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
What Can You Expect From Parkinsons Disease
Because Parkinsons disease follows a broader pattern, it moves at different speeds among different people and brings out changes at a different rate. An individual affected by the disease shows the symptoms over a period, and they become worse with time. It is also possible for the patients to show new signs from time to time throughout the period.
The Parkinsons disease does not have any effect on your lifespan. However, it does possess the ability to change on how you lead the life. What we are talking about is the quality of life. Parkinsons disease changes it, and after a decade, many people will show some significant symptoms such as physical disability or dementia.
Treating Behavioral Issues In Parkinsons
The treatment of ICDs in PD is to lower dopaminergic medications. Often this is challenging because the medications are needed to treat the movement disorder aspect of PD. Stopping PD medications altogether in order to treat an ICD is usually not practical. However, stopping or reducing the dose of the suspected agent often helps.
Particularly when lowering or stopping a dopamine agonist, care has to be taken not to precipitate a withdrawal syndrome. Lowering a dopamine agonist slowly is therefore essential. Symptoms of withdrawal could include irritability, depression and even suicidality. Patients and care partners should therefore be warned about the possibility of withdrawal when the dose of a dopamine agonist is lowered.
Regardless of the pharmacologic intervention used to treat ICDs, behavioral measures are also an important part of management. Behavioral measures are especially important because they can prevent some of the consequences of such behaviors. Behavioral interventions include taking away credit and bank cards, and limiting account access in the case of gambling. Restricting use of the Internet and video player can help in some cases for hypersexuality. For some ICDs 12-step gambling groups can also be helpful.
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How Does Parkinsons Disease Affect The Body
Recognising the signs
A combination of signs can help a doctor make an early diagnosis. If Parkinsons disease is diagnosed early, the chances of being able to treat and manage the condition are greater. Individual signs may not be an indication of Parkinsons disease. Some signs such as loss of smell could be caused by an infectious illness, or joint stiffness by conditions like arthritis.
Parkinsons is most commonly diagnosed with a very physical examination and assessment of a persons medical history. There are very specific markers for diagnosis which doctors use to assess for possible Parkinsons disease. These markers have a lot to do with a combination of very specific signs and symptoms and if recognised early enough, can be better managed.
1. Primary motor symptoms
2. Secondary motor symptoms
Other motor symptoms include:
Some individuals may also experience the following:
- Hunched over / stooped posture – When standing, the body may begin to slouch or lean inwards, causing a hunched over appearance.
- Impaired gross motor coordination
- Impaired fine motor dexterity and motor coordination
- Difficulties with swallowing or chewing
- Cramping
- Production of excess saliva and drooling
- Sexual dysfunction
- Dystonia
- Akathisia
3. Non-motor symptoms
Symptoms that do not involve physical movement or coordination, and often precede motor problems, can include:
Symptoms are initially mild, even if they develop suddenly, and typically affect one side of the body at first.
Medicines For Parkinson’s Disease
Medicines prescribed for Parkinson’s include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.
People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinsons symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
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What Causes Parkinson’s Disease
Parkinsons disease occurs when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.
How Do Symptoms Progress
The most common symptoms of Parkinson’s are tremor, rigidity and slowness of movement.
Not everyone with Parkinson’s experiences the same combination of symptoms they vary from person to person.
Also, how Parkinson’s affects someone can change from day to day, and even from hour to hour. Symptoms that may be noticeable one day may not be a problem the next.
Many of the symptoms can be treated or managed with medication and therapies.
Many people with Parkinson’s lead active and fulfilling lives. An important part of coping with Parkinson’s is understanding how it affects you and how to work around it.
It may not always be easy to maintain a positive outlook, especially immediately after diagnosis. But we can give you help and support.
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What Is Parkinson’s Disease
Parkinson’s disease is the second most common neurodegenerative disorder and the most common movement disorder. Characteristics of Parkinsons disease are progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.
The progression of Parkinson’s disease and the degree of impairment varies from person to person. Many people with Parkinson’s disease live long productive lives, whereas others become disabled much more quickly. Complications of Parkinsons such as falling-related injuries or pneumonia. However, studies of patent populations with and without Parkinsons Disease suggest the life expectancy for people with the disease is about the same as the general population.
Most people who develop Parkinson’s disease are 60 years of age or older. Since overall life expectancy is rising, the number of individuals with Parkinson’s disease will increase in the future. Adult-onset Parkinson’s disease is most common, but early-onset Parkinson’s disease , and juvenile-onset Parkinson’s disease can occur.
How Bad Does Parkinson’s Get
Symptoms usually get worse over time, and new ones probably will pop up along the way. Parkinson’s doesn’t always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.
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Changes In Sleeping Patterns
As Parkinsons progresses, you can also develop problems with sleep patterns. These may not happen in the early stages, but can be noticeable later. You might wake up often in the middle of the night or sleep more during the day than you do at night.
Another common sleep disturbance for people with Parkinsons is rapid eye movement sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable if someone is sharing your bed. Dr. Rundle-Gonzalez says many times a bed partner will be the one to notice sleep problems.
REM sleep behavior disorder can also happen in people who dont have Parkinsons. However, if this isnt something youve dealt with before, its likely related to your disease. There are medications your doctor can prescribe to help you sleep comfortably through the night.
