Parkinsons Foundation To Present Most Recent Mental Health Research Findings
Non-movement Parkinsons disease symptoms can impact mental health, relationships and quality of life. The Parkinsons Foundation has conducted two recent studies dedicated to learning more about treating non-movement symptoms within its Center of Excellence Network.
Centers of Excellence are medical centers with a specialized team who are up to date on the latest Parkinsons medications, therapists and research to provide the best care to a combined 185,500 people with Parkinsons.
This year, the Parkinsons Foundation will share their research findings at two international conferences: at the International Congress of Parkinsons Disease and Movement Disorders in Nice, France, and at the World Parkinson Congress , which took place in June at Kyoto, Japan.
Both conferences gather thousands of neurologists, researchers and health professionals in the Parkinsons community.
Multidisciplinary Care Models for Parkinsons Disease: The Parkinsons Foundation Centers of Excellence Experience
People living with Parkinson’s benefit most from a comprehensive, team-based healthcare approach, where different specialists treat motor and non-motor symptoms as the disease progresses. Every Center of Excellence works with a multidisciplinary team in one of three different care models:
Apathy In Parkinson’s Disease
Apathy is understood as a reduced interest and participation in normal purposeful behavior, lack of initiative with problems in initiation or sustaining an activity to completion, lack of concern or indifference and a flattening of affect. Many studies have evaluated the prevalence of apathy in patients with PD using different scales and have reported a prevalence rate of 16.5-70%, depending on the assessment procedure and the study population. Evidence suggests that apathy in PD is not related to depression, anxiety, severity of motor symptoms. However, some of the recent studies suggest high level of comorbidity between apathy and depression in patients with PD. However, some studies suggest that apathy may be a side effect of DBS and other suggest that apathy in PD is determined by the level of cognitive impairment. Recent evidence suggests that in non-depressed non-demented patients, apathy may in fact be a predictor of cognitive decline and dementia in PD.
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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Neurological Disorders: Public Health Challenges
There is ample evidence that pinpoints neurologicaldisorders as one of the greatest threats to publichealth. There are several gaps in understanding themany issues related to neurological disorders, butwe already know enough about their nature andtreatment to be able to shape effective policyresponses to some of the most prevalent amongthem.
Neurological disorders: public health challengesdescribes and discusses the increasing globalpublic health importance of common neurologicaldisorders such as dementia, epilepsy, headachedisorders, multiple sclerosis, neuroinfections,neurological disorders associated with malnutrition,pain associated with neurological disorders,Parkinsons disease, stroke and traumatic braininjuries.
The book provides the public health perspective forthese disorders and presents fresh and updatedestimates and predictions of the global burden borneby them. It provides information and advice on publichealth interventions that may be applied to reducethe occurrence and consequences of neurologicaldisorders. It offers health professionals and plannersthe opportunity to assess the burden caused bythese disorders in their country and to takeappropriate action.
Caregiving & Helping Others
Parkinsons disease can be emotionally difficult for caregivers, but it also has its rewards.
Here are some strategies that can be helpful while caring for a person with Parkinsons disease:
According to a 2018 study, the cognitive symptoms of Parkinsons disease had a greater emotional impact on loved ones and caregivers than the physical symptoms. As the dementia progresses, carers may experience a sense of grief and loss, as they feel their loved ones are not themselves anymore.
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Treatment Recommendations For Dual Diagnosis
Although the treatment of PD patients with an MH comorbidity or exacerbation can be a challenge, there are recommended steps to ensure that each disease state is adequately treated.
The first step in treating PD patients with an MH condition or disturbance is to rule out underlying conditions and causative nonantiparkinsonian medications, followed by simplification of the PD medication regimen.28,29 The reduction or removal of causative antiparkinsonian medications can facilitate the treatment of psychosis, ICDs, and mania.18-22 If a loss of motor function occurs in a patient undergoing dosage or medication reduction, the addition of an antipsychotic may be considered. These steps are outlined in FIGURE 2.
Cholinesterase inhibitors, such as rivastigmine, may be considered. These agents serve as an alternative to antipsychotics in patients with mild-to-moderate psychosis.28 Rivastigmine has been found to be consistently effective for the treatment of PD psychosis.28,36,37 Trials also demonstrate that rivastigmine is more effective than donepezil.6,31
David: On Anxiety Sleep And Focusing On The Positive
David , a 74 year-old man with PD diagnosed two years ago, has been dealing with anxiety and depression for decades. I was in therapy as a teenager and young adult for issues of anxiety and depression. But about five to six years ago, the anxiety worsened, and he sought out the care of the same therapist he saw when he was in his thirties.
