Robin Was Very Aware That He Was Losing His Mind And There Was Nothing He Could Do About It
Schneider added: Robin was very aware that he was losing his mind and there was nothing he could do about it.
Jacqueline Cannon said of her fathers condition: He always used to say to me, Im losing my mind. We say to people that LBD is not just about memory. Its about the other symptoms that go with it, especially the hallucinations.
In the spotlight
Like Parkinsons disease there is currently no cure for LBD, and a need to raise awareness the case of Robin Williams will no doubt help. Dedicated research centres do already exist, such as the leading Biomedical Research Unit in Lewy Body Dementia at Newcastle University.
Professor Ian McKeith, president of the Lewy Body Society, believes there is cause for hope however. In a piece published by The Conversation, he wrote: Therapeutic trials have been few and far between in LBD because of a combination of a lack of compounds to test, a pre-occupation with targeting Alzheimers and a reluctance of regulatory bodies to recognise LBD. All of these are now changing and LBD is increasingly viewed as a malleable and commercially-viable target.
Asceneurons Innovation In Pdd And Dlb
Several symptomatic treatments addressing motoric disturbances in PD are currently available. In contrast, there is a very high unmet medical need for novel symptomatic medications to mitigate the cognitive decline in Parkinsons disease dementia patients since available options have limited efficacy and considerable side effects. As the disease progresses, balancing the benefits of medications with their side effects becomes challenging for caregivers.
Given the high unmet medical need in PDD, a symptomatic treatment for one of the more debilitating facets of PD would bring significant benefit to PD patients and their caregivers.
In May 2022, Asceneuron has initiated a preclinical proof-of-concept study to assess the disease-modifying properties of Asceneurons OGA inhibitor ASN51 in a preclinical model of inherited PD. The genetic model is characterized by the overexpression of -synuclein harbouring the A53T mutation known to cause early-onset, familial PD in humans. Aggregated forms of -synuclein are the main component of the characteristic Lewy body pathology and thus thought to be causative of the loss of dopaminergic neurons in PD. The aim of this study is to extend previously published findings demonstrating a reduction of motor impairment with Asceneurons OGA inhibitors to this alternative genetic disease model.
Alzheimers And Parkinsons Disease: Similarities And Differences
James M. Ellison, MD, MPH
Swank Center for Memory Care and Geriatric Consultation, ChristianaCare Configure
- Expert Advice
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?
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What Causes Lewy Body Dementia
Lewy body dementia is a broad term covering two separate neurological disorders: dementia with Lewy bodies and Parkinsons disease dementia. The same biological changes to the brain cause both disorders.
A buildup of Lewy bodies causes LBD. Lewy bodies build up in neurons located in certain areas of the brain that are responsible for behavior, movement, and cognitive ability.
Doctors do not know why you or your loved one develop LBD while others do not. There is some thought that the combination of mutation in a persons genes, environmental risk factors and natural aging might lead to the development of LBD in some people. Research into specific causes is ongoing.
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.
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How Is Lewy Body Dementia Diagnosed
There are no medical tests that can diagnose Lewy body dementia with 100% accuracy. Specialists, including neurologists, geriatric psychiatrists, neuropsychologists and geriatricians, make the diagnosis of probable LBD based on the combined results of tests and patient symptoms.
Your healthcare provider will perform a thorough neurological and physical examination. You or your loved one will also complete mental status and neuropsychological tests. These tests check thinking abilities, including memory, word-finding, attention and visual-spatial skills. Your doctor will ask you and your family about your mental status and the history of your symptoms. Be sure to tell your healthcare provider of any physical, cognitive, memory, emotional, behavioral, movement, sleep or physical changes you or your loved one is having. Also, tell your healthcare provider about any of your current medications, supplements, vitamins, herbal products and frequently used over-the-counter products. These will be reviewed to see if they might be a cause of your or your loved ones symptoms.
Depending on your symptoms, your doctor may also test your blood. If your doctor needs more information, brain imaging studies may be performed.
If you have cognitive deficiency severe enough to impair daily life in the presence of any following clinical features, your doctor may suspect diagnosis of LBD:
The Pathologies Are Different But Many Of The Symptoms Can Be Similar
We do know that the pathology is quite different between Parkinsons and dementia, said Dr. Odinachi Oguh, a neurologist at the Cleveland Clinic Lou Ruvo Center for Brain Health. But the processes in which memory is impacted in both diseases is about the same.
