Alzheimers And Parkinsons Disease: Similarities And Differences
James M. Ellison, MD, MPH
Swank Center for Memory Care and Geriatric Consultation, ChristianaCare Configure
Explore the similarities and differences between two common degenerative brain disorders.
Ron brings his 78-year-old wife, Sara, to the Memory Clinic, with a pressing concern. Sara is forgetting things more often even though her Parkinsons disease symptoms appear to be under good control with standard medications, healthy diet, and plenty of physical activity. She is losing her train of thought mid-sentence and she became very confused about where she was while driving the well-traveled route to her daughters home. Is she developing dementia? Is that a part of Parkinsons disease? Or is she developing Alzheimers disease? And what are the differences between Alzheimers and Parkinsons?
Management Of Parkinsons Disease Dementia
The relative importance of cholinergic network dysfunction in PDD is reflected in current treatment strategies, which focus on the use of AChEIs, such as rivastigmine, donepezil and galantamine, to boost cholinergic function. Two large placebo-controlled trials have shown that rivastigmine significantly improves deficits in orienting of attention, vigilance and cognitive fluctuation in patients with PDD , and indeed patients with more severe attentional deficits appear to respond best . These results serve to reinforce the cholinergic basis of attention deficits in PDD according to the neural network model. Benefits from AChEIs have also been demonstrated for executive deficits visuospatial tasks and hallucinations . Whether these improvements are due to amelioration of the cholinergic network deficits underlying these cognitive processes, or are secondary to an overall improvement in attention assisting other overlapping cognitive functions, or a combination of both, is unknown.
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These include a new or worsened confusion, hallucinations, agitation and symptoms of depression or apathy. As well as being an underlying cause of another symptom, pain can also be the symptom of other features of PD, such as rigidity, dyskinesia, but also non-motor features, for example, depression and fatigue.
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Treatment Of Behavior And Mood Problems In Lewy Body Dementia
Behavioral and mood problems in people with LBD can arise from hallucinations, delusions, pain, illness, stress, or anxiety. They may also be the result of frustration, fear, or feeling overwhelmed. The person may resist care or lash out verbally or physically.
Medications are appropriate if the behavior interferes with the person’s care or the safety of the person or others. If medication is used, then the lowest possible dose for the shortest period of time is recommended.
The first step is to visit a doctor to see if a medical condition unrelated to LBD is causing the problem. Injuries, fever, urinary tract or pulmonary infections, pressure ulcers , and constipation can worsen behavioral problems and increase confusion.
Certain medications, such as anticholinergics and antihistamines may also cause behavioral problems. For example, some medications for sleep problems, pain, bladder control, and LBD-related movement symptoms can cause confusion, agitation, hallucinations, and delusions. Similarly, some anti-anxiety medicines can actually increase anxiety in people with LBD. Review your medications with your doctor to determine if any changes are needed.
Antidepressants can be used to treat depression and anxiety, which are common in LBD. Many of them are often well tolerated by people with LBD.
Living With Parkinsons Disease
Coming to terms with a diagnosis of Parkinsons and living with the disease is challenging and will take a lot of adjustment. There are still things you can do that can help you to feel more in control of your situation and to stay positive. Some things that might help could include:
- choosing to lead a healthy lifestyle
- making informed decisions related to your treatment
- keeping a diary of your symptoms in preparation for meetings with health and social care professionals
- attending a self-management course
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How Is Psp Diagnosed
Currently there are no tests or brain imaging techniques to definitively diagnose PSP. An initial diagnosis is based on the persons medical history and a physical and neurological exam. Identifying early gait problems, problems moving the eyes, speech and swallowing abnormalities, as well as ruling out other similar disorders is important. Diagnostic imaging may show shrinkage at the top of the brain stem and look at brain activity in known areas of degeneration.
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How Is A Diagnosis Made
Because other conditions and medications mimic the symptoms of PD, getting an accurate diagnosis from a physician is important. No single test can confirm a diagnosis of PD, because the symptoms vary from person to person. A thorough history and physical exam should be enough for a diagnosis to be made. Other conditions that have Parkinsons-like symptoms include Parkinsons plus, essential tremor, progressive supranuclear palsy, multi-system atrophy, dystonia, and normal pressure hydrocephalus.
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Is Parkinson’s Diagnosed In The Brain
Parkinson’s disease is one of the most challenging neurological disorders to diagnose and treat. If your doctor suspects you have Parkinson’s disease, you will usually be referred to a neurologist for further tests. These tests will involve certain movements and exercises to check your symptoms.
