Symptoms Of Parkinsons Disease Dementia
Signs and symptoms of Parkinsons disease dementia include:
- Mental inflexibility
- Short-term memory issues and memory loss
- Trouble with decision making
- Executive function difficulty
- Slow processing speed
- Inattention
- Visual processing difficulty
Non-motor symptoms that can be associated with PDD include:
- Psychosis :
- Hallucinations
- Delusions
Diagnosis Of Parkinsons Disease Dementia
Diagnosis of PDD typically requires the initial diagnosis of PD, with the signs of Parkinsons disease of rest tremor, bradykinesia , rigidity , and postural instability.
At Pacific Movement Disorders Center we regularly monitor patients for cognitive changes which could signal the beginning of dementia, utilizing evidence-based screening tests. If concern arises, detailed neuropsychological evaluation with clear delineation of cognitive strengths and weakness can be obtained. On occasion, volumetric MRI scanning or PET scanning may play a role.
Differentiating between PDD and Dementia with Lewy Bodies can be challenging, given both conditions pertain to dementia and parkinsonism .
Lewy Bodies in PD patients predominate in the deep part of the brain called the substantia nigra, whereas in DLB they are widespread from onset.
The main differentiating factor is the clinical history:
In PDD, parkinsonism comes first, typically years prior to onset of dementia, whereas in DLB, cognitive changes either precede or coincide with onset of parkinsonism.In PDD, there tends to be clear improvement with levodopa for the motor symptoms at least.
For more on differentiating between PDD and DLB, see this comparison table.
What Are The Parkinsons Disease Dementia Criteria
Many people with Parkinsons disease experience cognitive changes , but not all of them develop full-blown dementia. So at what point does Parkinsons disease cause dementia?
On average, Parkinsons disease dementia happens about 10 years after a person first starts having movement problems.
It happens many, many years after someone has developed Parkinsons,Lynda Nwabuobi, MD, assistant professor of clinical neurology at Weill Cornell Parkinsons Disease and Movement Disorders Institute, tells Health. It can be around 10 to 15 years.
In fact, if someone shows signs of dementia early on in their Parkinsons diagnosis , it could be that they were misdiagnosed out of the gate. They might have dementia with Lewy bodies, Dr. Nwabuobi explains.
Timing is the main factor in Lewy body dementia versus Parkinsons disease dementia. While the two can look very similar, the dementia symptoms occur before motor symptoms in Lewy body dementia, and in Parkinsons disease the reverse is true.
If you look at the brain, its difficult to distinguish them, Dr. Litvan says. But clinically, they are different.
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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
Movement Problems And Lewy Body Dementia
Some people with LBD may not experience significant movement problems for several years. Others may have them early on. At first, movement symptoms, such as a change in handwriting, may be very mild and easily overlooked. Movement problems may include:
- Muscle rigidity or stiffness
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What Are Parkinson’s Disease Dementia Medical Treatment And Medications
There is no specific therapy for dementia in Parkinson’s disease. Although cognitive symptoms initially may appear to respond to drugs that promote dopamine production, the improvement is mild and transient in contrast to the early responses to motor control improvement with medication in patients with Parkinson’s disease.
Parkinson’s disease dementia medications
Various medications are used to treat the movement disorders of Parkinson’s disease, some may exacerbate symptoms related to dementia.
- These include dopamine given in the form of levodopa medications known as dopamine agonists that act on the dopamine receptor and medications that slow down the metabolism of dopamine. They are often used in conjunction with monoamine oxidase inhibitors such as rasagiline. In addition, anticholinergic drugs are sometimes used.
- Unfortunately, these drugs may affect cognitive symptoms and mood disorders.
- Anticholinergic drugs, for example, help balance levels of dopamine and acetylcholine, another neurotransmitter, in the brain. These drugs can improve movement disorders but often make memory loss worse.
The dementia of Parkinson’s disease may respond to drugs used in patients with Alzheimer’s disease. However, these drugs, called cholinesterase inhibitors , lead to only small and temporary improvements in cognition.
Mood disorders and psychoses are usually treated with other medication.
Caring For Someone With Parkinsons
Practice patience and understanding when dealing with Parkinsons. You may be very frustrated and challenged as a caregiver, but those with Parkinsons are just as frustrated. Their physical and mental conditions can be debilitating, depressing, and humiliating.
Diet and nutrition can have a huge impact on the health and comfort of a Parkinson patient. Eating well, getting more rest, sleeping well, fresh air, and exercise can make a difference. Getting the right medication and complementary therapies is also important.
As Parkinsons impacts a patients motor skills, modifications to the living environment may have to be made to accommodate wheelchairs and limited mobility issues. Professional in-home assistance for Parkinsons can allow Parkinson patients to remain independent and can enhance quality of life.