Parkinson’s Disease Symptoms: Life Expectancy
Even though Parkinson’s disease is a serious, progressive condition, it is not considered a fatal illness. People who have Parkinson’s disease usually have the same average life expectancy as people without the disease.
But when the disease is in its advanced stages, Parkinson’s symptoms can lead to life-threatening complications, including:
- Falls that lead to fractured bones
- Pneumonia
- Choking
Thinking about the progression of Parkinson’s disease can be frightening. But proper treatments can help you live a full, productive life for years to come. And researchers hope to one day find ways to halt the progression of Parkinson’s and restore lost functioning.
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What Does Parkinson’s Do To The Brain
Deep down in your brain, there’s an area called the substantia nigra, which is in the basal ganglia. Some of its cells make dopamine, a chemical that carries messages around your brain. When you need to scratch an itch or kick a ball, dopamine quickly carries a message to the nerve cell that controls that movement.
When that system is working well, your body moves smoothly and evenly. But when you have Parkinson’s, the cells of your substantia nigra start to die. There’s no replacing them, so your dopamine levels drop and you can’t fire off as many messages to control smooth body movements.
Early on, you won’t notice anything different. But as more and more cells die, you reach a tipping point where you start to have symptoms.
That may not be until 80% of the cells are gone, which is why you can have Parkinson’s for quite a while before you realize it.
Understanding Why Some Days Are Good Or Bad Is Still A Mystery
I understand the fluctuations that Parkinsons Disease patients experience during the day as reflecting their medication levels, their activities, their sleep, their social interactions and a number of other social and physical stresses and strains that I dont know about. But I have little idea of why the average Parkinsons Disease patient will tell me that theyve had a good few days or a bad few days, without any noticeable change in their medications or in their environment. Although I dont understand these variations, I try to teach my patients that after we make a change in their treatment regiment, to give the change a week or so, if possible, to see what changes occur. When they report that the change resulted in a decline the first day, I ask for patience, since many a patient will have such a decline without a change in anything. We need to see a pattern emerge, and that may take a week or so.
If any patients have figured out what makes a good or a bad day, Id love to hear from you.
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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.
How Long Does It Take For Parkinsons Disease To Progress
It is quite common for any individual suffering from Parkinsons disease to wonder about the unfolding of the condition. If you belong to the group that in search for the answers related to the progression of Parkinsons disease, then you will try to learn about the symptoms that you can acquire with the condition, when they start, and the changes the disease brings in the body.
The questions are basic, but Parkinsons disease is not. Like other illnesses, Parkinsons disease does not have a specific path of progression. Due to this, it is difficult to state or pin down the exact time or the path of the progression.
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Memory Or Thinking Problems
Having issues with thinking and processing things could mean your disease is progressing. Parkinsons is more than a movement disorder. The disease has a cognitive part as well, which means it can cause changes in the way your brain works.
During the final stage of the disease, some people may develop dementia or have hallucinations. However, hallucinations can also be a side effect of certain medications.
If you or your loved ones notice that youre getting unusually forgetful or easily confused, it might be a sign of advanced-stage Parkinsons.
How Does Parkinson’s Affect The Body
The telltale symptoms all have to do with the way you move. You usually notice problems like:
Rigid muscles. It can happen on just about any part of your body. Doctors sometimes mistake early Parkinson’s for arthritis.
Slow movements. You may find that even simple acts, like buttoning a shirt, take much longer than usual.
Tremors. Your hands, arms, legs, lips, jaw, or tongue are shaky when you’re not using them.
Walking and balance problems. You may notice your arms aren’t swinging as freely when you walk. Or you can’t take long steps, so you have to shuffle instead.
Parkinson’s can also cause a range of other issues, from depression to bladder problems to acting out dreams. It may be a while before abnormal movements start.
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Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes difficulty swallowing, chewing, and speaking urinary problems or constipation skin problems and sleep disruptions.
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
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What Are The Later Secondary Signs And Symptoms Of Parkinson’s Disease
While the main symptoms of Parkinson’s disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These secondary symptoms vary in severity, and not everyone with Parkinson’s will experience all of them, and may include:
How Does Alcohol Affect Parkinsons Medication
The interaction between Parkinsons medications and alcohol is a common topic on MyParkinsonsTeam. I miss my red wine and whiskey on occasion, one member wrote. I found that it just makes my meds stop working. Another member said, My husband has been told he shouldn’t drink with his meds.
Alcohol can exacerbate the side effects of one of the most common Parkinsons medications, levodopa/carbidopa. Many neurologists recommend avoiding alcohol while taking this drug.
I have to limit myself to one Scotch on the rocks now, a MyParkinsonsTeam member said. I used to have three or four, but the side effects are too bad. Another wrote, Never really a good idea to mix alcohol with meds.
Whether you decide to continue your current drinking habits, cut down, or eliminate alcohol altogether, its important to listen to your body and have open conversations about these topics with your neurologist.
If you find yourself drinking alcohol to cope with other issues, such as depression and anxiety, you may find that healthy practices such as physical activity can help. In addition, participating in activities such as tai chi, yoga, and meditation may help ease the symptoms and complications of PD.
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