Thursday, March 28, 2024

Is Parkinson’s Associated With Dementia

Visual Perceptual Dysfunction And Hallucinations: Multiple Network Involvement

Parkinson’s Disease Dementia

Patients with Parkinsons disease exhibit both subtle visuospatial deficits , and visuoperceptive deficits , in some patients from early in the disease . These deficits become more marked and more common with disease progression and show high sensitivity in detecting the transition to PDD . Indeed impairment on the Pentagon Copying Test from the MMSE at baseline has been shown to be predictive of PDD at 5-year follow-up .

Visual hallucinations are also well-recognized in Parkinsons disease and are typically complex, consisting of well-formed people, animals or objects . Although they can be induced by anti-parkinsonian drugs, correlations between use of these agents and presence of hallucinations are actually relatively weak, and instead cognitive impairment has been shown to be the major risk factor, indicating that they are a core symptom of the dementing process . Visual hallucinations generally occur in the latter stages of the disease course with a progressive nature . Their presence is a strong predictor of PDD and indeed the prevalence of hallucinations in PDD is 70% . Although insight is initially maintained in patients with PDD, 81% will lose insight over 3 years , which severely affects quality of life for both patients and caregivers .

Prognostic Factors For Development Of Parkinsons Disease Dementia

In the clinic the diagnosis of PDD is based upon the Movement Disorders Society Task Force criteria , which incorporates detection of the cognitive features described above. However, it is recognized that early identification of patients at risk of developing PDD is useful in order to monitor them more closely so that therapeutic and supportive strategies can be implemented at a stage of the disease when they are likely to have greatest efficacy. Detailed neuropsychological testing, although able to detect early subclinical deficits, is not widely available, and therefore identification of clinical features with high predictive value for PDD has pragmatic value for clinicians. Large longitudinal cohort studies have demonstrated that inability to copy the intersecting pentagons figure on the MMSE, impairments of semantic verbal fluency and recognition memory, and development of a postural instability and gait difficulty motor phenotype are significant predictors for PDD . Errors on the Pill Questionnaire and presence of REM sleep behavioural disorder are also associated with later development of PDD, although their positive predictive values are lower .

Conceptualization Of The Diseases Needs And Interventions

Both dementia and PD are incurable and progressive diseases with often complex problems and needs, for which tailored interventions are available . For dementia, experts agree that recognizing its eventual terminal nature is the basis for anticipating future problems and an impetus to the provision of adequate palliative care . Some advocate advanced dementia to be a terminal disease to support eligibility for palliative care. However, as about half of dementia patients never reach an advanced stage , it may be a late trigger to initiate palliative care. There is no consensus, however, at which stage palliative care in dementia should start .

Table 2. Conceptualization of the disease, needs of patients and family caregivers, and interventions.

For PD there are no curative treatments either, but the success of dopaminergic replacement therapy and deep brain stimulation has enabled the majority of patients to live independently with a relatively low symptom burden for the first 10 years after diagnosis-when they live up to a decade . This may contribute to PD generally not being recognized as an illness for which a palliative approach may be helpful . A US patient and caregivers council recommends palliative care to be available from diagnosis of PD . This is also the ideal of the European Parkinson’s Disease Association although they emphasize that when to start palliative care is an individual decision.

Also Check: Parkinson’s And The Brain

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.

Stereological Analysis Of Axonal Loss

15 Early Signs Of Parkinson

Axonal length density, based on Bielschowsky silver impregnated sections, was quantified using the stereological space balls probe from stereoinvestigator software and Leica microscope DMR HC . Serial sections were used for quantification, and counting parameters were chosen to allow counting200 axon intersections for each sub-region. A sphere was used along with a sampling grid 2700 m×2700 m. ROIs corresponding to the grey matter of the agranular and dysgranular sub-regions were drawn at a low magnification and axonal quantification was completed at higher magnification . Only nerve fibers were counted and when a counting frame/sphere contained tangles or other pathologies, they were not counted and the following counting frame was used. Moreover, a fiber was counted only when it fully intersected with the sphere at least once. Tissue thickness was measured manually at each sampling frame and coefficient of error was calculated for each sub-region .

