What Is Needed For A Parkinson’s Disease Dementia Diagnosis
There is no definitive medical test that confirms cognitive decline or dementia in Parkinson’s 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 individual’s 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 scans and MRIs are of little use in diagnosing dementia in people with Parkinson’s disease. Positron emission tomographic scan may help distinguish dementia from depression and similar conditions in Parkinson’s disease.
Attention Difficulties In Parkinsons
Attention involves filtering information, and people with PD who experience attention difficulties have trouble maintaining focus, especially as the complexity of a situation increases. Attention difficulties can affect both intellectual pursuits and everyday activities, such as walking and holding a conversation at the same time.1,3
Risk Factors For Psychosis
Not everyone with Parkinsons will develop hallucinations or delusions, but there are several things can increase your risk:
- Dementia or impaired memory
- Depression: Individuals suffering from depression and PD are at a greater risk. In addition, severe depression alone can cause psychosis.
- Sleep disorders, such as vivid dreaming. Individuals commonly report vivid dreaming prior to the onset of psychosis. Other associated sleep disturbances include REM sleep disorder and general insomnia.
- Impaired vision
- Use of PD medications
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Box 2 Diagnostic Procedure Movement Disorder Society Pdd Criteria8144
Level I Parkinson disease dementia
A diagnosis of Parkinson disease based on the UK Brain Bank criteria for PD
PD developed prior to the onset of dementia
Mini-Mental State Examination below 26
Cognitive deficits severe enough to impact daily living independent of motor symptoms
Impairment in more than one cognitive domain, that is, at least two of the following aspects:
Months Reversed or Seven Backward
Lexical Fluency or Clock Drawing
Absence of other abnormalities that obscure diagnosis
Level II Comprehensive assessment for characterizing PDD
The level II evaluation assesses four domains:
Computerized cognitive testing
Digital computerized cognitive testing, which can be carried out remotely from patients homes, has become an interesting alternative to traditional pen-and-paper testing. Benefits of computerized testing include the opportunity for frequent testing with less learning effects, which increases the sensitivity to detect decline, cost-efficiency and the availability of large normative databases. Opportunities for conducting both remote functional assessments and digital interventions on the same online platform are being studied,.
Advice For Carers Family And Friends
Living with or caring for someone with both Parkinsons and cognitive problems can be very challenging. There will be times when they rely heavily on your help and support, and there will be other times when it is better to take a step back and allow them to do things for themselves. This balance will be difficult to judge to begin with, and it is likely to take time and patience to establish new routines and approaches to day-to-day living.
Encouragement, stimulation and helping the person maintain their independence is very important. The suggestions in the How can I help myself? section above may be helpful, but remember that rest is also important.
If cognitive problems become more advanced, support and respite will be essential for carers/partners. There are many trained professionals who can provide expert help and advice, as well as organisations such as carer support groups. The persons doctor or social worker should be able to identify those who can help in your area, or you may find contacts in a telephone directory or online.
As both cognitive difficulties and some Parkinsons symptoms can make speech and conversation difficult, the following tips may be helpful when communicating with the person with Parkinsons:
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Cognitive Problems And Parkinsons
Many people with Parkinsons experience some mild memory loss and thinking problems. Symptoms vary widely and may fluctuate through the day. Research has shown that cognitive problems tend to be more severe in people with Parkinsons with more pronounced bradykinesia and rigidity, and less severe in those with more pronounced tremor.
If you are experiencing changes in your thinking and mental abilities, its natural to be concerned. You may worry you could go on to develop dementia however, this happens to comparatively few people. One study found that after ten years with Parkinsons, 80% of people with the condition experienced some cognitive difficulties, but less than 20% had developed dementia – known as Parkinsons disease dementia . The symptoms of PDD are very different from those of Alzheimers disease.
Some Parkinsons symptoms can make speech and facial communication difficult, and slowed thinking will often make things even harder. As the ability to remember words is affected, your vocabulary can become limited and humour may be less understood. It can also get harder to follow conversations, and this can result in you not making sense, or forgetting what you have said and repeating things.
Parkinsons Disease Linked To Sleep Disorders Sleep Disturbances
Written byDevon AndrePublished onFebruary 9, 2016
Parkinsons disease has been linked to sleep disorders and sleep disturbances. Parkinsons disease is characterized by the loss of brain cells that control movement. Symptoms of Parkinsons disease can include tremors, stiffness, slowness of movements, as well as balance and coordination problems. Memory problems, depression, and sleep problems can all occur in Parkinsons disease, too.
