Apda In Your Community
For many people, one of the most concerning non-motor features of Parkinsons disease is cognitive decline. Attention, working memory, executive function, memory, language and visual reasoning are the cognitive skills most frequently affected in PD which can be concerning because these skills allow us to perform daily functions such as paying attention, solving problems, remembering where items are and how to do certain tasks.
Cognitive changes can be an intrinsic part of PD, caused by abnormal accumulation of the protein alpha-synuclein into Lewy bodies in the thinking areas of the brain. When this occurs, there are strategies ranging from cognitive therapy to medications to help support cognitive function which you can read about here.
Todays blog will focus on a different angle on the vast array of treatable medical problems that can worsen cognitive function. These factors are crucial to identify, because if they are treated, cognitive function may improve.
Assessments Of Central Auditory Processing
Speech intelligibility in noise was assessed using the Words in Noise test in which 2 lists of 25 words are presented to each ear in the presence of background masking noise. Participants repeated each word they heard.
Computerized versions of the following tests were administered in which the audio tracks from CDs were triggered by a program written in Matlab and played through a digital-to-analog converter and amplifier connected to the inputs of a GSI-61 clinical audiometer . The sounds were then delivered to the listener via ER3A insert earphones . Playing, pausing, and repeating of test items were controlled from a computer screen interface. Tests were conducted at a minimum of 35dB sensation level .
Responses were indicated by the participant using either a verbal response or computer touchscreen tap. Participant responses were immediately entered by the tester using a graphical version of the appropriate score sheet that was displayed on a computer screen. Scoring and storage of results were performed by the computer program, as was the randomization of the order in which the tests were conducted. Subjects were encouraged to take breaks, and testing was discontinued if fatigue or frustration was evident. This portion of the testing protocol lasted approximately two hours.
Statistical Association With Clinical Variables
Multivariate mixed effect models were also fitted to test the statistical significance of a set of clinical variables. Models like the one described by Equation were fitted, in which the fixed effect variables were: levodopa equivalent daily dose , disease duration and staging, motor impairment score. All of these variables are listed in .
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How To Find A Speech Therapist
Tell your doctor If you are experiencing any changes in your speech or voice. Ask for a referral and a prescription for a speech evaluation and treatment. If you have not noticed changes in your speech, but a spouse, care partner or friend has: pay attention to their comments. The sooner you get a speech evaluation and start speech therapy, the better.
Speech therapists work in many settings, including hospitals, outpatient rehabilitation centers and private practice offices. To locate one in your area, contact the American Speech-Language-Hearing Association at www.asha.org, or find a therapist certified in the Lee Silverman Voice Treatment by visiting www.lsvtglobal.com.
Ideally, you should see a speech therapist face-toface for a complete voice and speech evaluation and treatment. However, if a speech therapist is not available in your area, LSVT LOUD the most researched voice treatment for people with PD is virtually offered in select states. The speech therapist interacts with you in your home or office live through your computer screen.
Learn more about speech and Parkinsons by reading our free book Speech and Swallowing. Order online at Parkinson.org/Books or by calling our Helpline at 1-800-4PD-INFO .
Other Possible Contributors To Cognitive Decline In Parkinsons
Hearing is not the only modifiable contributor to cognitive decline. Consider reviewing this list with your doctor to make sure that you do not need to be evaluated for any of these conditions:
Tips and Takeaways
- Although cognitive decline can be a feature of PD itself, there may be other medical issues that are contributing. Being evaluated for these issues is crucial as modifying them can have a positive impact on cognition and your quality of life.
- Therefore its very important that you tell your doctor about any changes you notice in your cognitive function so potential corrective action can be taken as early as possible.
- Hearing loss can be a treatable contributor to cognitive decline. If hearing loss is suspected, consider asking your doctor for a referral for an audiogram. Hearing aids will likely improve your well-being and may improve cognitive decline as well.
- There are many other treatable contributors to cognitive decline including: medication effects, infection, thyroid abnormalities, low Vitamin B12 levels, strokes, head trauma, orthostatic hypotension, and sleep apnea.
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Dr. Rebecca Gilbert
APDA Vice President and Chief Scientific Officer
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Fewer Accidents And Falls
Although no one knows how many falls are associated with hearing loss per year, researchers at Johns Hopkins Medicine have found that people with hearing loss are three times more likely to fall than those without hearing loss.
Hearing loss is assumed to distract from spatial awareness, which raises the risk of tripping and dropping. Other studies have pointed out the balance issues that can occur when people live with untreated hearing loss.
Better Communication And Connection With Others
Untreated hearing loss can cause social isolation, as hearing problems and “missing out” on the jokes and anecdotes in real-time frequently cause individuals to withdraw from friends, loved ones, and activities that bring them happiness.
Numerous quality-of-life issues, including depression, disease, fatigue, and even shorter life spans, are closely related to social isolation. Treatment with hearing aids helps you to hear, engage, and ensure that you’re not missing out on the people and things that make life worth living.
