Parkinson Disease And Mental Health Issues

What Type Of Exercise Should I Do If I Have Parkinsons Disease

Exercise is a planned, structured, repetitive activity that is intended to improve physical fitness. There is no right exercise for people with Parkinsons. Everyones regimen will differ, depending on overall health, symptoms and previous level of activity. Any exercise helps, and a variety of exercise types may provide well-rounded benefits.

Aerobic exercise

Aerobic exercise involves activities that challenge your cardiorespiratory system such as walking, biking, running, and activities in the pool. Participating in aerobic exercise at least three days a week for 30-40 minutes may slow Parkinsons decline.

Strength training

Strength training involves using your body weight or other tools to build muscle mass and strength. Strength training two days per week, starting with low repetition and weight, may be beneficial in Parkinsons disease. A focus on extensor muscles, or muscles in the back of the body, can help with posture.

Flexibility training

Stretching two or more days per week can be beneficial to maintain range of motion and posture. Holding each stretch of major muscle groups for 30 to 60 seconds can improve muscle length.

Balance and agility training

This type of training often combines aerobic exercise, strength training, and flexibility training. Examples include:

• Tai chi, yoga or Pilates.

Some mental health issues are side effects of Parkinsons treatments, like hallucinations, paranoia, and delusions.

How Soon After Treatment Will I Feel Better And How Long Will It Take To Recover

The time it takes to recover and see the effects of Parkinson’s disease treatments depends strongly on the type of treatments, the severity of the condition and other factors. Your healthcare provider is the best person to offer more information about what you can expect from treatment. The information they give you can consider any unique factors that might affect what you experience.

Tips For Coping With Depression

Caring for your mental well-being is key to living well with Parkinson’s. These strategies can help you manage depression:

• Empower yourself with knowledge about PD and its symptoms, including depression.
• Ask for help it takes courage, but it also puts you in control of finding a way to feel better and overcome feelings of helplessness.
• Keep an open mind. Depression is not a personal failing or a sign of weakness, it is a chemical imbalance in the brain.
• Plan short-term goals that you can achieve daily. Makes plans to walk, do a chore or talk to a friend. Small accomplishments contribute to a feeling of self-worth.
• Maintain social ties. Plan to connect with a friend once a week or take on volunteer work.
• Plan something to look forward to. Think about things you can do to enhance your quality of life and plan how to achieve them in small steps.
• If you have stopped or cut back on leisure activities because of Parkinson’s, try to resume one that you enjoyed or find a new one.
• Connect with the PD community. Compare notes on coping with depression with members of a support group.

Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson’s Foundation Center of Excellence.

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What Medications And Treatments Are Used

Medication treatments for Parkinsons disease fall into two categories: Direct treatments and symptom treatments. Direct treatments target Parkinsons itself. Symptom treatments only treat certain effects of the disease.

Medications

Medications that treat Parkinsons disease do so in multiple ways. Because of that, drugs that do one or more of the following are most likely:

Several medications treat specific symptoms of Parkinson’s disease. Symptoms treated often include the following:

• Erectile and sexual dysfunction.
• Hallucinations and other psychosis symptoms.

Deep brain stimulation

In years past, surgery was an option to intentionally damage and scar a part of your brain that was malfunctioning because of Parkinsons disease. Today, that same effect is possible using deep-brain stimulation, which uses an implanted device to deliver a mild electrical current to those same areas.

The major advantage is that deep-brain stimulation is reversible, while intentional scarring damage is not. This treatment approach is almost always an option in later stages of Parkinson’s disease when levodopa therapy becomes less effective, and in people who have tremor that doesnt seem to respond to the usual medications.

Experimental treatments

Researchers are exploring other possible treatments that could help with Parkinsons disease. While these arent widely available, they do offer hope to people with this condition. Some of the experimental treatment approaches include:

Exercise And Mental Health In Parkinsons Disease: What The Research Says

Parkinsons disease is most commonly associated with physical symptoms, such as tremors, rigidity and impaired posture. However, the impact of PD often goes far beyond physical impairment. The neurodegenerative disorder can also cause or increase the risk of a variety of non-motor symptoms, including depression, anxiety, impaired cognitive function and more.

While mental health issues are primarily treated with medication and psychotherapy, there is a growing body of research that suggests regular physical exercise may also have a role to play in supporting mental wellbeing in People with Parkinsons .

In this article, well explore some of the ways physical activity may help people with PD better manage non-motor symptoms.

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Limitations Of The Existing Animal Models Of Pd

Finally, we have summarized in Table 3 the current knowledge regarding the potential involvement of the neurotransmission systems in the pathophysiology of neuropsychiatric disorders through the different species used . It comes out that, although the DA and 5-HT systems seem to be involved in the pathophysiology of all these symptoms, the other systems have been much less studied. For example, in PD patients, there is evidence for an involvement of the cholinergic system in depression, apathy and psychosis but, to our knowledge, no animal study has yet shown causal links between an alteration of this system and the expression of a neuropsychiatric-like symptom. Furthermore, there is a real need for new preclinical studies on the pathophysiological substrates of apathy, psychosis and ICD as the arsenal of drugs to treat these disorders in patients is limited or non-existent .

