How To Deal With Parkinson’s Dementia

Lewy Body Dementia Vs Parkinsons Disease Dementia

Diagnoses of Lewy body dementia include dementia with Lewy bodies and Parkinsons disease dementia. Symptoms in both of these diagnoses can be similar.

Lewy body dementia is a progressive dementia caused by abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also seen in Parkinsons disease.

The overlap in symptoms between Lewy body dementia and Parkinsons disease dementia include movement symptoms, rigid muscles, and problems with thinking and reasoning.

This seems to indicate that they could be linked to the same abnormalities, though more research is needed to confirm that.

The later stages of Parkinsons disease have more severe symptoms that may require help moving around, around-the-clock care, or a wheelchair. Quality of life can decline rapidly.

Risks of infection, incontinence, pneumonia, falls, insomnia, and choking increase.

Hospice care, memory care, home health aides, social workers, and support counselors can be a help in later stages.

Parkinsons disease itself isnt fatal, but complications can be.

Research has shown a median survival rate of about

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Causes Of Parkinsons Disease With Dementia

Experts do not know what causes Parkinsons disease. Genetic and environmental factors may play a role. Someone who has family members with the disease is slightly more likely to develop Parkinsons. It has also been linked with exposure to pesticides and to head injuries. There is some evidence that having never smoked or drank caffeinated beverages like coffee and tea actually increases a persons chance of developing Parkinsons.

Between 50 and 80 percent of people with Parkinsons Disease will develop dementia because of the spreading deterioration of brain cells over time. Motor skills and movement are affected first causing shaking, rigidity, and slowness but after enough time the brains structure changes to the point where problem solving and memory become affected.

Risk factors for someone who has Parkinsons to develop PDD are: Old age Gender Long duration of Parkinsons Family history of dementia Hallucinations before other dementia symptoms Movement problems that are beyond typical for Parkinsons

How PDD Compares to Dementia with Lewy Bodies

How PDD Compares to Alzheimers Disease

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Mental Health Concerns In Advanced Parkinsons Disease

Today we continue Parkinsons Disease: Planning for the What Ifs, a special series of posts to address both motor and non-motor issues of people with advanced Parkinsons disease . We are defining advanced PD as those who are no longer independent in their activities of daily living, and require help for their self-care such as eating, bathing, dressing and toileting. Remember, PD is a very variable condition and many never reach the advanced stages. Additional background and thefull introduction to the series is still available if you missed it.

I receive a lot of questions through our Ask a Doctor feature on our website concerning advanced PD, specifically around mental health issues. In a previous blog, I discussed the management of psychosis and behavioral problems in advanced PD. Today I will discuss cognitive decline/dementia, depression, anxiety and apathy in advanced Parkinsons disease .

Tips For Communicating With Your Parent

• Avoid power struggles. Dont push, nag or harangue your parents. Making ultimatums will only get their backs up, and yelling, arguing or slamming doors could seriously damage the relationship. Laura Ellen Christian, 15 Expert Tips for When Your Aging Parents Won’t Listen, The Arbor Company Twitter:

• Ask about your loved one’s preferences. Does your loved one have a preference about which family member or what type of service provides care? While you might not be able to meet all of your loved one’s wishes, it’s important to take them into consideration. If your loved one has trouble understanding you, simplify your explanations and the decisions you expect him or her to make.

Don’t fire off questions or ask complicated questions. First off, don’t pepper elders with questions or complicated choices. Instead of saying, Do you have to use the bathroom? say, We are going to the bathroom. If the word shower upsets them, don’t use it. Come with me, you say, and you end up at the shower. If someone with dementia is frightened, acknowledge it and say, You are safe with me. I’ll protect you. After they’re calmer, you can try to get them to do something. The one question that people with dementia often respond to is this: I really need your help. Can you help me with this?” Stacey Burling, They’re Not Just Stubborn: How to Get People with Dementia to Participate, Philly.com Twitter:

6 Ways To Handle Stubbornness In Seniors, Alternatives for Seniors Twitter:

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Volunteer To Help Out

Everyday responsibilities like shopping, cooking, and cleaning become much more difficult when you have a movement disorder. Sometimes people with Parkinsons need help with these and other tasks, but they may be too proud or embarrassed to ask for it. Step in and offer to run errands, prepare meals, drive to medical appointments, pick up medications at the drug store, and help with any other day-to-day tasks they have difficulty with on their own.

Do Try To Be Forgiving And Patient

Do not forget that dementia is the condition that results in irrational behavior and causes dementia sufferers to act the way they do. The patients demand plenty of patience and forgiveness from the people looking after them. Have the heart to let things go instead of carrying grudges around for something that the patient may not be in control of.

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Signs And Symptoms Of Pdd

Common signs and symptoms of Parkinsons disease dementia include:

• Poor memory and concentration

• Depression
• Visual hallucinations

If youve noticed some of the above signs and symptoms in yourself or a loved one, its important to get them checked out. But dont jump to conclusions. People with Parkinsons often experience cognitive changes such as anxiety, lack of motivation, and slowed thinking. These symptoms do not automatically mean dementia.

