Patient And Public Involvement
In the past years, there has been growing attention on the need to include patients, their caregivers and families in all stages of the research process. The increasing contribution of patient and public involvement groups in defining research questions, designing and conducting clinical trials, disseminating outcomes, and shaping research roadmaps reflects the concept of research as a shared effort among all stakeholders. Although in PD research this concept is increasingly being recognized, further involvement of patients and families, also inclusive of diverse patient populations, in research focused on PD-associated cognitive impairment is needed.
The Link To Quality Of Life
While a diagnosis of Alzheimers and a diagnosis of Parkinsons are very different, they both have the potential to negatively impact quality of life and longevity if they are not diagnosed early and treated correctly. Many Parkinsons and Alzheimers patients suffer from depression and a lack of quality sleep, and several experience a decrease in both dreaming and non-dreaming phases of sleep. Recent studies have been conducted to better understand the link between these two conditions, and researchers now believe that Alzheimers patients are about eight times as likely to develop Parkinsons in their lifetime. As a result of this finding, many scientists now believe that understanding one condition can help us to better understand and possibly even cure the other in our lifetime.
How Are Parkinsons And Dementia Related
Parkinsons and dementia are two of the most common degenerative neurological conditions in this country, affecting many thousands of people. However, there are a lot of myths and misunderstandings about the illnesses.
If you have been told that you have either condition, the future may seem bleak and bewildering. Whether youve found this blog having been recently been diagnosed, or are worried about a loved one, then read on, hopefully, we can help you to gain some understanding.
You May Like: How Long Do You Live With Parkinson’s
How Are They Alike
MS and Parkinsonâs both affect your central nervous system, which includes your brain and spinal cord. Thatâs why they both can affect how you move, sleep, feel, and talk.
These diseases both affect your nerves. MS can break down the coating, called myelin, that surrounds and protects your nerves. In Parkinsonâs, nerve cells in a part of your brain slowly die off.
Both can start out with mild symptoms, but they get worse over time.
Common symptoms of both diseases include:
- Shaky fingers, hands, lips, or limbs
- Slurred speech thatâs hard for others to understand
- Numb or weak limbs that make your walk unsteady
- Loss of muscle control that often affects one side of your body at first, then later both
- Spastic limb movements that are hard to control
- Loss of bladder or bowel control
- Poor balance
Depression is another symptom common to both conditions.
What Are The Symptoms Of Lewy Body Dementia
LBD is a progressive disease. This means that the symptoms start slowly and get worse over time. The most common symptoms include changes in cognition, movement, sleep, and behavior:
- Dementia, which is a loss of mental functions that is severe enough to affect your daily life and activities
- Changes in concentration, attention, alertness, and wakefulness. These changes usually happen from day to day. But sometimes they can also happen throughout the same day.
- Visual hallucinations, which means seeing things that are not there
- Problems with movement and posture, including slowness of movement, difficulty walking, and muscle stiffness. These are called parkinsonian motor symptoms.
- REM sleep behavior disorder, a condition in which a person seems to act out dreams. It may include vivid dreaming, talking in one’s sleep, violent movements, or falling out of bed. This may be the earliest symptom of LBD in some people. It can appear several years before any other LBD symptoms.
- Changes in behavior and mood, such as depression, anxiety, and apathy
In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease gets worse, people with LBD need more help due to problems with thinking and movement. In the later stages of the disease, they often cannot care for themselves.
Don’t Miss: Seizures And Parkinson’s
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.
What Is The Best Way To Communicate With A Person With Pdd
PD-related mood and motor changes can impact communication; cognitive changes and Parkinsons disease dementia can further these difficulties.;
The Differences Between Parkinsons Disease And Alzheimers
Degeneration Of Neurotransmitter Systems
More widespread dopaminergic deficits in the brain
By definition, all patients with PD have a moderate-to-severe loss of dopaminergic neurons in the nigrostriatal projection pathway. More widespread degeneration of dopaminergic terminals in the striatum particularly denervation of dopaminergic terminals in the associative dorsal caudate nucleus occurs in those with PD-MCI than in those with PD without cognitive impairment . However, in patients with PD-MCI, there is relative preservation of other dopaminergic systems in the brain, whilst those with PDD have a considerable loss of the lateral dopaminergic system to frontal, parietal and temporal cortical regions . In healthy individuals, cortical dopamine modulation can boost working memory as well as visuospatial and attentional processing, and promotes cognitive effort,, suggesting a key role for dopamine in cognitive function.
Fig. 2: Neurotransmitter deficits associated with cognitive decline in PD and DLB.
Noradrenergic locus coeruleus and sympathetic systems
Basal forebrain cholinergic systems
Serotonergic dysfunction is not directly related to cognitive decline
Read Also: Is Lewy Body Dementia Present In All Parkinson’s Residents
How Is Parkinsons Disease Dementia Diagnosed
No single test can diagnose Parkinsons disease dementia. Instead, doctors rely on a series or combination of tests and indicators.
