What Can You Do If You Have Pd
- Work with your doctor to create a plan to stay healthy. This might include the following:
- A referral to a neurologist, a doctor who specializes in the brain
- Care from an occupational therapist, physical therapist or speech therapist
- Meeting with a medical social worker to talk about how Parkinson’s will affect your life
For more information, visit our Treatment page.
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
How Is Age Related To Pdd
Both PD and PDD are more common with increasing age. Most people with PD start having movement symptoms between ages 50 and 85, although some people have shown signs earlier. Up to 80% of people with PD eventually develop dementia. The average time from onset of movement problems to the development of dementia is about 10 years.
Executive Dysfunction In Parkinsons
Executive functions in cognition are higher-order mental processes, including the ability to plan, organize, initiate and regulate behavior to meet goals. Executive functioning is present in activities such as multitasking, switching tasks, and solving problems. The prefrontal cortex of the brain and the dopamine system are responsible for executive function. As PD damages these areas, executive dysfunction occurs, and executive dysfunction is one of the most common cognitive impairments found in people with PD.3,4
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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
Contact Our Information And Referral Helpline
The Parkinson Canada Information and Referral Helpline is a toll-free Canada-wide number for people living with Parkinsons, their caregivers and health care professionals. We provide free and confidential non-medical information and referral services. When you have questions or need assistance, our information and referral staff help connect you with resources and community programs and services that can help you. We provide help by phone or email, Monday to Friday, 9:00 a.m. 5:00 p.m. ET.
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Seeking Help For Cognitive Changes
Cognitive change is a sensitive issue. In fact, the doctor is often as hesitant to address this subject as the person with PD is to ask about it. Sometimes, the doctor will delay discussing cognitive impairment out of concern for the person who is still coping with the shock of a new PD diagnosis or struggling with motor symptoms.
For this reason, the person with PD often needs to be the one to initiate the conversation. Tell your doctor if you or your loved one is experiencing problems that upset the family or cause interruptions at work.
Cognitive issues are never too mild to address with your care team. A doctor can provide ways to help, often, referring psychiatrist, neuropsychologist, speech or occupational therapist for further evaluation and assistance. The neuropsychological evaluation can be particularly useful, especially in the early stages of a cognitive problem. Having this baseline test can help the doctor determine whether future changes are related to medications, the progression of the PD itself or to other factors such as depression.
When reporting symptoms of mild cognitive impairment, the doctor will first want to rule out causes other than PD, such as Vitamin B-12 deficiency, depression, fatigue or sleep disturbances. It should be noted that PD does not cause sudden changes in mental functioning. If a sudden change occurs, the cause is likely to be something else, such as a medication side-effect.
Effects Of Memory And Cognitive Changes
While it may seem clear to you that emotional states can have a significant impact on your thinking, the reverse is also true: Your thinking can sometimes strongly influence your emotional states. You know the proverbial story of two men who see the same glass of water but one sees it as half full and the other as half empty? The same goes for thinking and emotional states.
Sometimes your assessment of a situation can influence your emotional reaction to that situation. More generally, executive cognitive functions can influence your mood states because those executive functions control all the information you have about the situations you find yourself in. Executive functions control your appraisal of those situations. If you find it difficult to recall happy memories, you may become more sad or depressed. If you find it difficult to plan a vacation, you may put off the vacation and thus influence your mood states and so forth.
Problems with executive functions can also get you into trouble over serious matters like money. If you find it difficult to balance the checkbook, you may get a bit sloppier about your finances. Consider also that the extra jolt of dopamine that comes from taking dopamine medications can sometimes make you temporarily more energized and impulsive. Now when you couple a heightened sense of impulsivity with a lowered capacity for thinking efficiently through decisions, you sometimes get impulsive respondingbad decisions.
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Mild Memory And Cognitive Problems
Mild memory loss and thinking problems are known as mild cognitive impairment, or MCI. Many people experience some form of thinking or memory problems at some point in life, perhaps due to factors such as grief or stress. But when people experience greater difficulties with memory, language, thinking or judgment than might be expected at their age, they may have MCI.
The terms memory problems and ‘memory loss’ can be misleading because far more than just memory may be affected. If you have mild cognitive problems, you may experience:
- Slowed thought processes. You may find it hard to follow a number of steps to complete a task or have problems multi-tasking
- Difficulties with planning, problem-solving or making decisions
- Difficulties following and taking part in conversations
- Difficulty finding the right word
- Poor concentration
- Lack of motivation
- Short-term memory loss difficulty remembering names or the sequence of recent events
- Problems with judging distances or direction. Describing how to get from one place to another may become hard.
