How Can We Support The Sleep/wake Cycle Of Pdd
For people with PDD who are confused about the day-night cycle, some daily strategies can be helpful. At night, starting a lights out routine that happens at the same hour every day, where all curtains are closed and lights are turned off, can help the person understand that it is sleep time. During the day, opening the curtains, allowing the person with PDD to spend as much time in the daylight as possible, avoiding naps, and organizing stimulating activities, can be helpful. Having lots of calendars and clocks in every room might also help a person with PDD be less confused about the time of day.
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Behaviors Seen In Parkinsons Disease Dementia
As dementia progresses, managing disorientation, confusion, agitation, and impulsivity can be a key component of care.
Some patients experience hallucinations or delusions as a complication of Parkinsons disease. These may be frightening and debilitating. Approximately 50 percent of those with the disease may experience them.
The best thing to do when giving care to someone experiencing hallucinations or delusions from Parkinsons disease dementia is to keep them calm and reduce their stress.
Take note of their symptoms and what they were doing before they exhibited signs of hallucinating and then let their doctor know.
This element of the disease can be particularly challenging for caregivers. Patients may become unable to care for themselves or be left alone.
Some ways to make caregiving easier include:
- sticking to a normal routine whenever possible
- being extra comforting after any medical procedures
- limiting distractions
- using curtains, nightlights, and clocks to help stick to a regular sleep schedule
- remembering that the behaviors are a factor of the disease and not the person
What Is Alzheimers Disease
Alzheimers is named after Dr. Alois Alzheimer, a German neurologist who first discovered the cognitive function disease. Alzheimers disease is a neurologic disorder that is characterized by damage to the brain cells and actual brain shrinkage, or atrophy. Alzheimers disease is the leading cause of dementia, a generic term for behavioral and cognitive decline that may affect your basic ability to function as an AD patient.
While research still does not know the exact cause of Alzheimers disease, the basic mechanism involves dysfunction in brain proteins. This disrupts normal function in brain cells for an AD patient, known as neurons. The neurodegenerative disease results in damage to the neurons, a loss of connection between neurons, and eventually dead brain cells for an Alzheimers patient. This process typically starts in areas of the brain involved with memory, but this can start years prior to any noticeable cognitive symptoms. The neuronal atrophy eventually spreads to other regions of the brain, leading to increased brain shrinkage and severe cognitive issues.
There is currently no known cure for an Alzheimers patient, but medication can help to manage symptoms, maximize function, and slow the cognitive impairment diseases progress, enough to support your independence for some time.
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Things You Should Know About The Link Between Parkinsons And Dementia
Both Parkinsons disease and dementia were ravaging the brain and behavior of actor Robin Williams before his death, but at the time, he didnt realize he had the latter.
Despite the fact that the signs of this combination can be confusing, the double diagnosis of Parkinsons and dementia impacts a large number of people. Of the one million people who have Parkinsons in the U.S., 50 to 80 percent may have dementiaeither as a result of Parkinsons pathology, or separately.
Robin Williams widow, Susan, wrote an editorial published in Neurology that was addressed to neurologists after his death. In it, she shared what it was like seeing her husband experience both Parkinsons disease and Lewy body dementia firsthand.
My hope is that it will help you understand your patients along with their spouses and caregivers a little more, Susan wrote.
Williams was first diagnosed with Parkinsons disease, which at first seemed to provide some answers for his out-of-character symptoms.
But it wasnt until after his death that an autopsy revealed he had been in the later stages of Lewy body dementiaa common form of dementia characterized by deposits of Lewy body proteins in the brain, which can impact physical movement, mood, memory and behavior.
I will never know the true depth of his suffering, nor just how hard he was fighting, Susan wrote. But from where I stood, I saw the bravest man in the world playing the hardest role of his life.
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Identification Of Common Molecular Mechanisms
Common molecular mechanisms between AD and PD were identified with the help of a systematic literature mining approach with post-hoc manual curation. More specifically, the text mining engine SCAIView was used to construct cause-effect relationships between molecules, pathways, biological processes and imaging features in both, AD and PD, see Domingo-Fernandez et al. and Kodamullil et al. for details, for details. After manual curation, two computable disease maps, one for AD and one PD were created. Finally, we have also made them interactively usable via a dedicated web application .
Calculation of the intersection of cause-effect relationships described in the AD and PD disease maps resulted into 27 genes grouped into 15 cause-effect relationship sub-graphs, called mechanisms from now on . While some of these mechanisms describe only posttranslational modifications of a single protein, others reflect more complex proteinprotein interactions and signaling cascades . Key proteins described in both diseases include e.g. APOE, TAU, SNCA and TOMM40. These proteins are involved into several known disease relevant processes that we have made computationally accessible via our earlier developed NeuroMMSig database.
We mapped 148 genetic variants measured in ADNI1, ADNI2/GO as well as PPMI to the 27 common AD/PD disease genes via a combination of two strategies: a) proximity and b) eQTL mapping, see details in Supplements on page 2.