Table 3. Overview on the involvement of DA and non-DA systems in the pathophysiology of neuropsychiatric disorders through the different species used.

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Anxiety As An Early Warning Sign

It may be that anxiety disorders that are diagnosed as much as two decades before Parkinsons disease may be a harbinger of the disease, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic. Parkinsons disease, like Alzheimers disease, has what experts call a long approach, he says, and anxiety may be part of that long approach.

One theory is that the anxiety that comes before Parkinsons results from the same underlying changes in brain chemistry and circuitry. Others believe that Parkinsons disease and anxiety share a common genetic risk factor. Either way, taking a closer look at the link can help doctors understand the causes of Parkinsons and treat patients with the disease.

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Neuropsychiatric Disorders In Parkinsons Disease: What Do We Know About The Role Of Dopaminergic And Non

• 1Inserm U1171 Degenerative and Vascular Cognitive Disorders, Lille University Medical Center, Lille, France
• 2CNRS, Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Lyon University, Bron, France

Besides the hallmark motor symptoms , patients with Parkinsons disease have non-motor symptoms, namely neuropsychiatric disorders. They are frequent and may influence the other symptoms of the disease. They have also a negative impact on the quality of life of patients and their caregivers. In this article, we will describe the clinical manifestations of the main PD-related behavioral disorders . We will also provide an overview of the clinical and preclinical literature regarding the underlying mechanisms with a focus on the role of the dopaminergic and non-dopaminergic systems.

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After The Clinical Diagnosis

Many studies now show that patients with PD have a poorer health-related quality of life than their age- and sex- matched peers.,, Not only does this perceived poor quality of life stem from the chronic nature of PD, but also cognitivebehavioural comorbidities such as depression and apathy play a major role in the life quality of patients with PD.,, A recent review has shown that moderate exercise was beneficial for mental health. However, due to the motor disability resulting from PD, a vicious cycle of lesser exercise and a lower quality of life is created. Moreover, dopaminergic medications used to treat motor symptoms of PD can precipitate or exacerbate these mental problems, thus treatment requires a fine balance between motor and cognitivebehavioural benefits and evidence-based guidance on such dilemmas is unfortunately lacking.

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Depression In Parkinson’s Disease

Depression has been reported to be very common in patients with PD. In fact the relationship of depression and PD follows a vicious cycle, with the presence of either increasing the risk of other disorder. The risk of PD is patients with depressive disorders have been reported to be more than that seen in general population. A large sample retrospective study of a matched cohort of 23,180 participants , reported that patients with depression were 3.24 times more likely to develop PD compared with the control patients. Another register-based study that had data of 105,416 subjects evaluated the history of depression in patients diagnosed with PD and reported a life time prevalence of depression prior to onset of PD to be 9.2% compared to 4% in the control population and the difference between the two groups was statistically significant and the odds of having depression in patients with PD was 2.5. Few studies have evaluated the incidence of depression in patients with PD and reported the incidence rate to be 1.86-5.1% per year.

Can Parkinson’s Disease Be Cured

No, Parkinson’s disease is not curable. However, it is treatable, and many treatments are highly effective. It might also be possible to delay the progress and more severe symptoms of the disease.

A note from Cleveland Clinic

Parkinson’s disease is a very common condition, and it is more likely to happen to people as they get older. While Parkinson’s isn’t curable, there are many different ways to treat this condition. They include several different classes of medications, surgery to implant brain-stimulation devices and more. Thanks to advances in treatment and care, many can live for years or even decades with this condition and can adapt to or receive treatment for the effects and symptoms.

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Treatment Of Neuropsychiatric Conditions

Drug treatments for neuropsychiatric symptoms are available, but most have limited evidence for safety and efficacy when used to treat patients with PD.7

Anxiety and DepressionAntidepressants are among the best studied, and recent systematic reviews suggest that selective serotonin reuptake inhibitors are the most effective and well-tolerated in patients with PD.8 However, other classes of antidepressants such as selective serotonin and norepinephrine reuptake inhibitors and tricyclics may be equally effective, although with a slight increase in potential side effects. While there are currently no evidence-based drug treatments for anxiety in persons with PD, antidepressants are likely useful, and cognitive-behavioral therapy has demonstrated efficacy across several trials for both anxiety and depression.9

ApathyTreatment of apathy is a major unmet need. Optimizing dopaminergic management for the motor symptoms of PD can improve the patients level of activity but does not eliminate apathy.

Impulse-Control DisordersTreatment of impulse-control disorders includes eliminating the triggering agent, which is usually a dopamine agonist, and obtaining appropriate psychiatric consultation.

How Do I Take Care Of Myself

If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.

• Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinson’s disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
• See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
• Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.

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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.

Get Support For Your Mental Health

You can call our free and confidential helpline on 0808 800 0303.

It’s open Monday-Friday 9am-7pm and Saturday 10am-2pm. Our trained advisers can provide support to anyone affected by Parkinson’s.

You can also contact the Mind Infoline on 0300 123 3393, which is open 9am-6pm, from Monday to Friday.