To calculate estimated axonal length , total number of intersections of fibers with space balls throughout all sections was multiplied by the volume of sampling frame. The volume is divided by the surface area of sphere ) multiplied by the reciprocal of sampling fraction of the section . To calculate density, total axonal length was divided by sampled reference volume per ROI. Reference volume was derived through planimetry, calculated as a measure of total area of the ROI multiplied by section height .

Recommended Reading: Non Tremor Parkinson’s Disease

Parkinson’s Disease Dementia And Dementia With Lewy Bodies

The key pathological hallmark found in brains of Parkinson’s disease and Parkinson’s disease dementia patients are abnormal microscopic deposits composed of -synuclein. This protein is found widely in the brain and its normal function is not yet well understood. The deposits are called “Lewy bodies”. Lewy bodies are also found in several other neurodegenerative brain disorders, including dementia with Lewy bodies . Evidence suggests that Parkinson’s disease and Parkinson’s disease dementia, and dementia with Lewy bodies, may be linked to the same underlying abnormalities in caused by the deposition of -synuclein.

What Happens In Pdd

People with PDD may have trouble focusing, remembering things or making sound judgments. They may develop depression, anxiety or irritability. They may also hallucinate and see people, objects or animals that are not there. Sleep disturbances are common in PDD and can include difficulties with sleep/wake cycle or REM behavior disorder, which involves acting out dreams.

PDD is a disease that changes with time. A person with PDD can live many years with the disease. Research suggests that a person with PDD may live an average of 57 years with the disease, although this can vary from person to person.

Don’t Miss: How Do I Get Tested For Parkinson Disease

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.

Alzheimers Vs Parkinson’s Disease Dementia

Possible link between vitamin B12 levels and dementia in Parkinsons disease

The dementia of Parkinsons disease has some similarities to the dementia of Alzheimers disease. And there are some differences, too. Alzheimers disease causes dementia slowly over time, while the dementia of Parkinsons disease often develops more quickly and dramatically.

The symptoms of Parkinsons dementia can come and go from day to day, while the symptoms of Alzheimers dementia will not go away.

You May Like: Best Parkinson’s Doctors In Usa

What Are Parkinsons Disease Dementia And Lewy Body Dementia

Parkinsons disease is a progressive, degenerative neurological movement disorder that affects approximately 7 million people worldwide. It is the second most common neurodegenerative disorder after Alzheimer’s disease.

Up to 80% of Parkinsons disease patients will develop Parkinsons disease dementia that is characterized by a progressive loss of memory and decline in intellectual abilities.

About 15% of Parkinsons disease diagnoses include so-called Parkinsons plus syndromes. One of these syndromes is Lewy body dementia , also known as dementia with Lewy bodies , a form of progressive dementia accounting for 20% of dementias in people over the age of 65.

Axonal Length Density Is Significantly Reduced In The Agranular Insula

Using modified Bielschowsky silver impregnation and stereology, axonal length and axonal length density were assessed within the anterior anterior insular sub-regions across all groups. Taking all groups together, the mean total axonal length density for the agranular and dysgranular insula were ×109 m/m3 and × 109 m/m3, respectively. The axonal length density was significantly higher in the dysgranular compared to the agranular insula among all groups =2.7, P=0.01 and t=5.7, P< 0.001). A significant effect of disease group on axonal length density was only observed in the dysgranular sub-region =3.7, P=0.04 agranular: F=2.5, P=0.11). Specifically, a significant reduction was found in DLB compared to PD and PDD donors .