Sleep problems and sleep disorders may occur as an early sign of Parkinsons disease, even before motor symptoms have started. Common sleep disorders experienced in Parkinsons disease include insomnia, excessive daytime sleepiness, nightmares, sleep attacks, REM sleep behavior disorder , periodic leg movement disorder, restless leg syndrome, sleep apnea, and nocturia, which is frequent nighttime urination.
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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
Language Dysfunction In Parkinsons
There are several functions within language, including naming objects, generating words, comprehension, and verbal concepts. PD most often affects a persons ability to find a word, although as PD progresses, additional language difficulties may develop, including difficulty naming, difficulty comprehending information, and the use of more simplified and less spontaneous speech.3,4
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Signs Of Parkinsons Disease
In 1817, Dr. James Parkinson published An Essay on the Shaking Palsy describing non-motor, as well as, motor symptoms of the illness that bears his name. Parkinsons is not just a movement disorder, explained Dr. Shprecher. Constipation, impaired sense of smell, and dream enactment can occur years before motor symptoms of Parkinsons. The latter, caused by a condition called REM sleep behavior disorder, is a very strong risk factor for both Parkinsons and dementia . This has prompted us to join a consortium of centers studying REM sleep behavior disorder.
Thinking And Memory Problems Associated With Parkinsons Disease
People living with Parkinsons Disease may be affected by thinking and memory problems. These cognitive issues can have a significant impact on a persons quality of life and interfere with their daily function.
To some degree, cognitive impairment affects many people with PD. The same brain changes that lead to motor symptoms can also result in slowness in memory and thinking. Stress, medication and depression can also contribute to these changes. There are two levels of cognitive impairment.
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Causes And Risk Factors
PD is idiopathic, meaning that a doctor does not know why a person has the condition. However, according to Johns Hopkins Medicine, early-onset Parkinsons disease has links to genetic inheritance from a parent.
Researchers have identified several risk factors that may make a person with Parkinsons disease more likely to experience dementia.
These risk factors include:
- advanced age at time of diagnosis
- experiencing excessive daytime sleepiness
- hallucinations before the onset of other dementia symptoms
- having a specific Parkinsons symptom that causes a person to have difficulty starting to take a step or to halt mid-step while walking
- a history of mild thought impairment
- more severe movement impairment symptoms than most people with Parkinsons disease
However, researchers do not know why some people with Parkinsons disease develop cognitive difficulties as well as movement problems.
Mild Memory And Cognitive Problems
Mild memory loss and thinking problems are known as mild cognitive impairment, or MCI. Many people experience some form of thinking or memory problems at some point in life, perhaps due to factors such as grief or stress. But when people experience greater difficulties with memory, language, thinking or judgment than might be expected at their age, they may have MCI.
The terms memory problems and ‘memory loss’ can be misleading because far more than just memory may be affected. If you have mild cognitive problems, you may experience:
- Slowed thought processes. You may find it hard to follow a number of steps to complete a task or have problems multi-tasking
- Difficulties with planning, problem-solving or making decisions
- Difficulties following and taking part in conversations
- Difficulty finding the right word
- Poor concentration
- Lack of motivation
- Short-term memory loss difficulty remembering names or the sequence of recent events
- Problems with judging distances or direction. Describing how to get from one place to another may become hard.
Visual hallucinations or delusions may accompany cognitive problems in some people. Sometimes these are drug induced or they may be related to Lewy body dementia so you should let your doctor know if you experience these symptoms.
People with cognitive difficulties may be unaware of the problems they are experiencing, and friends and family may notice first.
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Causes Of Cognitive Impairment In Pd
The exact causes of cognitive impairment or dementia in Parkinsons disease are not fully understood. There may be changes in the neurochemical signals that the brain uses to pass along information to different regions of the brain. Besides dopamine, the neurochemical signals acetylcholine, serotonin, and norepinephrine are especially important for cognition, memory, attention, and mood. In autopsy studies, Lewy bodies, abnormal protein accumulations, have been found in neurons in brain regions responsible for cognitive processes. Other causes include co-existing strokes or mini-strokes or Alzheimers disease pathology.