If you need to talk to someone outside of these hours, Samaritans are free to call 24/7 on 116 213.

There are lots of places where you can connect with people who may be experiencing similar issues to you.

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How Is Depression Diagnosed

Diagnosis is vital to effective treatment and recovery. A person must experience one of the following symptoms most of the time over the previous two weeks:

• Loss of interest or pleasure in activities once enjoyed

In addition, some of the following symptoms must be present:

• Changes in sleep or appetite
• Increased fatigue
• Suicidal thoughts or a wish for death

Psychosis In Parkinson’s Disease

Psychosis is generally not considered as a primary symptom of idiopathic PD, although there are case reports of psychosis in patients with PD from the pre-levodopa era. The inability to reliably discriminate post-encephalitic Parkinsonism from idiopathic PD and the lack of recognition of the numerous parkinsonian disorders that are not idiopathic PD make these reports suspect. In fact some authors suggest that the occurrence of psychotic symptoms in an untreated PD patient constitutes an atypical feature and cast doubt on the diagnosis.

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Changes In Cognition And Parkinsons Disease

Some people with Parkinsons may experience changes in their cognitive function, including problems with memory, attention, and the ability to plan and accomplish tasks. Stress, depression, and some medications may also contribute to these changes in cognition.

Over time, as the disease progresses, some people may develop dementia and be diagnosed with Parkinsons dementia, a type of Lewy body dementia. People with Parkinsons dementia may have severe memory and thinking problems that affect daily living.

Talk with your doctor if you or a loved one is diagnosed with Parkinsons disease and is experiencing problems with thinking or memory.

Checkpoints The Prevalence Of Depression In Patients With Parkinson Disease Is Around 40% Half Of These Patients Meet Criteria For Major Depression And Half Meet Criteria For Less Severe Forms Of Depression Optimal Control Of The Physical Aspects Of Pd Is A Prerequisite To Adequate Treatment Of Depression Studies Have Shown A Tight Correlation Between Off Periods And Depression And Unless There Is Good Control Of The Fluctuations Antidepressant Therapy Will Be Suboptimal Findings Suggest That Dementia Develops Within 9 Years Of The Onset Of Parkinson Disease In About 26% Of Patients This Percentage Rises To About 52% After 13 Years And To About 78% After 17 Years The Personality Traits That Frequently Accompany Pd May Be Described As Decreases In Novelty

Despite the prevalence of depression in patients with PD, there are few controlled, well-designed studies that direct treatment. In a randomized trial that compared nortriptyline, paroxetine controlled-release , and placebo, nortriptyline was superior to placebo and paroxetine CR.9 The trial also established that treatment of depression leads to improvements in quality of life, sleep, and some aspects of cognition.10 Findings from a short-term, randomized, placebo-controlled pilot study suggest that both citalopram and desipramine are more effective than placebo.7

The two studies noted above have led to an increased focus on the role of norepinephrine for depression in patients with PD. As in all of psychiatry, however, there are significant interindividual differences in response to medications and often tolerability is the most important factor to consider. The many tolerability issues include the anticholinergic effects of tricyclics and the risk of a slight worsening of the motor signs of PD with SSRIs.11 In addition, there is a potentially serious interaction between selegiline and rasagiline-monoamine oxidase B inhibitors that are widely used for their mild therapeutic and potential disease-slowing effects-and antidepressants.

Patients should be encouraged to exercise, to keep up their social contacts, and to seek out local PD support groups. Furthermore, supportive therapy directed at education and maintenance of activities outside the home is often beneficial.

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Risk Of Parkinson’s Disease In Patients With Psychiatric Disorders

The influence of mental illness early in life on the subsequent risk of PD and its clinical picture remain obscure. Several studies have identified certain psychiatric illnesses, particularly anxiety, depression and schizophrenia as risk factors for PD. Anxiety has been suggested to be one of the earliest manifestations of PD in several case-control and cohort studies.

What Are The Symptoms

The best-known symptoms of Parkinson’s disease involve loss of muscle control. However, experts now know that muscle control-related issues aren’t the only possible symptoms of Parkinson’s disease.

Motor-related symptoms

Motor symptoms which means movement-related symptoms of Parkinsons disease include the following:

Additional motor symptoms can include:

• Blinking less often than usual. This is also a symptom of reduced control of facial muscles.
• Cramped or small handwriting. Known as micrographia, this happens because of muscle control problems.
• Drooling. Another symptom that happens because of loss of facial muscle control.
• Mask-like facial expression. Known as hypomimia, this means facial expressions change very little or not at all.
• Trouble swallowing . This happens with reduced throat muscle control. It increases the risk of problems like pneumonia or choking.
• Unusually soft speaking voice . This happens because of reduced muscle control in the throat and chest.

Non-motor symptoms

Several symptoms are possible that aren’t connected to movement and muscle control. In years past, experts believed non-motor symptoms were risk factors for this disease when seen before motor symptoms. However, theres a growing amount of evidence that these symptoms can appear in the earliest stages of the disease. That means these symptoms might be warning signs that start years or even decades before motor symptoms.

Non-motor symptoms include:

Stages of Parkinsons disease

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