Depression And Parkinsons Disease
Depression is a common problem in patients with Parkinsons disease. Prevalence rates have been reported from 11% to 44% depending upon the presence of minor or major depressive symptoms and the assessment scales used. Prevalence of 31% was reported in a recent meta-analysis.
The manifestations include apathy, psychomotor retardation, memory impairment, pessimism, irrationality, and suicidal ideation without suicidal behaviour. Depression has been strongly related to the patients quality of life in Parkinsons disease.
The symptoms of depression in Parkinsons disease vary slightly from the typical symptom profile of primary depression. Depressed parkinsonian patients experience less guilt and self reproach and more irritability, sadness, and concern with health. Depression associated with agitation creates additional functional incapacity to which young onset parkinsonian patients appear particularly prone.
Mood fluctuations can accompany motor fluctuations of on-off states. Depression increases in the off state and improves in the on state. Completed suicide appears to be rare in the Parkinson population even though verbalised suicidal ideation is not uncommon. Younger onset patients appear to be more at risk for suicide and suicidal gestures than older patients. Severe depression in Parkinsons disease may anticipate the development of intellectual impairment. Depression may also present as pseudodementia that resolves with effective treatment of the depression.
Breathing Problems And Parkinsons Disease
Usually, trouble breathing is not thought of as a symptom of PD. Those with PD who complain of this will typically have testing of their heart and lung function. This is necessary since, as we continue to emphasize, a person with PD can develop medical problems unrelated to PD and needs every new symptom evaluated like someone without PD. However, often the testing does not reveal a cardiac or pulmonary abnormality. Could difficulty breathing be a symptom of PD itself?
There are a number of ways in which difficulty breathing may be a symptom of PD:
Shortness of breath can be a wearing-OFF phenomenon
Some non-motor symptoms can fluctuate with brain dopamine levels, which means that they change as a function of time from the last levodopa dose. For some people, shortness of breath can be one of the non-motor symptoms that appears when medication levels are low. However, shortness of breath can be due to anxiety which can also be a wearing-OFF phenomenon. Sometimes it is not possible to determine whether the key symptom is anxiety or shortness of breath. Treatment involves changing medication dosing and timing so that OFF time is minimized. You can view this webinar which discusses the concept of wearing OFF and potential treatments.
Abnormal breathing can be a type of dyskinesia
Restrictive lung disease
Types Of Pain In Parkinsons
One review classified the types of PD pain as follows:
- musculoskeletal, in which the pain results from problems with the muscles , bones or joints
- dystonic, which is due to abnormal muscle contractions caused by PD or the medications used to treat it
- radicular pain or nerve pain
- central pain, which is poorly understood and thought to be due to abnormalities in the brain itself
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How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
Causes Of Parkinsons Disease
At present, we do not know the cause of Parkinsons disease. In most people there is no family history of Parkinsons Researchers worldwide are investigating possible causes, including:
- environmental triggers, pesticides, toxins, chemicals
- genetic factors
- combinations of environment and genetic factors
- head trauma.
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How Is Parkinsons Disease Diagnosed
Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.
To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.
If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.
Cognitive And Mental Symptoms
The changes occurring in the brain that affect movement and muscle tone can also influence how a person thinks, affecting our cognitive functions. Furthermore, the weight of the physical symptoms and the uncertainties of the prognosis can triggermental health concerns.
Below are some of the cognitive and mental health symptoms that people with Parkinsons might experience.
20. Anxiety and Depression
The cognitive changes happening in someone with PD bear similarities to those with anxiety and depression. On top of that, the stress and concerns that come with medication, therapy, and not being able to do things like before can increase the risk of anxiety and depression.
21. Memory Problems and Cognitive Changes
A reduced ability to recall things and difficulty in focusing may not appear until the later stages of Parkinsons, butexperts say the risk is there. In fact, many individuals with PD tend to developdementia towards the later stages.
22. Hallucinations and Delusions
Previously,experts believed that psychotic symptoms, particularly hallucinations and delusions, mainly arise from long-term use of PD medications now, though, they found that these could be related to the disease itself.
Because of their physical symptoms like pain and reduced ability to move, individuals often develop a lack of interest in daily activities . People around them may also notice changes in their personality and behaviour.