The intensification of his anxiety preceded his diagnosis of PD by a few years, a relatively common phenomenon in which particular non-motor symptoms of PD appear before the motor symptoms. In addition, since his diagnosis of PD, he started noticing some cognitive issues specifically trouble with his memory and word-finding difficulties.
Initially, controlling the anxiety and dealing with the cognitive changes were very difficult for David and the two issues were inter-related for him. A word-finding difficulty would inevitably trigger anxiety. I used to go crazy because I couldnt think of particular words. And that anxiety would then make it even harder to find the right word.
He cant emphasize enough the importance of a good nights sleep. He used to get four hours of restless sleep. Now with the help of his more relaxed view of life and current medication regimen, he is able to get 6-7 hours of restful sleep and that has led to a major improvement in his quality of life.
Key lessons that David can share about his mental health include:
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Read Messages From Our Community Related To Mental Health In Advanced Pd:
My Dad fights aggressively when his aides try to get him to do something he doesnt want to. He gets so angry and is so strong it can take many people to restrain him.
My Mom lives at home, but constantly thinks that she is somewhere else and wants to go home. She becomes irritated and angry with the family because she says that we are holding her hostage.
My husband is verbally abusive towards me. This is an entirely new aspect to his personality. He was always very loving. Now he is aggressive.
My wife is severely depressed. Although she can get out of bed with help, she would rather stay in bed and do nothing. She also doesnt seem to mind that she is doing nothing all day.
Often, my brother doesnt recognize me when I visit. Last week, I saw my brother in the morning, but when I spoke with him on the phone later on in the evening, he mentioned that he had not seen me in a long while.
These quotes highlight a set of very problematic issues in advanced PD which include cognitive decline/dementia, depression, apathy, anxiety, psychosis , and behavior problems . One person often has a mixture of these symptoms and the symptoms can be inter-related.
Drug Reactions: Psychosis And Impulse Control Disorders
PD pharmacologic treatment emphasises dopamine replacement, dopamine receptor stimulation, or prevention of enzymatic breakdown of dopamine in the synaptic cleft.3 While these drugs have their effects on a variety of CNS neurotransmitter systems, they primarily affect dopamine transmission. Thus, it is not surprising that they often produce dramatic behavioural changes that cause significant difficulties for patients and their families and carers.5 There are convincing data that suggest that treatment with dopaminergic agents may be associated with the development of a variety of impulse control disorders in some patients.5 Impulse control disorders, including severe gambling and hyper-sexuality as well as shopping and binge eating, can be extremely disruptive to patients and families.
As with psychosis, impulse control disorders are more commonly associated with the dopamine agonists, pramipexole and ropinirole.11 Given the impact of impulse control disorders, clinicians need to educate patients and monitor them for the early signs of these disturbances.5
Delusions are uncommon in the first two years of PD therapy, but may also occur and, as with hallucinations, are often preceded by vivid dreams.5 These delusions are usually persecutory in nature, including fears of being injured, influenced, poisoned, filmed, and/or tape-recorded.5
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Mood And Memory Changes In Parkinsons Disease
The Profile of Memory and Cognitive ChangesDetails: Parkinsons and mental health You may experience a range of mental health issues alongside your physical Parkinsons symptoms, Depression in Parkinsons disease affects quality of life, These can range from depression and anxiety to hallucinations, as well as the great burden it adds to these patients, frustration, and it might be the second milestone in treatment of Parkinsons disease after the introduction of L-dopa and dopamine agonists, Lack of motivation to leave the house or get out of bed, memory problems and dementia., The hallmark signs of Parkinsons disease are aIntroduction, Loss of interest in hobbies that once were a priority, frustration
Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
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Other Factors That May Affect Your Mental Health
Other features of PD that contribute to mental health issues include sleep disorders, fatigue and apathy. To complicate matters further, in some cases, PD medications can contribute to mental health problems, for example, by contributing to psychosis or compulsivity.
Of course, each persons mental health does not exist in a PD vacuum, but rather reflects his/her baseline personality, ingrained coping mechanisms, and life circumstances both uplifting and stressful- beyond PD, including family and work.
APDA has educational supplements on depression and cognitive changes that you can access for more information on these topics.