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What Is Lewy Body Dementia Causes Symptoms And Treatments
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Lewy body dementia is a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood. Lewy body dementia is one of the most common causes of dementia.
LBD affects more than 1 million individuals in the United States. People typically show symptoms at age 50 or older, although sometimes younger people have LBD. LBD appears to affect slightly more men than women.
Diagnosing LBD can be challenging. Early LBD symptoms are often confused with similar symptoms found in other brain diseases or in psychiatric disorders. Lewy body dementia can occur alone or along with other brain disorders.
It is a progressive disease, meaning symptoms start slowly and worsen over time. The disease lasts an average of five to eight years from the time of diagnosis to death, but can range from two to 20 years for some people. How quickly symptoms develop and change varies greatly from person to person, depending on overall health, age, and severity of symptoms.
In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease advances, people with LBD require more help due to a decline in thinking and movement abilities. In the later stages of the disease, they often depend entirely on others for assistance and care.
Number Of People Affected
Parkinson’s disease is thought to affect about 2 percent of Americans over 65. Of those, about 50 to 80 percent will go on to develop Parkinson’s-related dementia.1 The Parkinson’s Foundation estimates that nearly 1 million Americans will be living with Parkinson’s by 2020. The disease affects 1.5 times more men than women.7
Approximately 5.8 million Americans are currently living with Alzheimer’s disease. That number is expected to increase to 14 million by 2050.8 There is little difference between the numbers of men and women who develop Alzheimer’s, but there are more women with the disease because women tend to live longer than men.3
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Alzheimers Vs Dementia: Understanding The Difference
Worldwide, about 50 million people live with dementia, and 60 to 70 percent of those people have Alzheimers disease. Although Alzheimers disease and dementia are related, they are not the same.
Dementia is the umbrella term used to describe memory-related symptoms and changes in the ability to think and reason. Unlike normal aging, the problem is serious enough to impact daily life. Alzheimers is one of several types of dementia. Some of the symptoms may overlap. But understanding the difference between Alzheimers vs. dementia is important to best manage and treat the condition.
Can Dementia Be Prevented
Although dementia cant be prevented, living a health-focused life might reduce risk factors for certain types of dementia.
Keeping blood vessels clear of cholesterol buildup, maintaining normal blood pressure, maintaining healthy blood sugar levels, staying at a healthy weight basically, staying as healthy as you can can keep your brain fueled with the oxygen and nutrients it needs to function at its highest possible level. Specific healthful steps you can take include:
- Follow a Mediterranean diet, which is one filled with whole grains, vegetables, fruits, fish and shellfish, nuts, beans, olive oil and only limited amounts of red meats.
- Exercise. Get at least 30 minutes of exercise most days of the week.
- Keep your brain engaged. Solve puzzles, play word games and try other mentally stimulating activities. These activities may delay the start of dementia.
- Stay socially active. Interact with people, discuss current events, and keep your mind, heart and soul engaged.
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Axonal Length Density Is Significantly Reduced In The Agranular Insula
Using modified Bielschowsky silver impregnation and stereology, axonal length and axonal length density were assessed within the anterior anterior insular sub-regions across all groups. Taking all groups together, the mean total axonal length density for the agranular and dysgranular insula were ×109 m/m3 and × 109 m/m3, respectively. The axonal length density was significantly higher in the dysgranular compared to the agranular insula among all groups =2.7, P=0.01 and t=5.7, P< 0.001). A significant effect of disease group on axonal length density was only observed in the dysgranular sub-region =3.7, P=0.04 agranular: F=2.5, P=0.11). Specifically, a significant reduction was found in DLB compared to PD and PDD donors .
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Theres A Spectrum Of Pathologies
Scientists have been examining this linkand how the two diseases often overlapfor some time, but still arent completely certain how they contribute to one another. As a result, physicians sometimes group the diseases into different combinations when making diagnoses.
Dementia in Parkinsons patients can present itself in varying forms. In some cases, the Parkinsons pathology can trigger the dementia pathologya situation that results in whats known as Parkinsons disease dementia, says Dr. Aaron Ritter, Director of the Clinical Research Program at the Cleveland Clinic Lou Ruvo Center for Brain Health.
A substantial subset of folks with Parkinsons who live long enough, will develop dementia, Ritter said.Its separate from Alzheimers, but its likely related to Parkinsons pathology, a sort of spreading of Parkinsons.
In other cases, patients may develop a form of dementia like Alzheimers separately from their Parkinsons disease, though this isnt visible until after death, through an autopsy.
Many people with Parkinsons may also develop Lewy body dementia shortly after their diagnosis. When you have Parkinsons, and see cognitive declineor things like hallucinations and delusionsup to a year after your Parkinsons diagnosis, you may have Lewy body dementia, Oguh said.