A neurologist will look for motor symptoms such as:
- A tremor that occurs at rest
- Slowed movement
- Muscle stiffness
If you have two or more of these symptoms and your doctor has taken blood tests to rule out other causes, it’s likely you will be diagnosed with Parkinson’s disease. Your symptoms will be closely monitored to see any progression of Parkinson’s disease, which can take years.
Parkinsons In The Brain
In the present study, a team led by researchers from the University of California San Diego in La Jolla wanted to contribute to this knowledge.
They conducted a study in mice to understand the relationship between neural circuits in the brain and some of the functions that are typically affected by Parkinsons disease, such as cognitive and motor abilities.
They looked in particular at the external globus pallidus in the brains of mice, which previous research has linked to the motor symptoms of Parkinsons.
The researchers used multiple methods to give a more detailed overview of this region of the mices brains, including electrophysiology, viral tracing, and behavioral experiments.
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A Study Reveals One Of The Reasons Why Neurons Die In Parkinsons Patients
According to World Health Organization estimates, around 7 million individuals worldwide suffer from Parkinsons disease. Although the origins of this neurodegenerative disorder are not entirely understood, it is known that many of its symptoms are caused by the death of neurons that create dopamine.
A study conducted in mice by a research team at the University of Cordoba has uncovered one of the causes of this neuronal loss: the key resides in the protein called DJ1, whose association with Parkinsons disease has previously been established, but its specific role was unknown until now.
This research took things a step further by revealing one of the proteins action mechanisms. To accomplish this, the researchers conducted a comparative study of neurons in the brains of mice with and without this active gene, with the goal of comparing the differences between the two protein patterns and, thus, studying the mechanisms that may be altered, explains Raquel Requejo, the studys lead researcher and a member of the BIO126 group at the University of Cordoba.
Image of the team that carried out the investigation Credit: University of Córdoba
When dividing is not an option
This is what is known in the scientific literature as an aberrant cell cycle and its relationship with this neurodegenerative disease and the absence of the DJ1 protein has been described for the first time in this study, said Requejo.
Cognitive Problems And Parkinsons
Many people with Parkinsons experience some mild memory loss and thinking problems. Symptoms vary widely and may fluctuate through the day. Research has shown that cognitive problems tend to be more severe in people with Parkinsons with more pronounced bradykinesia and rigidity, and less severe in those with more pronounced tremor.
If you are experiencing changes in your thinking and mental abilities, its natural to be concerned. You may worry you could go on to develop dementia however, this happens to comparatively few people. One study found that after ten years with Parkinsons, 80% of people with the condition experienced some cognitive difficulties, but less than 20% had developed dementia known as Parkinsons disease dementia . The symptoms of PDD are very different from those of Alzheimers disease.
Some Parkinsons symptoms can make speech and facial communication difficult, and slowed thinking will often make things even harder. As the ability to remember words is affected, your vocabulary can become limited and humour may be less understood. It can also get harder to follow conversations, and this can result in you not making sense, or forgetting what you have said and repeating things.
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Risks And Side Effects Of Deep Brain Stimulation
Like any surgery, deep brain stimulation can have side effects, and it carries potential risks. Its also important to consider the complications and side effects of medications you take since their dosages can often be reduced following surgery.
While DBS may cause side effects, it may also reduce side effects from medications.
Mimicking Human Conditions In Animal Models
With the advance of the medical research, it is possible to mimic certain human conditions in selected animals, such as mouse or rat, to study the development of a disease and search for treatment. In addition to being very close to the human physiology, these animal models are reliable and critical to develop new treatment strategy and to understand the pathophysiology of a disease.
In the laboratory of Professor Musa V. Mabandla, we have by exposing pups to early maternal separation once daily, from post-natal day 1 to 14. We thereafter injected these rat models with depressive-like behaviors with a preclinical dose of 6-hydroxydopamine stereotaxically into the medial forebrain bundle to mimic Parkinsonism. This has resulted to a rat model of PD associated with depressive-like behaviors.
We also injected these animal models with Fluvoxamine maleate , an antidepressant widely used for the treatment of psychiatric disorders, to investigate the neuroprotective effects of the drug on a parkinsonian rat model of neurodegeneration.
Our findings show that early maternal separation exacerbated the effects of 6-hydroxydopamine, but FM treatment attenuated neurodegeneration associated with 6-hydroxydopamine toxicity.
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Is Parkinsons Diagnosed In The Brain
Parkinsons disease is one of the most challenging neurological disorders to diagnose and treat. If your doctor suspects you have Parkinsons disease, you will usually be referred to a neurologist for further tests. These tests will involve certain movements and exercises to check your symptoms.