From the pathology standpoint, both diseases are characterized by a neurodegenerative process, Oguh said. The neurodegeneration results in abnormal accumulation of protein, which builds up and becomes toxic to the brain.
Alzheimers, for example, affects memory areas of the brain, which include the temporal lobes, as well as the memory center, or hippocampus. Parkinsons, meanwhile, starts in the basal ganglia part of the brain, and as the disease progresses, it can also affect the memory center, resulting in forgetfulness, an early sign of Alzheimers or other forms of dementia.
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What Are The Complications Of Parkinson Disease
Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.
Parkinson disease dementia can cause problems with:
- Speaking and communicating with others
- Problem solving
- Forgetfulness
- Paying attention
If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.
Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.
What Are The Symptoms Of These Diseases
The main symptoms of Parkinson’s disease involve motor control, such as tremor , slowness of movement, stiffness of the limbs and trunk as well as postural instability. Many patients develop a decline in thinking and reasoning known as Parkinsons disease dementia if it occurs more than one year after the initial diagnosis of Parkinsons disease. Common symptoms for PDD include decline in memory, concentration and judgment, visual hallucinations, depression, irritability, and anxiety.
The central feature of Lewy body dementia is progressive cognitive decline, combined with pronounced fluctuations in alertness and attention, complex visual hallucinations, and motor symptoms such as rigidity and the loss of spontaneous movement. It can easily be mistaken for Alzheimers disease or for Parkinsons disease dementia .
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Lewy Bodies Dementia And Parkinsons What Does It All Mean
Here are two common scenarios that may sound familiar:
Scenario 1A patient develops a series of neurologic symptoms, is evaluated by a neurologist and is told that she has Parkinsons disease . She then visits another neurologist for a second opinion and is told she has Lewy Body Dementia .
Scenario 2A patient has his first visit with his neurologist and is told that he has PD, at a subsequent visit the diagnosis is changed to Parkinsons disease dementia , and at a follow up visit the diagnosis is changed yet again to Dementia with Lewy Bodies .
Both of these situations understandably cause great uncertainty and frustration.
How Exactly Is Lewy Body Dementia Related To Alzheimers Disease And Parkinsons Disease
Lewy body dementia is a broad, general term for dementia in which lewy bodies are present in the brain. Dementia with lewy bodies and Parkinsons disease dementia are two related clinical disorders that make up the general broader category of Lewy body dementia. Sometimes LBD is first diagnosed as Parkinsons disease or Alzheimers disease based on its symptoms.
- Parkinsons disease dementia : You might be diagnosed with Parkinsons disease if you start out with a movement disorder typical to Parkinsons but then have your diagnosis changed to PDD when dementia symptoms develop.
- Alzheimers disease : You might start out with memory or cognitive disorder that leads to a diagnosis of AD. Over time, other distinctive symptoms begin to appear and your diagnosis is then changed to dementia with lewy bodies. Distinctive symptoms of LBD include the changes in attention, alertness and cognitive ability changes in walking and movement visual hallucinations REM sleep behavior disorder and severe sensitivity to some antipsychotics used to treat hallucinations.
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Pathophysiology Of Cognitive Impairment
The neurobiological basis for cognitive impairment in DLB and PDD is multifocal, related to a synergistic effect of both Syn/LB and AD pathologies and dysfunction of dopaminergic, noradrenalinergic, serotonergic, and cholinergic systems . The emergence of PDD and DLB occurs on the background of severe dopamine deficits and correlates with a marked loss of limbic and cortically projecting dopamine, noradreanaline, serotonin, and ACh neurons. The relationship between these lesions is not yet fully understood.
Severe pathology also involves the noradrenergic locus ceruleus and the serotonergic dorsal raphe nucleus as well as the ventral tegmental area not always associated with coincidental AD lesions . LC neuronal loss and the accompanying norepinephrinergic deficiency are an important cause and pharmacological target for the treatment of PD/PDD/DLB . The prominent role of serotonergic degeneration also involving the anterior caudate nucleus, the orbitofrontal and cingulate cortex for neuropsychiatric symptoms in PD , emphasizes its important role in both PDD and DLB, and stimulates new insight into novel treatments by modulating 5-HT receptors .