What Is Aggressive Parkinsons Disease

As written above, Parkinsons dementia aggression is that form of Parkinsons which makes the patient exhibit aggressive behavior. They vent out their aggression either verbally or physically, in the various forms that have been written above. Besides verbal and physical outbursts, PD Dementia patients are also prone to hallucinating caused by the medication administered. Hallucinations in PD Dementia patients primarily occur because of the effects of dopaminergic agents for motor symptoms.

Loss of dopamine neurons in the ventral tegmental area is one of the likeliest of all neuropathological causes as changes in serotonin and norepinephrine systems are not. For the uninitiated, the ventral tegmental area is the origin of the mesolimbic dopaminergic projection. Plenty of studies have gone into analyzing the cause behind the aggression in PD Dementia patients. Depression in PD Dementia patients has been identified due to changes in the medial frontal cortex and the anterior cingulate. Akinetic-rigid variants have been found in patients showing signs of major depression.

Recommended Reading: Cleveland Clinic Parkinson’s Bicycle Study 2017

Paranoia Delusion And Hallucinations

Distortions of reality, such as paranoia, delusions, and hallucinations, can be another result of the disease process in dementia. Not everyone with dementia develops these symptoms, but they can make dementia much more difficult to handle.

Lewy body dementia, in particular, increases the likelihood of delusions and hallucinations, although they can occur in all types of dementia.

Caregiving For People Living With Parkinsons

Caring for a loved one with PD can be a challenging job, especially as the disease progresses. Former caregivers of a loved one with PD suggest doing the following : Get prepared, Take care of yourself, Get help , Work to maintain a good relationship with your loved one, and Encourage the person with PD for whom you care, to stay active.

Preparing for caregiving starts with education. Reading this fact sheet is a good start. More resources are available to you in theResources section of this fact sheet. Early Parkinsonâs disease usually requires more emotional support and less hands-on care. It is a good time for family members/caregivers to educate themselves about the disease.

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A Person With Dementia Doesnt Always Fit Into One Stage

Dementia affects each person in a unique way and changes different parts of the brain at different points in the disease progression.

Plus, different types of dementia tend to have different symptoms.

For example, someone with frontotemporal dementia may first show extreme behavior and personality changes. But someone with Alzheimers disease would first experience short-term memory loss and struggle with everyday tasks.

Researchers and doctors still dont know enough about how these diseases work to predict exactly what will happen.

Another common occurrence is for someone in the middle stages of dementia to suddenly have a clear moment, hour, or day and seem like theyre back to their pre-dementia abilities. They could be sharp for a little while and later, go back to having obvious cognitive impairment.

When this happens, some families may feel like their older adult is faking their symptoms or just isnt trying hard enough.

Its important to know that this isnt true, its truly the dementia thats causing their declining abilities as well as those strange moments of clarity theyre truly not doing it on purpose.

Advice For Carers Family And Friends

Living with or caring for someone with Parkinsons disease dementia can be challenging. Sometimes help and support will be relied on heavily but there will be times when it will be better to step back and allow the person with dementia to do things for themselves. This balance will be difficult to judge at first, but with time and patience new routines and approaches to day-to-day living can be established.

It is important to encourage, stimulate and help the person with dementia, but remember too that rest is important.

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Surgery And Deep Brain Stimulation

Deep brain stimulation is a treatment for Parkinsonâs disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications , its adjustability , and its reversibility DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic , more than 80,000 patients have undergone DBS surgery worldwide.

Typical candidates are those who have motor fluctuations or periods of âoffâ time with troublesome symptoms alternating with periods of âonâ time with good symptom control, and also with possible periods of excessive movement .

Not all patients with Parkinsonâs disease are good candidates for treatment with DBS. Approximately 10â20% of patients considered for possible treatment with DBS include those:

The 5 Stages Of Parkinsons Disease

Getting older is underrated by most. Its a joyful experience to sit back, relax and watch the people in your life grow up, have kids of their own and flourish. Age can be a beautiful thing, even as our bodies begin to slow down. We spoke with David Shprecher, DO, movement disorders director at Banner Sun Health Research Institute about a well-known illness which afflicts as many as 2% of people older than 65, Parkinsons Disease.

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How Parkinsons And Alzheimers Affect The Body And Brain Differently

Alzheimers and Parkinsons are both neurological illnesses. Both diseases are caused by damaged brain cells. Both conditions can involve dementia, as well as depression, anxiety, and sleep disturbances. Both conditions can lead to psychotic symptoms such as delusions and hallucinations.

While Alzheimers and Parkinsons share certain causes and effects, the two diseases are different. They impact the brain and progress in different ways. Both disorders affect people differently, manifest themselves differently, and progress at different rates.

I had a father with Parkinsons and a mother with dementia. My experience was that the Parkinsons progressed at a slower rate and was more motor-related than mental.