Visual hallucinations or delusions may accompany cognitive problems in some people. Sometimes these are drug induced or they may be related to Lewy body dementia so you should let your doctor know if you experience these symptoms.
People with cognitive difficulties may be unaware of the problems they are experiencing, and friends and family may notice first.
Are There Medicines To Treat Pdd
Though there is no cure for PDD yet, there are medications that help manage the symptoms. These medications are called cholinesterase inhibitors, and they can help if a person with PDD is having memory problems. Some examples of these medicines are donepezil, rivastigmine and galantamine. Sleep problems may be managed by sleep medications such as melatonin.
Because people with PDD are usually very sensitive to medications, any new medication, even one that is not being used for the brain, needs to be reviewed with the persons provider to avoid potential contraindication.
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How Can I Help Myself
Keeping physically active and mentally stimulated is very important when living with both Parkinsons and cognitive problems.
Avoiding stress is also important. Anything that puts you under pressure is likely to worsen memory problems, so try to take each day at a steady pace. Allow time for rest and relaxation, and make time to do the things you enjoy. Relaxing effectively can help to improve your concentration, attention span and ability to plan. Complementary therapies such as yoga and Tai Chi, together with exercise such as swimming may help with this.
We can all be forgetful and while this is often frustrating, a good quality of life can still be enjoyed if you make some adaptations.
You could begin by adapting your home and work environments to accommodate your needs. For example, removing clutter will reduce the number of visual distractions and make it easier for you to find your way around. Keeping furniture in the same place and having a regular daily routine may be helpful. At night, you may find it useful to keep a low-level night light on to minimise possible disorientation if you wake.
As time passes, carrying out more complex tasks is likely to become harder. Try writing down the various steps you have to go through in order to complete specific tasks, and follow these steps one by one.
The following tips may also help maintain brain function and improve quality of life:
Managing Depression In Parkinsons Disease
People with Parkinsons, family members and caregivers may not always recognize the signs of depression and anxiety. If you are experiencing depression as a symptom of Parkinsons, it is important to know it can be treated.
Here are some suggestions:
- For information and support on living well with Parkinsons disease, contact our Information and Referral line.
- As much as possible, remain socially engaged and physically active. Resist the urge to isolate yourself.
- You may want to consult a psychologist and there are medications that help relieve depression in people with Parkinsons, including nortriptyline and citalopram .
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How Are Cognitive Problems Treated
Much remains to be learned about the basic biology that underlies cognitive changes in PD. Researchers work towards the development of diagnostic tests to identify people who seem to be at greatest risk for cognitive changes and to differentiate cognitive problems in people with PD from those that occur in another disorder related but different known as dementia with Lewy bodies.
The Profile Of Memory And Cognitive Changes
Even in the very early stages of Parkinson’s disease people can have difficulty with their thinking processes. Most authorities agree that the primary difficulty lies with the so-called executive cognitive functions.
Executive cognitive functions refer to such thinking processes as memory retrieval, planning, generation of words or concepts, attention, and monitoring and adjustment of non-routine and goal-directed behaviors. The common denominator in all of these executive functions is that they require cognitive control in order to operate smoothly.
The term cognitive refers to processes or operations involved in the processing of all kinds of information. So cognitive control processes are those processes that are used by the mind and brain to regulate the storage, retrieval, and usage of information .
Problems with executive functions are typically mild in early PD. They usually involve a generalized slowing of cognitive processing speed and subtle deficits in attention and working memory. It may be difficult, for example, to hold two different pieces of information in the mind at the same time, or to efficiently generate words and concepts as quickly as one used to. As the disease progresses, these executive cognitive deficits are made more severe by common Parkinson-related mood disorders and Parkinson-related emotional problems such as depression and anxiety.
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How Is Parkinsons Disease Dementia Diagnosed
No single test can diagnose Parkinsons disease dementia. Instead, doctors rely on a series or combination of tests and indicators.
Your neurologist will likely diagnose you with Parkinsons and then track your progression. They may monitor you for signs of dementia. As you get older, your risk for Parkinsons dementia increases.
Your doctor is more likely to conduct regular testing to monitor your cognitive functions, memory recall, and mental health.
How Can We Support The Sleep/wake Cycle Of Pdd
For people with PDD who are confused about the day-night cycle, some daily strategies can be helpful. At night, starting a lights out routine that happens at the same hour every day, where all curtains are closed and lights are turned off, can help the person understand that it is sleep time. During the day, opening the curtains, allowing the person with PDD to spend as much time in the daylight as possible, avoiding naps, and organizing stimulating activities, can be helpful. Having lots of calendars and clocks in every room might also help a person with PDD be less confused about the time of day.