What Causes Cognitive Changes In People With Pd
One cause is a drop in the level of dopamine, the neurotransmitter that is involved in regulating the bodys movements. However, the cognitive changes associated with dopamine declines are typically mild and restricted.
Other brain changes are likely also involved in cognitive decline in PD. Scientists are looking at changes in two other chemical messengers acetylcholine and norepinephrine as possible additional causes of memory and executive function loss in Parkinsons.
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Beyond The Substantia Nigra
In Parkinsons, other areas of the brain beyond the substantia nigra are involved as the condition progresses. Changes in higher brain areas are linked to non-motor symptoms that can affect people with Parkinsons later on in the condition, and often have a significant impact on quality of life.
For instance, symptoms that affect memory and thinking can be linked to the presence of Lewy bodies in the largest area of the brain the cerebral cortex as well as the limbic system. The limbic system is also believed to be involved in symptoms involving mood and pain, and similar changes in the inferior temporal gyrus, an area of the brain involved in processing what we see, are thought to be the reason for hallucinations.
But research into the spread of Parkinsons through these areas, and how we can stop it , is just one side of the story. There is also ongoing research into where Parkinsons starts, and the effects it is having before it reaches these areas.
The presence of non-motor symptoms many months and maybe even years before the physical symptoms, such as tremor and slowness of movement, points towards the presence of other changes in the body long before the loss of dopamine-producing cells in the substantia nigra. These early symptoms could even help researchers predict those who will go on to be diagnosed with Parkinsons, which would help in the development of new and better treatments.
How Is Parkinson Disease Treated
Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
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Fatigue In Parkinsons Disease
Fatigue is a common but under-recognized problem for people with Parkinsons disease . Fatigue can be defined as an unpleasant sensation of lacking energy, making the performance of routine activities, physical or mental, a strain. People with PD may experience physical fatigue, mental fatigue, or both. Fatigue in PD is not the same as the feeling you might get at the end of a hard days work. It is not necessarily something that goes away with rest. When people with PD are asked about fatigue, they use phrases such as, I feel run down, I am out of energy, I am unable to do anything, I cant get motivated.
Fatigue in Parkinsons Brochure
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Fatigue is common in PD
Fatigue and Depression
There is a large overlap between fatigue and other problems in PD, especially depression and sleep disorders. People with fatigue are more likely to be depressed and people who are depressed are more likely to be fatigued, but there is nonetheless a large group of PD patients who are fatigued but not depressed. Depression in PD typically responds to antidepressant treatment, and depression-related fatigue may improve with such treatment.
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Fatigue and Sleep disorders
Causes of Fatigue
Parkinsons Disease Treatment And Its Future
Parkinsons disease has no cure. However, millions of dollars are going into research every year to help better understand the disease, from how its defined to how its treated. The ultimate end goal is developing a cure for Parkinsons, but in the meantime, doctors and researchers have developed treatment plans based on what they presume is causing the disease in the first placemost often the lack of certain brain chemicals and cells like dopamine.
The plans vary per patient, and some of these treatment options include:
There isnt any real way to definitively prevent the disease, either. As with prevention for any disease or malady, its suggested that you maintain a healthy lifestyle before and after a diagnosis. Remaining physically engaged through activities like running, yoga, and weight lifting and eating healthy are both ways to provide your body with the best opportunity for a healthy life.
Clinical trials are also viewed as a treatment option because they may give you as good of a chance of relieving symptoms as other already-existent treatments. There are clinical trials happening year-round with various institution and foundations, and your demographic may fit a trial in its beginning pre-clinical stage or an advanced stage.
Talk to your doctor about any available clinical trials that you may qualify for and how to become a part of them. Also stay in contact with your doctor regarding any concerns that you may have with Parkinsons or how to get it treated.
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How Are Cognitive Changes In Pd Different Than Alzheimers Disease
Overall, dementia produces a greater impact on social and occupational functioning in PD than with Alzheimers due to the combination of motor and cognitive impairments.
- There is some overlap between symptoms and biological changes seen in Alzheimers and PD. However, it is less likely for both disorders to occur at the same time.
- Development of dementia in people with PD represents progression of the disease, usually after several years of motor impairment.
- Dementia may or may not occur in people with PD. According to recent research, 30 percent of people with Parkinsons do not develop dementia as part of the disease progression
- See 10 Signs of Alzheimers.