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Do I Need To See A Doctor About This
Parkinson.org image from Parkinsons Foundation
Given the importance of preventing falls and associated loss of independence,2 it is imperative that people with PD who suffer from dizziness discuss it with their neurologist. Dizziness can be due to many reasons. It may be due to falling blood pressure when you stand up, a primary brain-related cause or an ear-related issue. Any of these can make you feel unsteady and fall, and almost all of these falls may be preventable. Some of the causes of dizziness are reversible. In addition to falls, loss of hearing can affect your attention and has been associated with cognitive impairment.3 Your neurologist may refer you to an ENT doctor for further assessment.
Functional Hearing Impairment Common In Parkinsons Disease: Insights From A Pilot Study
D. Nene, M. Choi, A. Yu, M.S Mirian, J.A Small, L.M Jenstad, S. Appel-Cresswell
Objective: The primary objective of this pilot study was to investigate hearing and its relationship to the neuropsychiatric profile, cognition and quality of life in Parkinsons disease .
Background: Negative consequences of undiagnosed and unmanaged hearing loss such as social withdrawal, depression, and lower quality of life are well documented in the general population. Hearing impairment in Parkinsons has received only limited attention in the past, possibly because PD patients often report no perceived hearing disability yet negative consequences of hearing impairment might aggravate communication difficulties and social withdrawal.
Method: Participants with PD were recruited in a tertiary movement disorder clinic. Demographic, audiological, neuropsychiatric , cognitive screen and quality of life data was collected from each participant
Poor functional hearing was present in the majority of PD participants, occurred early in the disease, was not noticed by participants and was independent of cognition and other NMS. Functional hearing deficits in PD will require further investigation and tailored treatment.
To cite this abstract in AMA style:
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Low Vision Support Group For Older Adults
THIS PROGRAM IS CURRENTLY ON HOLD
This group meets monthly and offers individuals the opportunity to discuss their insights and challenges of living with vision loss. Additionally, participants have accessed resources that could help them understand their vision impairments and develop skills to manage daily living tasks successfully.
Meets the first Tuesday of the month
10:15 – 11:45 a.m.
Levy Senior Center Library, 300 Dodge Avenue, in Evanston, Illinois
To learn more, please email or call 847.424.5684.
Asymptomatic Hearing Impairment Frequently Occurs In Early
1Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
2Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
3Department of Audiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Parkinson’s Disease Patients Versus Controls
To compare patients with Parkinson’s disease to control subjects, an ANOVA test for repeated measurements was used. The frequency band and the ear were treated as within-subject factors . The between-subjects factor, disease, is a two-level factor, distinguishing patients from controls. Sex was included as a between-subjects two-level factor, and age was included as a covariate factor. A complete factorial model was studied.
In such a comparison between two distinct populations, the sensitivity of the results mainly depends on the testretest and inter-subject fluctuations of the diagnostic technique. At low signal levels, typical of elderly and/or impaired subjects, the advanced DPOAE technique used in this study helps to reduce these uncertainties however, PTA may still prove more sensitive, because the typical change in DPOAE levels due to sensorineural hearing loss is 50% of the audiometric change in cross-section studies .
Hearing Loss In Neurological Disorders
- 1Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline , Nanjing, China
- 2Research Institute of Otolaryngology, Nanjing, China
Sensorineural hearing loss affects approximately 466 million people worldwide, which is projected to reach 900 million by 2050. Its histological characteristics are lesions in cochlear hair cells, supporting cells, and auditory nerve endings. Neurological disorders cover a wide range of diseases affecting the nervous system, including Alzheimers disease , Parkinsons disease , Huntingtons disease , autism spectrum disorder , etc. Many studies have revealed that neurological disorders manifest with hearing loss, in addition to typical nervous symptoms. The prevalence, manifestations, and neuropathological mechanisms underlying vary among different diseases. In this review, we discuss the relevant literature, from clinical trials to research mice models, to provide an overview of auditory dysfunctions in the most common neurological disorders, particularly those associated with hearing loss, and to explain their underlying pathological and molecular mechanisms.
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Can This Information Be Used To Slow Down My Pd
Auditory strategies have been shown to improve symptoms: timing of gait and associated stability.5 Rehabilitation using Neurofeedback with auditory signals may possibly reduce the risk for falls.6 The information we have currently is not enough to suggest a disease modifying effect and thus needs further investigation.
Speech Therapy And Parkinson’s
Research shows that 89 percent of people with Parkinsons disease experience speech and voice disorders, including soft, monotone, breathy and hoarse voice and uncertain articulation. As a result, people with PD report they are less likely to participate in conversation, or have confidence in social settings than healthy individuals in their age group.
Speech disorders can progressively diminish quality of life for a person with PD. The earlier a person receives a baseline speech evaluation and speech therapy, the more likely he or she will be able to maintain communication skills as the disease progresses. Communication is a key element in quality of life and positive self-concept and confidence for people with PD.