Your neurologist will likely diagnose you with Parkinsons and then track your progression. They may monitor you for signs of dementia. As you get older, your risk for Parkinsons dementia increases.
Your doctor is more likely to conduct regular testing to monitor your cognitive functions, memory recall, and mental health.
Biomarkers Of Cognitive Decline
Many of the pathologies associated with cognitive impairment can be identified in vivo using a variety of imaging and blood-based or CSF-based markers. These biomarkers can be used to provide an increased understanding of the mechanisms underlying cognitive impairment in PD and, from a clinical perspective, can identify patients with an increased risk of early and rapid cognitive decline.
One of the first identified predictive markers was temporo-parietal atrophy on MRI , confirmed in many subsequent studies. In addition, basal forebrain atrophy observed using MRI is also associated with cognitive impairment in PD,. Hypometabolism in the medial frontal and parietal regions using FDG-PET is associated with a decline in executive and memory function. More recent MRI techniques, such as diffusion tensor imaging, also hold promise as biomarkers of cognitive function. For example, increased radial and axial diffusivity in the thalamus observed using diffusion tensor imaging was associated with a decline in MoCA scores.
Read Also: Does Flu Shot Cause Parkinson’s
The Pathologies Are Different But Many Of The Symptoms Can Be Similar
We do know that the pathology is quite different between Parkinsons and dementia, said Dr. Odinachi Oguh, a neurologist at the Cleveland Clinic Lou Ruvo Center for Brain Health. But the processes in which memory is impacted in both diseases is about the same.
From the pathology standpoint, both diseases are characterized by a neurodegenerative process, Oguh said. The neurodegeneration results in abnormal accumulation of protein, which builds up and becomes toxic to the brain.
Alzheimers, for example, affects memory areas of the brain, which include the temporal lobes, as well as the memory center, or hippocampus. Parkinsons, meanwhile, starts in the basal ganglia part of the brain, and as the disease progresses, it can also affect the memory center, resulting in forgetfulness, an early sign of Alzheimers or other forms of dementia.
Impact Of Pd Treatments
The clinical choice of initial PD medication inhibitor) at disease onset does not seem to make a difference in terms of cumulative dementia rates,. However, there is strong evidence that medications with anticholinergic properties , and particularly the long-term exposure to multiple medications or medications with greater anticholinergic properties, are associated with worse long-term cognition in the general population and patients with PD,, and thus represent a target for clinical management. In patients with PDD, simplification of antiparkinsonian treatment through a stepwise withdrawal of non-levodopa PD medications starting with anticholinergic drugs, followed by amantadine, selegiline, dopamine agonists and then catechol-O-methyltransferase inhibitors, might be useful, particularly if comorbid psychosis is present.
In addition, several studies have found that DBS can worsen cognitive functioning; as a result, cognitive testing is recommended as part of the pre-DBS surgery evaluation process, and patients with severe cognitive impairment should not undergo brain surgery. However, the use of model-based stimulation parameters to minimize the spread of the electrical current to non-motor portions of the subthalamic nucleus reversed the cognitive decline that occurred after DBS in one study. Encouragingly, a subsequent study of DBS in younger patients with shorter disease duration showed short-term cognitive tolerability similar to the best medical therapy.
Read Also: Does Parkinson’s Go Into Remission
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.
Theres No Cure For The Diseases But Some Therapies May Help
Certain drugs, like cholinesterase inhibitors and antipsychotic medications, are prescribed as treatment for people with Parkinsons and dementia. And lifestyle changesfrom improved diet, sleep, exercise and socializinghave been shown to have beneficial effects on patients with these diseases.
Oguh noted she hopes that improved treatments that will help some of the emotional and behavioral problems in these patients will be on the horizon soon.
Im hoping that with the new advances in medication, well be able to control better, Oguh said. I believe there will be better medication to improve cognition in patients, and that that will be seen in the next five to 10 years.
Also Check: Can Someone With Parkinson’s Drive
What Is Parkinsons Disease Dementia
Parkinsons disease dementia is a brain disorder that occurs in somebut not allpeople living with Parkinsons disease. The brain cell damage caused by the disease can lead to a loss of memory and other cognitive functions such as problem solving and speed of thinking. These changes in thinking and behavior can impact your daily living, independence, and relationships.
In those who do develop Parkinsons disease dementia, there is at least one yearand usually 10 to 15 yearsbetween the Parkinsons diagnosis and the onset of dementia. According to estimates by the Alzheimers Association, 50% or more of people with Parkinsons disease eventually experience dementia, although there are a number of risk factors that impact the likelihood of developing symptoms:
- Parkinsons patients who experience hallucinations, excessive daytime sleepiness, and more severe motor control problems are at higher risk for dementia.