A neurologist will look for motor symptoms such as:
- A tremor that occurs at rest
- Slowed movement
- Muscle stiffness
If you have two or more of these symptoms and your doctor has taken blood tests to rule out other causes, its likely you will be diagnosed with Parkinsons disease. Your symptoms will be closely monitored to see any progression of Parkinsons disease, which can take years.
How Parkinsons Disease Affects The Body
Life with Parkinsons is challenging, to say the least. This progressive disease starts slowly, and because theres currently no cure, it gradually worsens how you think and feel.
Giving up may seem like the only solution, but it certainly isnt. Thanks to advanced treatments, many people are able to continue living healthy, productive lives with Parkinsons.
Take a glance at this infographic to get a visual picture of how Parkinsons can affect everything from your memory to your movement.
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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.
Managing Cognitive Impairments In Parkinsons
After a thorough evaluation to rule out other causes of cognitive impairment, patients with PD may be treated with medication, occupational therapy, and/or speech therapy. The medications used to treat cognitive impairments in people with PD are based on treatments used for Alzheimers disease. Occupational therapy can help a person with PD by providing adaptive strategies for daily activities. Speech therapy can help with language functions, as well as information processing. 3,4
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How Does Deep Brain Stimulation For Parkinsons Work
Deep brain stimulation works by modifying abnormal electrical activity in the brain. It was first approved for Parkinsons tremors in 1997 and has become an established treatment to control additional motor symptoms of Parkinsons disease.
DBS involves three main components:
- Leads: Leads are implanted in the brain in a region responsible for motor activity.
- Implantable pulse generator : A separate procedure is performed to implant a battery-operated device in the chest or in the abdomen. An IPG is similar to a pacemaker for the heart and has been coined by some as a pacemaker for the brain.
- Extension: A thin, insulated wire is passed beneath the skin between the leads and implantable pulse generator to deliver the electrical stimulation from the pulse generator to the leads.
The target area in the brain is first identified by magnetic resonance imaging or computed tomography . Then, the leads are placed via small holes that a surgeon drills in the skull.
This is considered a minimally invasive surgery that is done in the operating room with local anesthesia. It usually requires an overnight stay.
The IPG is inserted in a separate surgical procedure in the operating room roughly a week later.
After a few weeks, a neurologist begins to program the unit. This process can take several additional weeks to months. When this is completed, people are able to manage the device with a handheld remote control.
Symptoms Of Parkinsons Disease
Parkinsons has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Muscle stiffness, where muscle remains contracted for a long time
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include:
The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, 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 Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.
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Treating Movement Symptoms In Lewy Body Dementia
LBD-related movement symptoms may be treated with medications used for Parkinson’s disease, called carbidopa-levodopa. These drugs can help make it easier to walk, get out of bed, and move around. However, they cannot stop or reverse the disease itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Because of this risk, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.
People with LBD may benefit from physical therapy and exercise. Talk with your doctor about what physical activities are best.
What Causes The Condition
Although there are several recognized risk factors for Parkinsons disease, such as exposure to pesticides, for now, the only confirmed causes of Parkinsons disease are genetic. When Parkinsons disease isnt genetic, experts classify it as idiopathic . That means they dont know exactly why it happens.
Many conditions look like Parkinsons disease but are instead parkinsonism from a specific cause like some psychiatric medications.
Familial Parkinsons disease
Parkinsons disease can have a familial cause, which means you can inherit it from one or both of your parents. However, this only makes up about 10% of all cases.
Experts have linked at least seven different genes to Parkinsons disease. Theyve linked three of those to early-onset of the condition . Some genetic mutations also cause unique, distinguishing features.
Idiopathic Parkinsons disease
Experts believe idiopathic Parkinsons disease happens because of problems with how your body uses a protein called -synuclein . Proteins are chemical molecules that have a very specific shape. When some proteins dont have the correct shape a problem known as protein misfolding your body cant use them and cant break them down.
With nowhere to go, the proteins build up in various places or in certain cells . The buildup of these Lewy bodies causes toxic effects and cell damage.
Induced Parkinsonism
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Nervous Systems And The Nervous System
Nervous SystemThe human body is one of the most complex structures known to mankind. To this day, we still do not have all the answers to how our body functions. One of the most complex structures in the human body is the nervous system, which controls the voluntary and involuntary actions, as well as send signals throughout the body. The nervous system is split up into two parts the peripheral and central nervous systems. The central nervous system consists of two main parts the
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