Most importantly, seek help and support from family, friends, and caregiving support groups. Take advantage of the resources in your community. Shouldering all the burden can take a toll on a caregiver.
Take care of yourself or you wont be able to take care of your loved one. Follow the preventive advice provided above for yourself as well, and take deep breaths!
Resources
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Severity Of Motor Symptoms
Compared to those without dementia, PDD patients had more severe motor features with a greater impairment in balance. Of the 36 participants, 13 were characterised H & Y stage IV and V, whereas the others were between stages IIII. In particular, of the seven PDD participants, six were characterised by having H & Y stages IV and V.
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.4 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 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
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Treatment Of Parkinsons Disease Dementia
Currently, statistics on cognitive change and dementia in PD come from studying patients who were first diagnosed ten or twenty years ago, prior to widespread recommendations about physical activity and exercise.
While no treatments have been proven to prevent development of Parkinsons and dementia, there is strong reason to believe that physical and cognitive activity could play a powerful role in slowing disease progression in the early stages of Parkinsons disease and throughout the course of disease.
Treatment of PDD involves the use of rivastigmine, an oral or transdermal medication that boosts the brains acetylcholine .
Rivastigmine is the only medication FDA approved for PDD but other medications sometimes used off label include donepezil , also an acetyhlcholine boosting drug, and memantine , an NMDA receptor antagonist.
Medications for dementia help somewhat, and other treatments may play a role for behavior issues in PDD.
Research, including clinical trials, is ongoing to find disease-modifying treatments for PDD.
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How Can I Help Myself
Adapting your daily routine, making changes to your environment and physical activity where possible can all help to manage DLB.
Keeping physically active and mentally stimulated is very important if you have DLB. Avoiding stress can also help as stress is likely to worsen memory problems, so try to take each day at a steady pace. Allow time for rest and relaxation, and make time to do the things you enjoy. Complementary therapies such as yoga and Tai Chi, together with exercise such as swimming may help with this.
Many people find it helps to adapt their home and work environments to their needs. For example, you may want to remove clutter to reduce the number of visual distractions and make it easier for you to find your way around. Keeping furniture, visual and hearing aids in the same place and having a regular daily routine may help you too. At night, you may find it useful to keep a low-level night light on to minimise possible disorientation if you wake.
As time passes, carrying out more complex tasks is likely to become harder. Try writing down the various steps you have to go through in order to complete specific tasks, and follow these steps one by one.
Use memory aids such as post-its, a whiteboard for notes, a notebook and alarms. Doing a crossword or Sudoku puzzles will also keep your brain active.
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Key Brain Changes Are Different
The key brain changes linked to Parkinsons disease and Parkinsons-related dementia are abnormal deposits of common brain proteins, called alpha-synuclein. These deposits are known as Lewy bodies, named after the doctor who discovered them. As more of these proteins clump in the brain, normal brain cells begin to die off.1
In Alzheimers disease, the key brain changes include the buildup of different brain proteins, called amyloid and tau. When amyloid proteins clump together, they form abnormal structures known as plaques. Abnormal groups of tau proteins form tangles.3 Over time, the buildup of these proteins causes normal brain cells to die, and affected parts of the brain may shrink.5
Parkinsons Disease Dementia Surgery And Gene Therapy
- Great strides have been made in the surgical treatment of Parkinsons disease. Several different procedures are now available, and they are successful in many patients in relieving movement symptoms. Unfortunately, surgery has no effect on cognitive symptoms. In fact, most people with dementia are not candidates for surgery.
- Gene therapy is in its infancy there are ongoing human and animal trials with various methods to insert genes into neuronal cells to reduce or stop Parkinsons disease symptoms by causing cells to produce dopamine coded by the newly inserted genes. Early results with the treatment termed ProSavin are encouraging. However, it is not clear if such therapy could prevent or reverse Parkinsons disease dementia.
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Core Features Of Probable Pdd
The primary defining feature of PDD is dementia that develops in the setting of established PD . Therefore, the critical first step in the diagnosis process is to identify idiopathic PD, prior to the development of dementia. For a diagnosis of PDD, two core features must be present: a diagnosis of PD according to the Queen Square Brain Bank criteria and PD developed prior to the onset of dementia .
In this case, a dementia syndrome is defined as impairment in at least two cognitive domains and cognitive deficiency severe enough to impair daily life that must be independent of impairment because of PD motor symptoms. The MDS Task Force recommended that the Mini-Mental State Examination may be useful as a screening instrument for identifying cognitive impairment in PDD patients the MMSE is a simple and universally applied scale that can be easily and quickly performed in the clinical setting . An MMSE score of 25 or below is proposed as the cut-off for identifying clinically significant cognitive impairment in this population .