My father experienced tremors, as well as changes in his walking and facial expressions. But his cognitive ability was relatively intact up to the very last stages of the disease. My mothers dementia made her feeble and uncertain on her feet, but she remained active and mobile, even as her cognitive ability declined.

It Is The Disease Making These Accusations Not My Loved One

It is not an easy concept to internalize, but it is essential to your emotional wellbeing. Often, the quality of your relationship with your loved one prior to the onset of Parkinsons will impact your willingness to accept this reality.

We all attribute reasons for peoples actions to experiences with them in the past. If you had a loving marriage for 30 years before your husband showed signs of dementia, it might not take that long for you to realize the disease is the cause of his confusion and outbursts. On the other hand, if you hadnt spoken to your mother for many years before you became her caregiver, her paranoia and negativity might reopen old wounds and make caring for her even more complicated and trying. Accusations of adultery, theft and trying to murder the patient are extremely painful when you are making sacrifices to provide care. Each situation is unique, and not everyone will encounter these scenarios. But if they do occur, remind yourself that it is the disease talking. See the videos on Thinking Changes for more information.

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Emotional Aspects Of Parkinsons

It is important to examine the various emotions that a person living with Parkinsons disease can undergo in living daily with the condition. The emotional factors that affect your loved one can be both internal and external. Some changes that occur can be directly due to the disease process, which causes an alteration in brain chemistry. Other emotional changes are influenced by external factors and the persons reaction to those factors.

Having a chronic neurological condition is stressful, and people react to stress in different ways. Some see it as a challenge and others see it as a problem. Parkinsons disease has a significant impact on family and friends and can create many emotions. These emotions include:

DENIAL/DISBELIEF

Denial, a feeling of shock and disbelief is a common reaction, especially at the time of initial diagnosis and early in the disease process. Since PD can have a subtle onset before an actual diagnosis is made, people often attribute symptoms to other causes. People also sometimes report a general feeling of uneasiness or an anxious, depressed feeling prior to diagnosis. When a diagnosis is finally made, it can come partially as a relief, but there is often shock and fear of the future.

DEPRESSION

Depression is one of the most common reactions to Parkinsons disease, occurring in roughly 50 percent of clients. Some doctors feel that depression may actually be part of the disease process. PD medications can also cause depression in some patients.

What Is Needed For A Parkinson’s Disease Dementia Diagnosis

There is no definitive medical test that confirms cognitive decline or dementia in Parkinson’s disease. The most accurate way to measure cognitive decline is through neuropsychological testing.

• The testing involves answering questions and performing tasks that have been carefully designed for this purpose. It is carried out by a specialist in this kind of testing.
• Neuropsychological testing addresses the individual’s appearance, mood, anxiety level, and experience of delusions or hallucinations.
• It assesses cognitive abilities such as memory, attention, orientation to time and place, use of language, and abilities to carry out various tasks and follow instructions.
• Reasoning, abstract thinking, and problem-solving are tested.
• Neuropsychological testing gives a more accurate diagnosis of the problems and thus can help in treatment planning.
• The tests are repeated periodically to see how well treatment is working and check for new problems.

Imaging studies: Generally, brain scans such as CT scans and MRIs are of little use in diagnosing dementia in people with Parkinson’s disease. Positron emission tomographic scan may help distinguish dementia from depression and similar conditions in Parkinson’s disease.

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As Part Of Our Livetalk Series Being Patient Spoke With John Gastil And Movement Disorder Specialist Dr Zoltan Mari About The Symptoms Diagnosis And Treatment Of Parkinsons And Lewy Body Dementia

Parkinsons is the second most common neurodegenerative disease after Alzheimers roughly 60,000 people in the United States are diagnosed with the former annually. As a child, John Gastil watched his grandmother navigate Alzheimers. Decades later, his father was diagnosed with Parkinsons and eventually Lewy body dementia.

Being Patient spoke with Gastil about his fathers journey with the disorders and with Dr. Zoltan Mari, director of the Parkinsons and Movement Disorders Program at Cleveland Clinic Lou Ruvo Center for Brain Health, who shared insights in the diagnosis, clinical care and science of the neurodegenerative diseases.

• While Alzheimers is characterized by beta-amyloid plaques and tau tangles, the hallmark of Parkinsons and Lewy body dementia is a protein called alpha-synuclein.
• The sequence of symptoms between Parkinsons disease dementia and Lewy body dementia differ early on, but as the disorders progress, their symptoms and brain changes are similar clinicians often think of the two as being on the same spectrum as opposed to distinct diseases.
• Early on, Parkinsons damages the nigrostriatal pathway, a brain region with dopamine-producing neurons that regulate movement.
• Dr. Mari urged people to consult with a movement disorder specialist for accurate diagnoses of Parkinsons and Lewy body dementia.

Being Patient: We often hear Parkinsons and dementia mentioned together, can you help us understand the two conditions?