinsons symptoms from medications. These include having a history of:
- Dementia
- Strokes or transient ischemic attacks
- Parkinsons in the family
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Environmental Toxins And Parkinsons Disease
Parkinsons disease is said to be because of the loss of dopamine-releasing nerve cells in a small, central part of the brain called the substantia nigra. The substantia nigra produces dopamine, which helps coordinate movement in our body.
But when nigral nerve cells are impaired, less dopamine is released and motor function is affected. And thats when hallmark Parkinsons symptoms including tremors, difficulty balancing, and slowed movement start to set in.
Several studies have suggested that environmental toxicants including pesticides, herbicides, and other pollutants are linked to an increased risk of developing Parkinsons disease.
Heres how these chemicals are said to play a role in the development of the neurological disorder:
Whats The Difference Between Multiple System Atrophy And Parkinsons
Parkinsons and MSA both affect the movement control system and the involuntary autonomic control system and early symptoms can make a differential diagnosis a challenge. MSA, however, tends to progress faster than Parkinsons balance problems and a stooped posture happen earlier and get worse more quickly with MSA and autonomic functions such as blood pressure, heart rate, breathing, sweating, bladder function, and sexual problems are more severe in people with MSA.
For more information on multiple symptom atrophy, read this fact sheet.
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Controlled Release Madopar And Sinemet
Controlled release preparations have the letters CR or HBS after the drug name.
These let the levodopa enter your body slowly instead of all at once. They can increase the time between doses.
They may be used when the dose of standard levodopa starts to wear off and the person taking it no longer feels the treatment is effective.
Controlled release options can sometimes reduce involuntary movements .