Parkinsons Disease And Mental Health: Whats The Link
The relationship between Parkinson’s disease and mental health is not straightforward. This is because, when it comes to the brain, no one is entirely sure what causes either Parkinson’s disease or mental illness. However, there is no evidence to suggest that a pre-existing mental health condition increases your risk of developing Parkinson’s disease . On the other hand, a diagnosis of Parkinson’s disease does make you more susceptible to developing mental health conditions.
Anxiety and depression are the most common mental health symptoms in people with Parkinson’s. Signs to look out for include:
- Changes in appetite, either eating too much or too little
- Excessive tiredness
- Lack of interest in hobbies and activities
- Feeling hopeless or down most days
- Feeling fearful or constantly worried
The mental health symptoms of Parkinson’s disease can also affect your physical symptoms and vice versa. For example, some people find that their anxiety increases when they have OFF episodes where their medication doesn’t work as well. Others report feeling depressed as a result of worsening symptoms.
If you’re struggling with the mental or emotional effects of Parkinson’s disease, you should talk to your doctor. He or she may suggest changing or adjusting your medication.
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Anxiety And Parkinsons Research
What does this finding mean for the future of diagnosis or treatment of Parkinsons? Ongoing research is compelling, says Pontone. Part of what we are doing is looking at anxiety disorders that occur long before the onset of Parkinsons to see if there are characteristics that may differentiate that anxiety or predict an increased risk of Parkinsons disease.
Meanwhile, because theres an established link between anxiety and Parkinsons disease, patients and their families should be upfront with their doctors about anxiety symptoms. Behavioral therapy and medications for example, anti-anxiety meds or antidepressants can effectively treat anxiety disorders. Theres no need for anyone to suffer in silence.
Targeting Parkinsons-Linked Protein Could Neutralize 2 of the Diseases Causes
Researchers report they have discovered how two problem proteins known to cause Parkinsons disease are chemically linked, suggesting that someday, both could be neutralized by a single drug designed to target the link.
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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Exacerbation Of Pd Symptoms
Treating MH comorbidities, especially psychosis, in patients with PD often leads to an exacerbation of PD symptoms. First-generation antipsychotics and second-generation antipsychotics have been linked to an increase in PD symptoms, owing primarily to prolonged use of dopamine receptor blockers. PD patients may experience worsening of extrapyramidal symptoms , including akathisia, parkinsonism, dystonia, and tardive dyskinesia .23
TD develops in approximately 20% of patients on long-term antipsychotic therapy, and there is some debate over a lower incidence with SGAs.23 It can present after brief exposure to a dopamine-blocking agent, but mostly develops after months or years of therapy.23 The comparatively lesser severity of EPS with SGAs is postulated to be due to dual serotonin-dopamine receptor antagonism.6 The risk of TD development in PD patients poses a problem for therapy.
SGAs are thought to have a more favorable side-effect profile than FGAs. The mechanisms of these agents will be discussed in the treatment recommendations section.
Is There A Cure For Parkinsons
Theres currently no cure for Parkinsons, a disease that is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinsons is often misdiagnosed.
Its reported that Parkinsons complications was the
Complications from Parkinsons can greatly reduce quality of life and prognosis. For example, individuals with Parkinsons can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal.
Proper treatment improves your prognosis, and it increases life expectancy.
It may not be possible to slow the progression of Parkinsons, but you can work to overcome the obstacles and complications to have a better quality of life for as long as possible.
Parkinsons disease is not fatal. However, Parkinsons-related complications can shorten the lifespan of people diagnosed with the disease.
Having Parkinsons increases a persons risk for potentially life threatening complications, like experiencing:
Parkinsons often causes problems with daily activities. But very simple exercises and stretches may help you move around and walk more safely.
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Mental Health Considerations For Caregivers
An important and yet often overlooked aspect of neuropsychiatric symptoms is that the patient is not the only person to bear the burden of these comorbidities. Family members, spouses, and friends increasingly assume the role of care partner as a patients course of illness progresses. Ideally, as a patients disability becomes more severe, this partnership helps the patient better manage symptoms, comply with treatment, and remain in the home. Yet the ability of a care partner to provide help is more often confounded by the presence of neuropsychiatric symptoms in the patient than the overall severity of his or her physical impairment. Therefore, best management should include not only treatments for the neuropsychiatic symptoms in the patient with PD but also awareness and support for the patients care partners.11
Providing assistance for a person with PD sometimes evolves into an overwhelming burden, upending lives and creating serious levels of family dysfunction. The mental health and coping skills of care partners has a major impact on their lives and the quality of life of the patient with PD. Interviewing care partners to assess their concerns, problems, and ability to effectively serve in this capacity is an important, although often neglected, aspect of patient care.