Read Also: Parkinson’s Disease Related Disorders

Atrophy Within The Medial Temporal Lobe Network Correlates With Progression To Parkinsons Disease Dementia

Medial temporal lobe structures are involved in memory storage and retrieval , and patients with Parkinsons disease demonstrate hypoactivation of these structures during visual memory tasks from the point of diagnosis . However, previous volumetric MRI studies have provided conflicting results as to whether significant MTL atrophy occurs in PDD . These discrepancies are likely due to the differing criteria for dementia used, and the fact that results were not co-varied by motor scores to determine atrophy specific to cognitive decline. To address these issues, a recent study used the MDS Task Force Criteria for PDD and recent criteria for PD-MCI to select representative patient groups for voxel-based morphometry MRI analysis . Having adjusted results by individual UPDRS motor scores they showed that cognitive progression from Parkinsons disease to PD-MCI to PDD specifically correlated with increasing grey matter atrophy in MTL structures including the hippocampi, parahippocampi and amygdalae. A recent meta-analysis of six voxel-based morphometry MRI studies involving a total of 105 patients with PDD and 131 control subjects confirms this .

Future Directions And Treatment Strategies

Parkinson

As this review has shown, the dysfunctional neural networks underlying the cognitive symptoms of PDD are diverse and distributed throughout the brain. There is overlap between network functions, each of which depend on differing primary neurotransmitters. In addition, evidence suggests that neurotransmitters can modulate the functional effects of one another , and thereby damage to one network during the pathogenesis of PDD may in turn influence dysfunction in another . Furthermore, as discussed in detail above, the cellular-level pathology causing damage to these networks in PDD is heterogeneous, while the effects of different genes on the pathophysiology of the disorder is only now being slowly unravelled.

Also Check: Parkinson’s Big And Loud Program

Dementia Can Be Treated Through Medication But Its Progression Will Continue

Some of the problems caused by dementia are treatable, but there are no medications that slow the progression of this problem, just as there are no treatments that slow the progression of the rest of the Parkinsons Disease syndrome. We often use the same medications that are used in Alzheimers disease to improve concentration and memory, although only one, rivastigmine, has been approved by the Food and Drug Administration for dementia in PD. Most experts believe that each of the Alzheimer drugs are about as useful in dementia in Parkinsons Disease as they are in Alzheimers, which, unfortunately, is not great. As with all medications used in PD, whether for slowness, stiffness, tremor, depression or sleep disorders, if the medication is not helpful, one should either try a higher dose or stop it. Since the drugs used to treat dementia take several weeks to work, and the dose often requires increases, the family needs to allow a reasonable time period, usually around two months, to decide if it is helpful or not. Obviously this needs to be discussed with the prescribing doctor.

There is a lot of research being done to better understand and better treat dementia in PD.

Pd Dementia And Safety Concerns

Safety issues should be considered and monitored from the time of diagnosis. As PDD progresses, ensure that your loved one is not left alone and try to:

  • Evaluate driving privileges before safety is a concern. Your doctor can make a driving evaluation referral.
  • Work out legal and financial issues and safeguard finances. People with dementia are at greater risk of falling victim to scams and fraud.
  • Minimize prescription risks. Confirm with the doctor the medication names and doses of the person with PD. If the person is in dementias early stages and capable, fill up their weekly pill box together and monitor use.
  • Look into medical alert systems. These systems can be critical in the event of a fall or if your loved one wanders outside of the home. Many types of systems are available, from bracelets and pendants to smartwatches with fall detection and one-button connections to 911.
  • Evaluate gun safety. If your loved one owns a firearm or has one in the home, consider bringing it up with their doctor and taking additional safety precautions.

Read Also: Tai Chi And Parkinson’s

Is There A Test To Diagnose Pd Dementia

There is no single test for PDD. The diagnosis is made clinically. If you or someone you spend time with notices cognitive changes, it is important to discuss them with your care team. If you dont have a care team in place, its important to find a specialist or physician familiar with dementia or geriatric medicine. Call the Parkinson’s Foundation Helpline 1-800-4PD-INFO for a referral.

How Can We Support The Sleep/wake Cycle Of Pdd

Parkinson’s, Alzheimer’s, and Huntington’s Disease – Medical-Surgical – Nervous System -@Level Up RN

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.

You May Like: Parkinson’s Disease Life Expectancy Dementia

Dysfunction In The Fronto

Volitional shifts of attention are thought to depend on top-down signals within a fronto-parietal network comprising prefrontal cortical areas and posterior parietal cortices , wherein prefrontal regions modulate activity in the network according to task demands .