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Parkinson’s Disease Dementia Follow
A person with Parkinson’s disease and dementia requires regular checkups with his or her health care professional.
- These checkups allow the health care professional to see how well treatment is working and make adjustments as necessary.
- They allow detection of new problems of cognition, mood, or behavior that could benefit from treatment.
- These visits also give the family caregiver an opportunity to discuss problems in the individual’s care.
Eventually, the person with Parkinson’s disease and dementia will likely become unable to care for himself or herself or even to make decisions about his or her care if the patient lives long enough with Parkinson’s disease and dementia.
- It is best for the person to discuss future care arrangements with family members as early as possible, so that his or her wishes can be clarified and documented for the future.
- A health care professional can advise patients and caregivers about legal arrangements that should be made to ensure that these wishes are observed.
Parkinson’s disease dementia prevention
There is no known way of preventing dementia in Parkinson’s disease. However, patients with Parkinson’s disease are urged to continue to exercise and live a healthy lifestyle as this may delay or reduce the onset of dementia, although there is no good data to indicate this will occur.
Parkinson’s disease dementia prognosis
Mild Memory And Thinking Problems
Mild memory and thinking problems can be a normal part of getting older. But sometimes, these symptoms are caused by Parkinsons.
This is when you have symptoms such as forgetfulness, problems concentrating and difficulty making decisions, but you can still manage your day-to-day life.
Mild memory and thinking problems are common in Parkinsons and can happen at any stage of the condition, but not everyone with Parkinson’s has these symptoms.
If you do experience these symptoms, your doctor may describe it as mild cognitive impairment .
Its normal to worry if youre experiencing memory and thinking problems, but it doesnt necessarily mean you have dementia, or that you will develop it in the future.
Dementia in Parkinsons is diagnosed when thinking and memory problems are steadily getting worse over time and affect everyday life and daily tasks such as cooking, cleaning and dressing.
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Ii Activities Of Daily Living
1 = Mildly affected. No difficulty being understood.2 = Moderately affected. Sometimes asked to repeat statements.3 = Severely affected. Frequently asked to repeat statements.4 = Unintelligible most of the time.
1 = Slight but definite excess of saliva in mouth may have nighttime drooling.2 = Moderately excessive saliva may have minimal drooling.3 = Marked excess of saliva with some drooling.4 = Marked drooling, requires constant tissue or handkerchief.
4 = Requires NG tube or gastrotomy feeding.
1 = Slightly slow or small.2 = Moderately slow or small all words are legible.3 = Severely affected not all words are legible.4 = The majority of words are not legible.
9. Cutting food and handling utensils
0 = Normal.1 = Somewhat slow and clumsy, but no help needed.2 = Can cut most foods, although clumsy and slow some help needed.3 = Food must be cut by someone, but can still feed slowly.4 = Needs to be fed.
1 = Somewhat slow, but no help needed.2 = Occasional assistance with buttoning, getting arms in sleeves.3 = Considerable help required, but can do some things alone.4 = Helpless.
1 = Somewhat slow, but no help needed.2 = Needs help to shower or bathe or very slow in hygienic care.3 = Requires assistance for washing, brushing teeth, combing hair, going to bathroom.4 = Foley catheter or other mechanical aids.
12. Turning in bed and adjusting bed clothes
13. Freezing when walking
Dementia With Lewy Bodies
The symptoms of dementia with Lewy bodies are very similar to those of Alzheimer disease. They include memory loss, disorientation, and problems remembering, thinking, understanding, communicating, and controlling behavior. But dementia with Lewy bodies can be distinguished by the following:
In the early stages, mental function fluctuates, often dramatically, over a period of days to weeks but sometimes from moment to moment. One day, people may be alert and able to pay attention and converse coherently, and the next day, they may be drowsy, inattentive, and almost mute. People may stare into space for long periods.
At first, attention and alertness may be more impaired than memory, including memory for recent events. In the early stages of this dementia, memory problems may result more from lack of attention than from actual problems remembering. More noticeable memory problems tend to occur later as the dementia progresses.
People have difficulty planning, solving problems, handling complex tasks , and using good judgment .
The ability to copy and draw may be impaired more severely than other brain functions.
may malfunction, preventing the body from regulating internal functions, such as blood pressure and body temperature. As a result, people may faint, sweat too much or too little, have a dry mouth, or have urinary problems or constipation.
After symptoms appear, people usually live about 6 to 12 years.
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