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Parkinsons Doesnt Always Cause Dementia
While cognitive decline is common in both Alzheimers and Parkinsons, it is less likely to occur in Parkinsons patients. According to studies, only half of those with Parkinsons develop cognitive difficulties. This can range from mild forgetfulness to full-blown dementia.
When dementia does manifest itself with Parkinson, it occurs in the subcortical area of the brain. Alzheimers dementia occurs in the cortical area of the brain. As a result of this, the clinical symptoms of these two dementias can be somewhat different.
Symptoms Of Parkinsons Disease
Some symptoms of Parkinsons affect a persons ability to move. These symptoms are often called motor symptoms, and they include:
- Stiffness of muscles
- Tremor of an arm or leg while at rest
- Unstable posture
Other symptoms of Parkinsons dont affect a persons movement. These nonmotor symptoms may include:
- Digestive problems, such as constipation
- Cognitive changes, such as loss of attention, difficulty solving problems, memory loss, and trouble with language
Parkinsons symptoms may take several years to appear. A majority of people with Parkinsons live for many years with the condition.
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Epidemiology Of Dementia And Parkinson’s Disease
Dementia and PD are both diagnosed frequently and increase mortality . Perhaps dementia is perceived more so as a memory problem and a disease of old age, but the incidence of dementia and PD in younger age is similar. In the Netherlands, for dementia, the incidence per 1,000 person-years is 0.4 among those aged 6064 , and for PD, it is 0.3 . Dementia incidence patterns, however, show a much steeper increase with age mounting to 27 per 1,000 person-years for those 85 and over, compared to 4 for PD over 85. In view of similar mortality , therefore, the prevalence of dementia in the general population is much higher than prevalence of PD . However, adjusted for age and other factors, 6-year mortality in PD is higher than in Alzheimer’s dementia . Age adjustment is relevant also as it shows that comorbid disease may be equally prevalent for Alzheimer’sa main type of dementiaand PD across the same age groups .
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
- Paying attention
If you have Parkinson disease and dementia, in time, you likely wont be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.
Experts dont 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 Alzheimers disease, another type of dementia.
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Dysfunction In The Fronto
Volitional shifts of attention are thought to depend on top-down signals within a fronto-parietal network comprising prefrontal cortical areas and posterior parietal cortices , wherein prefrontal regions modulate activity in the network according to task demands .
The major cortical neural networks affected in PDD. Areas of cortical atrophy associated with visuospatial and visuoperceptual deficits in PDD are based on the data presented in . Areas of cortical atrophy specifically associated with the presence of visual hallucinations in PDD are based on the data presented in . Functional cortical regions comprising the fronto-parietal attention network are based on the data presented in . Cortical regions are identified according to the Allen Brain Atlas for the human brain, and manually drawn onto the corresponding 3D brain image. In this representation the same cortical regions are affected symmetrically in both hemispheres, however in the original studies above the extent of atrophy in these regions was not symmetrical between hemispheres, and varied between individual patients. In the inferior view of the cortex the cerebellum has been removed to expose the fusiform gyri more clearly. DLPFC = dorsolateral prefrontal cortex PPC = posterior parietal cortex VLPFC = ventrolateral prefrontal cortex.
Dementia Can Be Treated Through Medication But Its Progression Will Continue
Some of the problems caused by dementia are treatable, but there are no medications that slow the progression of this problem, just as there are no treatments that slow the progression of the rest of the Parkinsons Disease syndrome. We often use the same medications that are used in Alzheimers disease to improve concentration and memory, although only one, rivastigmine, has been approved by the Food and Drug Administration for dementia in PD. Most experts believe that each of the Alzheimer drugs are about as useful in dementia in Parkinsons Disease as they are in Alzheimers, which, unfortunately, is not great. As with all medications used in PD, whether for slowness, stiffness, tremor, depression or sleep disorders, if the medication is not helpful, one should either try a higher dose or stop it. Since the drugs used to treat dementia take several weeks to work, and the dose often requires increases, the family needs to allow a reasonable time period, usually around two months, to decide if it is helpful or not. Obviously this needs to be discussed with the prescribing doctor.
There is a lot of research being done to better understand and better treat dementia in PD.
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Comparing Trajectories And Conceptualization Of Palliative Care For Dementia And Pd
The two disease trajectories may overlap partly as dementia is a frequent manifestation of PD. Mild cognitive impairment may already present upon diagnosis of PD . Importantly, it is independently associated with lower quality of life . Across studies, typically about a quarter of patients with PD have dementia , but ultimately, most develop dementia .
A clear conceptualization of palliative care in chronic-progressive diseases is important for the development of healthcare systems that facilitate the integration of a palliative approach . Therefore, in this article we compare the disease trajectories of dementia and PD in as far as relevant for the conceptualizations of palliative care. We do not include atypical Parkinsonian disorders such as multiple system atrophy because these warrant a special approach with earlier palliative care . We first provide background on where we are by describing how palliative care for dementia and PD developed.