The major cortical neural networks affected in PDD. Areas of cortical atrophy associated with visuospatial and visuoperceptual deficits in PDD are based on the data presented in . Areas of cortical atrophy specifically associated with the presence of visual hallucinations in PDD are based on the data presented in . Functional cortical regions comprising the fronto-parietal attention network are based on the data presented in . Cortical regions are identified according to the Allen Brain Atlas for the human brain, and manually drawn onto the corresponding 3D brain image. In this representation the same cortical regions are affected symmetrically in both hemispheres, however in the original studies above the extent of atrophy in these regions was not symmetrical between hemispheres, and varied between individual patients. In the inferior view of the cortex the cerebellum has been removed to expose the fusiform gyri more clearly. DLPFC = dorsolateral prefrontal cortex PPC = posterior parietal cortex VLPFC = ventrolateral prefrontal cortex.

Concomitant Dysfunction In Frontal And Arousal Networks Contributes To Generation Of Visual Hallucinations

Overlapping dysfunctions in a number of other cognitive networks are also likely to contribute to the generation of visual hallucinations in PDD. For example, several functional MRI studies comparing patients with Parkinsons disease with hallucinations to those without during performance of visual paradigms have demonstrated not only dysfunction in visual cortical areas in the former, but also simultaneous disruption of activity in frontal areas . The presence of hallucinations in PDD is closely associated with worsening impairments on tests of attentional control , as well as impairments on tests of inhibitory control such as the Stroop Test and Go/No-Go Task , deficits that might in part be attributable to dysfunctions in the fronto-parietal and noradrenergic networks respectively . This therefore suggests that breakdown in these frontal networks may play a contributory role in the generation of visual hallucinations in PDD, perhaps by reducing attentional and inhibitory control of perceptual errors arising from dysfunction in posterior visual cortices, allowing them to enter conscious perception as hallucinations .

Recommended Reading: Neil Diamond Parkinson’s Disease

Is Dementia A Symptom Of Both

One of the biggest similarities between PD and LBD is dementia. Some studies have found that approximately 78 percent of PD patients will eventually develop dementia. More specifically, almost half of Parkinsons patients will develop a certain type of dementia called Parkinsons Dementia, usually 10-15 years after their initial PD diagnosis.3,4

People with Parkinsons Dementia commonly experience poor memory and concentration, slowed thinking, confusion, depression, emotional changes, delusions, and visual hallucinations.

Parkinsons dementia is different than LBD, mainly in which symptoms occur first . Patients with Parkinsons Dementia will first show Parkinsons motor symptoms, followed by dementia many years after diagnosis. Conversely, LBD patients will first show dementia symptoms and may show motor symptoms later.3

Coping With A Parkinson’s Diagnosis

Pin on Parkinson

A diagnosis of Parkinsons can be a frightening experience for both you and your loved ones. While there is currently no cure, there are treatments available for Parkinsons symptoms and lifestyle changes you can make to slow the progression of the disease and delay the onset of more debilitating symptoms, including Parkinsons disease dementia. Early diagnosis can prolong independence and help you to live life fully for much longer.

If youve been diagnosed with Parkinsons you may feel anger, deep sadness, or fear about what the future will bring. These feelings are all normal. Its also normal to grieve as you deal with this enormous adjustment.

Give yourself some time to adjust. As with any major change in life, dont expect that you will smoothly snap into this new transition. You may feel alright for a while, and then suddenly feel stressed and overwhelmed again. Take time to adjust to this new transition.

Learn all you can about Parkinsons disease and Parkinsons disease dementia. Educating yourself and making important decisions early can help you feel more in control during this difficult time.

Reach out for support. Living with Parkinsons presents many challenges, but there is help available for this journey. The more you reach out to others and get support, the more youll be able to cope with symptoms while continuing to enrich and find meaning in your life.

You May Like: What Medication Is Used To Treat Parkinson’s Disease

Popular Articles
Related news