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Apda In Your Community
It is common for a person with Parkinsons disease to attribute every new symptom that develops to PD. That is largely because the list of non-motor symptoms commonly associated with PD is so varied, it can seem that almost anything is a symptom of PD! But if you take a closer look, there are some symptoms that are very commonly associated with PD, others that are virtually never associated with PD, and some in between.
Lets divide up non-motor symptoms into the following categories:
Aetiopathology Of Dementia In Parkinsons Disease
Deficits in dopaminergic, cholinergic, and noradrenergic mechanisms have been proposed as the basis of cognitive impairment in Parkinsons disease. However, there is no direct evidence for or against this postulation. In some patients, dopaminergic drugs provide benefit in cognition when treated for off periods. In a recent study, reduced fluorodopa uptake in Parkinsons disease in the caudate nucleus was related to impairment in neuropsychological tests measuring verbal fluency, working memory, and attentional functioning . This indicates that dysfunction of the dopamine system has an impact on the cognitive impairment of patients with Parkinsons disease. Acetylcholinesterase inhibitors may be useful because of their cholinergic effects. Defective noradrenergic transmission is considered to be important for attention deficit.
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What Are The Symptoms Of Atypical Parkinsonian Disorders
Like classic Parkinsons disease, atypical Parkinsonian disorders cause muscle stiffness, tremor, and problems with walking/balance and fine motor coordination.
Patients with atypical Parkinsonism often have some degree of difficulty speaking or swallowing, and drooling can be a problem. Psychiatric disturbances such as agitation, anxiety or depression may also be part of the clinical picture.
Dementia with Lewy bodies can cause changes in attention or alertness over hours or days, often with long periods of sleep during the day. Visual hallucinations typically of small animals or children, or moving shadows in the periphery of the visual field are common in DLB. DLB is second only to Alzheimers disease as a cause of dementia in the elderly, and it most commonly affects patients in their 60s.
Patients with progressive supranuclear palsy may have difficulties with eye movements, particularly when looking downward, and with balance when descending stairs, for instance. Backward falls are common and may occur during the early course of the disease. PSP is not usually associated with tremor, unlike Parkinsons disease.
Parkinson’s Disease and Movement Disorders Center
Living With Parkinsons Disease
Depending on severity, life can look very different for a person coping with Parkinsons Disease. As a loved one, your top priority will be their comfort, peace of mind and safety. Dr. Shprecher offered some advice, regardless of the diseases progression. Besides movement issues Parkinsons Disease can cause a wide variety of symptoms including drooling, constipation, low blood pressure when standing up, voice problems, depression, anxiety, sleep problems, hallucinations and dementia. Therefore, regular visits with a neurologist experienced with Parkinsons are important to make sure the diagnosis is on target, and the symptoms are monitored and addressed. Because changes in your other medications can affect your Parkinsons symptoms, you should remind each member of your healthcare team to send a copy of your clinic note after every appointment.
Dr. Shprecher also added that maintaining a healthy diet and getting regular exercise can help improve quality of life. Physical and speech therapists are welcome additions to any caregiving team.
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The 5 Stages Of Parkinsons Disease
Getting older is underrated by most. Its a joyful experience to sit back, relax and watch the people in your life grow up, have kids of their own and flourish. Age can be a beautiful thing, even as our bodies begin to slow down. We spoke with David Shprecher, DO, movement disorders director at Banner Sun Health Research Institute about a well-known illness which afflicts as many as 2% of people older than 65, Parkinsons Disease.
What Are The Non
While Parkinson’s disease is often associated with movement changes, there are a variety of non-motor symptoms, as well. Non-motor symptoms refer to the many other changes to a person’s health and wellbeing that can happen from Parkinson’s.
These symptoms can sometimes have an even greater impact on a person’s life than tremor, rigidity, and slow movement, so it’s important to keep an eye out for them in someone with the disorder. Here are some of the non-motor symptoms of Parkinson’s disease to look out for:
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Possible Risk Reduction Factors
While age, genetics, and being a man make it more likely you’ll develop Parkinson’s disease, some factors make it less likely. It is generally believed that Asian-Americans and African-Americans seem to have a lower risk of developing Parkinson’s as compared to Caucasians. Drinking coffee may lower risk, as a 30-year study of Japanese-American men found the greater amount of coffee they drank, the lower their risk of Parkinson’s disease became.