Can Parkinsons Disease Make You Aggressive
Parkinsons disease Dementia or PD Dementia can make a patient very aggressive. Parkinsons Dementia Aggression germinating from Parkinsons disease Dementia can lead patients to behave erratically, experience sudden anger outbursts, feel constantly irritated, and always be in a state of restlessness. Outbursts are generally in the form of:
- Shouting
- Falling
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Parkinsons Dementia Vs Alzheimers Dementia
According to experts, Parkinsons dementia can cause impaired physical activity and impacts motor skills. Two neurotransmitters called dopamine and serotonin tend to be damaged by Parkinsons.
In addition to causing issues with movement and coordination, this form of dementia can also cause a slower thought process and memory problems. This is usually less pronounced however, until the later stages of the disease.
With Alzheimers, two types of proteins in the brain, tangles and plaques , accumulate and kill brain cells. This Alzheimers-induced dementia affects memory, clear thinking, language skills, and orientation. It reduces comprehension, learning capacity, and judgement. Storing new information and memory retrieval are impacted more than motor skills.
Distinguishing between these neurodegenerative conditions is important to determine the best treatment approach. Medications for one of condition might create problems when given to a patient with the other condition.
How Does Parkinsons Disease Develop
As the disease progresses people who have Parkinsons are increasingly likely to have a tremor, shaking, slowness of movement and rigidity. It can also cause problems with balance, sleep, swallowing, speech and increase the risk of falls. This can cause embarrassment, distress, discomfort and social isolation.
Research has indicated that in Parkinsons disease the persons cognitive processes can also be affected and these may get progressively worse over the years, with some people going onto develop dementia in the later stages of Parkinsons. The cognitive changes could include:
- forgetfulness
- a reduction in reasoning, judgement, planning and decision-making abilities
- difficulty learning new things
The person may also show signs of depression or anxiety.
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What Are The Symptoms Of End
Stage four for Parkinsons disease is often called advanced Parkinsons disease because people in this stage experience severe and incapacitating symptoms. This is when medication doesnt help as much and serious disabilities set in.
Theres an increased severity in:
- How you speak a softer voice that trails off.
- Falling and trouble with balance and coordination.
- Freezing a sudden, but temporary inability to move, when you start to walk or change direction.
- Moving without assistance or a wheelchair.
- Other symptoms such as constipation, depression, loss of smell, low blood pressure when going to stand up, pain, and sleep issues.
Many times someone with advanced PD cant live on their own and needs help with daily tasks.
Stage five is the final stage of Parkinsons, and assistance will be needed in all areas of daily life as motor skills are seriously impaired. You may:
- Experience stiffness in your legs. It may make it impossible to walk or stand without help.
- Need a wheelchair at all times or are bedridden.
- Need round-the-clock nursing care for all activities.
- Experience hallucinations and delusions.
As Parkinsons disease progresses into these advanced stages, its symptoms can often become increasingly difficult to manage. Whether you or your loved one with end-stage Parkinsons lives at home, in an assisted living facility or a nursing home, hospice services can optimize your quality of life and that of your family members as well.
What Is Needed For A Parkinsons Disease Dementia Diagnosis
There is no definitive medical test that confirms cognitive decline or dementia in Parkinsons disease. The most accurate way to measure cognitive decline is through neuropsychological testing.
- The testing involves answering questions and performing tasks that have been carefully designed for this purpose. It is carried out by a specialist in this kind of testing.
- Neuropsychological testing addresses the individuals appearance, mood, anxiety level, and experience of delusions or hallucinations.
- It assesses cognitive abilities such as memory, attention, orientation to time and place, use of language, and abilities to carry out various tasks and follow instructions.
- Reasoning, abstract thinking, and problem solving are tested.
- Neuropsychological testing gives a more accurate diagnosis of the problems and thus can help in treatment planning.
- The tests are repeated periodically to see how well treatment is working and check for new problems.
Imaging studies: Generally, brain scans such as CT scan and MRI are of little use in diagnosing dementia in people with Parkinsons disease. Positron emission tomographic scan may help distinguish dementia from depression and similar conditions in Parkinsons disease.
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What Are The Types Of Lewy Body Dementia
There are two types of LBD: dementia with Lewy bodies and Parkinsons disease dementia.
Both types cause the same changes in the brain. And, over time, they can cause similar symptoms. The main difference is in when the cognitive and movement symptoms start.
Dementia with Lewy bodies causes problems with thinking ability that seem similar to Alzheimers disease. Later, it also causes other symptoms, such as movement symptoms, visual hallucinations, and certain sleep disorders. It also causes more trouble with mental activities than with memory.
Parkinsons disease dementia starts as a movement disorder. It first causes the symptoms of Parkinsons disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.
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