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Summary: Electrophysiological Measurements In Pd
A summary of study findings regarding electrophysiological measurements in early stage patients with PD can be found in Table 2. Based on various AEPs, neurophysiological alterations in auditory processing have been demonstrated in the clinical stage of PD. Considering early stage PD, a careful selection of electrophysiological paradigms may be suitable to discriminate patients with early stage PD from HCs. Study results particularly suggest a pattern of centrally located ABR abnormalities in PD. However, as ABR studies in early stage PD are limited and rather inconsistent, further research is warranted. Especially because of the potential involvement of the lower brainstem during the early stages of PD pathology . Furthermore, altered long latency AEPs in early stage PD may be evident when ERP paradigms are tailored to evaluate specific and/or more complex auditory processes. Regarding paired-stimulus and intensity dependence paradigms, an increased N1/P2 amplitude in early stage patients with PD has been found. These differences disappeared following initiation with dopaminergic medication in patients with PD. Regarding selective attention and three-stimulus oddball paradigms, studies have shown a decreased Nd amplitude and a decreased or increased P3a amplitude. Regardless of the direction of the P3a amplitude alteration, shifts of the P3a component were most evident when patients with PD were evaluated with dopaminergic medication.
Warning Disclaimer Use For Publication
WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health.
DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. All information is observation-only. Our phase IV clinical studies alone cannot establish cause-effect relationship. Different individuals may respond to medication in different ways. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. The use of the eHealthMe site and its content is at your own risk.
If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date.
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Limitations Of This Study
Because the sample size of this study was relatively small, our conclusions regarding auditory or cognitive deficits associated with PD should be interpreted in context. An extensive battery of cognitive assessments was not included in the study design therefore, we collected limited data on cognitive function of participants aside from auditory processing. Also, most of the PD patients who participated in this study were in the early or less severe stages of the disease. Therefore, we do not know how more severe PD might affect auditory processing. Finally, because there was a majority of males in our study sample, especially in the control group, we cannot make any assumptions about the performance of males versus females in this population.
Assessments Of Pd Severity
The Hoehn and Yahr and Schwab and England scales were used to assess the stage and severity of PD for individuals in the patient group.
PD patients were also asked to rate their abilities during the past week for 12 activities such as swallowing, handwriting, dressing, hygiene, falling, salivating, turning in bed, walking, and cutting food .
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The Benefits Of Treating Hearing Loss
The Hearing Health Foundation found that there are more people living with hearing loss than the combined amount of people living with Parkinsons disease, epilepsy, Alzheimers disease, and diabetes. Despite the prevalence of hearing loss, researchers report that only 20% of those in need of hearing aids have sought adequate medical care.
On the positive side, recent findings indicate that people with hearing loss who use hearing aids see a rapid increase in their ability to listen and comprehend in many environments. Many individuals report an improvement, whether in their relationships at home and work, in their social lives, or in their ability to interact with loved ones and colleagues. Some also claim that they feel more active and independent.
However, without hearing treatment, there could be consequences. Researchers are exploring the correlation between untreated hearing loss and a wide range of health problems. That’s why it is essential to take the treatment of any hearing loss seriously. Here are some of the many benefits of treating your hearing loss!
Long Latency Auditory Evoked Potentials
Regarding early stage PD, the same inconclusive pattern was found . Therefore, no clear alterations in stimulus-related sound detection in the early stage of PD can be assumed based on the current results from auditory oddball paradigms. However, in the study of Beucke et al. , altered intensity dependence of AEPs was demonstrated in early stage PD. A significantly increased IDAEP of the N1/P2 amplitude, indicating low serotonergic activity, was found in unmedicated patients with PD compared to HCs. This difference was no longer evident after 12 weeks of dopaminergic treatment in patients with PD . In addition, based on a paired-stimulus paradigm, Lukhanina et al. and Lukhanina et al. demonstrated significantly reduced post-excitatory inhibition of the auditory N1/P2 complex following the second stimulus in patients with PD evaluated without dopaminergic medication state compared to HCs. Subgroup analyses based on disease stage, revealed that diminished post-excitatory auditory cortical inhibition may be evident at the early stage of the disease . Furthermore, auditory inhibition of the second stimulus seems to improve after dopaminergic intake in patients with PD .
Processing Negativity or Nd
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Tinnitus May Warn Of Increased Risk For Alzheimers Parkinsons
The study, Tinnitus and risk of Alzheimers and Parkinsons disease: a retrospective nationwide population-based cohort study, was published in the journal Nature Scientific Reports.
Rates of tinnitus increase with age and studies have found that hearing loss, as well as central auditory dysfunction more generally, are associated with higher risks of cognitive dysfunction, particularly dementia, control of attention, and working memory.
Past studies, however, have not examined the relationship between tinnitus, Parkinsons, and Alzheimers in a population-based way.
A team of researchers from various Taiwanese institutions recently examined this association using records from Taiwans National Health Insurance system. The NHI records provide a large and nationally representative patient sample with long follow-up periods, as participation is nationwide and mandatory.
They identified 12,657 tinnitus patients and 25,314 control patients without tinnitus. Over a 10-year follow up period, 398 of those with tinnitus and 501 without developed Alzheimers.
A further 211 tinnitus patients and 249 control patients developed Parkinsons.