How Can We Manage Hallucinations
It may not be necessary to treat all hallucinations of a person with PDD. Hallucinations are often harmless, and it is okay to allow them to happen, as long as they are not disruptive or upsetting to the person or surroundings. Sometimes, recognizing the hallucination and then switching the topic might be an efficient way of handling frustrations that occur because of a hallucination. If hallucinations need medical treatment, your provider may be able to discuss and suggest some options. However, many of the medications used to treat hallucinations may make movement symptoms worse.
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Tip : Whatand Howyou Eat Can Make A Difference
Theres no specific Parkinsons disease diet, but by adjusting your eating habits, you can help protect your brain. Diets that are good for your heart tend to also be good for brain health. Eating habits such as those promoted in the Mediterranean diet can help reduce inflammation, protect neurons, and promote better communication between brain cells.
Primarily, its important to eat plenty of fruit and vegetables, cut down on sugary foods and refined carbs, reduce fried and processed foods, and boost your intake of healthy fats and home-cooked meals. High protein meals may also help to benefit your brain chemistry.
Managing The Effects Of Parkinsons Disease
Currently there is no cure for Parkinsons disease but UK and international research is ongoing.
With Parkinsons disease the interventions are focused on support, management of the changes, working with the person and their family to ensure they can live as well as possible with the condition. The physical effects of Parkinsons disease can be managed by:
- adapting the home environment so any trip hazards are removed and risks minimised
- a referral to Speech and Language Therapy if there are speech or swallowing problems
- a referral to a physiotherapist if there are movement issues
- a referral to an occupational therapist for aids and devices that may help around the house
If the person with Parkinsons has significant communication or cognitive issues they can be reduced by:
- reviewing the medication given for Parkinsons as this may be worsening the cognitive symptoms
- speaking slowly and clearly if understanding and thought processes are slowed
- reducing distractions
- giving time for communication it may take longer to respond
- asking questions to narrow down the answer, give choices or use yes/no cards or picture cards the person may have word finding difficulties as well as needing longer to respond
- using a mobile phone, tablet or electronic communication aid
- avoid unfamiliar or noisy places as they can cause distress
- providing a routine and activities that the person enjoys and feels comfortable with
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Parkinsons Disease: Symptoms Stages And Treatment
Parkinson’s disease usually begins after age 60, gradually progressing over the years. Some people can have early-onset Parkinson’s disease, starting in their 30s or 40s. It is primarily a movement disorder characterized by resting tremors and slowness and stiffness of movement.
In the late stages of the disease, Parkinson’s dementia can develop. But most people who have Parkinson’s disease do not develop dementia as a part of the condition.
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.
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What Causes Parkinsons Disease Dementia
A chemical messenger in the brain called dopamine helps control and coordinate muscle movement. Over time, Parkinsons disease destroys the nerve cells that make dopamine.
Without this chemical messenger, the nerve cells cant properly relay instructions to the body. This causes a loss of muscle function and coordination. Researchers dont know why these brain cells disappear.
Parkinsons disease also causes dramatic changes in a part of your brain that controls movement.
Those with Parkinsons disease often experience motor symptoms as a preliminary sign of the condition. Tremors are one of the most common first symptoms of Parkinsons disease.
As the disease progresses and spreads in your brain, it can affect the parts of your brain responsible for mental functions, memory, and judgment.
Over time, your brain may not be able to use these areas as efficiently as it once did. As a result, you may begin experiencing symptoms of Parkinsons disease dementia.
You have an increased risk of developing Parkinsons disease dementia if:
- youre a person with a penis
- youre older
Preventing And Delaying Cognitive Change
To overcome the cognitive changes linked to Parkinsons, it is recommended that you keep as active and stimulated as possible – physically, mentally and socially. It is important to stimulate all the different parts of the brain. Some useful tips include:
- Undertake regular exercise
- Complete simple arithmetic and crosswords
- Listen to and play music
- Participate in a social group
- Do volunteer work
- Maintain paid employment if possible
- Learn new skills
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Palliative Care In Parkinson’s Disease
Palliative care for people with PD and their caregivers has progressed over the last 10 years but it is still an upcoming field. Evidence of effects is limited but trials are underway . Qualitative studies on palliative care needs and natural history studies have indicated that the needs of people with advanced PD are complex. Awareness of the potential benefit of palliative care is growing, but we know little about useful components . To the best of our knowledge, there is no clear conceptualization of the specifics of palliative care in PD.
Living With Parkinson Disease
These measures can help you live well with Parkinson disease:
- An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
- High protein meals can benefit your brain chemistry
- Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
- If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.
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