What Are The Primary Motor Symptoms Of Parkinsons Disease
There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.
It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.
Walking or Gait Difficulties
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Can Parkinsons Disease Be Prevented
Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.
Symptoms Of Atypical Parkinsonism
PD symptoms vary from person to person. Some people have a tremor, usually on one side of the body. Others with PD have muscle freezing or balance difficulties. You might have PD symptoms that are mild for years. Someone else may have symptoms that worsen quickly.
Atypical Parkinsonian syndromes each have their own set of symptoms:
- VP: Gait and balance problems are common symptoms. Dementia, incontinence, and palsy also develop.
- LBD: Thinking and memory decline. Hallucinations, delusions, and difficulty staying alert are also symptoms.
- MSA: Walking and balance problems are common with this condition. You may also have symptoms related to autonomic dysfunction. This is when the autonomic nervous system doesnt function as it should. The ANS controls automatic bodily functions like breathing, digestion, and circulation. These symptoms might include:
- a sudden drop in blood pressure when you stand up
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The Plus Side Of An Early Diagnosis
The news is not nearly all bad for those with young-onset Parkinsons. For one thing, patients with YOPD are better candidates for surgical procedures and medical innovations being used or developed to treat Parkinsons disease. For another, younger patients are less likely to be coping with other health problems at the same time.
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.
Discuss With Your Physician
Non-motor symptoms can sometimes be difficult to recognize. Therefore, it is important to make your doctor aware of them.
One useful resource is the PD NMS Questionnaire. You can use this to record your symptoms and discuss them with your doctor.
Dr. Ron Postuma, whose research was funded by donations to the Parkinson Canada Research Program, has also developed tools to help people with Parkinsons and their physicians identify and manage non-motor symptoms.
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Trouble Moving Or Walking
Do you feel stiff in your body, arms or legs? Have others noticed that your arms dont swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem stuck to the floor.
What is normal?If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.
Surgery For People With Parkinsons Disease
Deep brain stimulation surgery is an option to treat Parkinsons disease symptoms, but it is not suitable for everyone. There are strict criteria and guidelines on who can be a candidate for surgery, and this is something that only your doctor and you can decide. Surgery may be considered early or late in the progression of Parkinsons. When performing deep-brain stimulation surgery, the surgeon places an electrode in the part of the brain most effected by Parkinsons disease. Electrical impulses are introduced to the brain, which has the effect of normalising the brains electrical activity reducing the symptoms of Parkinsons disease. The electrical impulse is introduced using a pacemaker-like device called a stimulator. Thalamotomy and pallidotomy are operations where the surgeon makes an incision on part of the brain. These surgeries aim to alleviate some forms of tremor or unusual movement, but they are rarely performed now.
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What Is Parkinson’s Disease
Parkinsons disease occurs when brain cells that make dopamine, a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a movement disorder. But constipation, depression, memory problems and other non-movement symptoms also can be part of Parkinsons. PD is a lifelong and progressive disease, which means that symptoms slowly worsen over time.
The experience of living with Parkinson’s over the course of a lifetime is unique to each person. As symptoms and progression vary from person to person, neither you nor your doctor can predict which symptoms you will get, when you will get them or how severe they will be. Even though broad paths of similarity are observed among individuals with PD as the disease progresses, there is no guarantee you will experience what you see in others.
Estimates suggest that Parkinsons affects nearly 1 million people in the United States and more than 6 million people worldwide.
For an in-depth guide to navigating Parkinsons disease and living well as the disease progresses, check out our Parkinsons 360 toolkit.
What Is Parkinson’s Disease?
Dr. Rachel Dolhun, a movement disorder specialist and vice president of medical communications at The Michael J. Fox Foundation, breaks down the basics of Parkinson’s.
Support For People With Parkinsons Disease
Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinsons disease and identify potential difficulties and possible solutions.There are a limited number of multidisciplinary teams in Victoria that specialise in Parkinsons disease management. But generalist teams are becoming more aware of how to help people with Parkinsons disease.
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