- Dementia is more common in people who are older at onset of Parkinsons.
- Dementia is a bigger risk factor in non-tremor predominant Parkinsons.
- Overwhelming stress, cardiovascular disease, and adverse reactions to the Parkinsons disease drug levodopa can also indicate an increased risk for developing dementia.
- Dementia is relatively rare in people who develop Parkinsons before age 50, no matter how long they have had the disease.
See A Doctor If Youre Noticing Symptoms Beyond Parkinsons
Sometimes the mood or memory changes a person experiences cannot entirely be explained just by Parkinsons. If this is the case, the caregiver should explore other diagnoses, because if something cannot be explained by Parkinsons, theres certainly a risk of it being dementia, Oguh said.
She added that some signs to look for include increased memory and behavioral problems, like mood swings, anxiety or depression. Psychiatric behaviors, like hallucinations, delusions or paranoia, cannot just be explained by Parkinsons, and are more likely to be caused by a form of dementia like Lewy body dementia.
Oguh urged caregivers to be aware of changing symptoms like these.
I think sometimes family members are able to realize sooner than the patient, Oguh said. Often the patient might lack insight as to what is happening. I would encourage family members to seek expert opinion and treatment options.
Also Check: Does Parkinson’s Affect Hearing
What Are The Types Of Lewy Body Dementia
There are two types of LBD: dementia with Lewy bodies and Parkinson’s 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 Alzheimer’s 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.
Parkinson’s disease dementia starts as a movement disorder. It first causes the symptoms of Parkinson’s disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.
Acknowledgments And Conflict Of Interest Disclosure
Data in this manuscript are original and were generated for the purpose of this study. Photomicrographs were taken from tissue provided by the Newcastle Brain Tissue Resource, which is funded in part by a grant from the UK Medical Research Council , by Brains for Dementia research, a joint venture between Alzheimers Society and Alzheimers Research UK and by the NIHR Newcastle Biomedical Research Centre awarded to the Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. DLB research is supported by NIHR Newcastle Biomedical Research Centre in Ageing and Long-Term Conditions. LW is funded by the Alzheimers Society. The authors have no conflicts of interest to declare.
You May Like: Does Diet Soda Cause Parkinson’s
What Is Known About Alzheimers Disease
Scientists do not yet fully understand what causes Alzheimers disease. There likely is not a single cause but rather several factors that can affect each person differently.
- Age is the best known risk factor for Alzheimers disease.
- Family historyresearchers believe that genetics may play a role in developing Alzheimers disease. However, genes do not equal destiny. A healthy lifestyle may help reduce your risk of developing Alzheimers disease. Two large, long term studies indicate that adequate physical activity, a nutritious diet, limited alcohol consumption, and not smoking may help people. To learn more about the study, you can listen to a short podcast.
- Changes in the brain can begin years before the first symptoms appear.
- Researchers are studying whether education, diet, and environment play a role in developing Alzheimers disease.
- There is growing scientific evidence that healthy behaviors, which have been shown to prevent cancer, diabetes, and heart disease, may also reduce risk for subjective cognitive decline. Heres 8 ways.
Also Check: Is Lewy Body Dementia A Genetic Disorder
To Support The Diagnosis Your Healthcare Provider Will Also Look For Other Symptoms:
- Micrographia;
- Reduced facial expression
- on one side of the body while walking
Symptoms such as shoulder pain, depression, sleep problems, constipation and loss of sense of smell can begin long before any of the motor symptoms appear. Because symptoms like these can be subtle at first, they are not always evident or meaningful before diagnosis. It is common after being diagnosed with Parkinsons to look back and realize symptoms had been coming on gradually for months or even years. Often people explore other treatment avenues for early symptoms, like physical therapy or even surgery for pain, only to discover later it was actually connected to Parkinsons.
Since doctors diagnose other medical conditions using sophisticated technology, many are surprised to learn a Parkinsons diagnosis is based on your medical history and a simple examination. While your healthcare provider may take other steps, such as order blood and urine tests, check copper levels and order a brain scan, such as an MRI or CT or DaTscan that measures dopamine, these tests do not diagnose Parkinsons. They are used to either confirm the diagnosis or determine if another medical condition is causing your symptoms.
Everyones experience of Parkinsons will be unique, and a person with YOPD may have similar symptoms as someone diagnosed later in life.
You May Like: What Are The Early Symptoms For Parkinson Disease
Whats The Difference Between Multiple System Atrophy And Parkinsons
Parkinsons and MSA both affect the movement control system and the involuntary autonomic control system and early symptoms can make a differential diagnosis a challenge. MSA, however, tends to progress faster than Parkinsons; balance problems and a stooped posture happen earlier and get worse more quickly with MSA; and autonomic functions such as blood pressure, heart rate, breathing, sweating, bladder function, and sexual problems are more severe in people with MSA.
For more information on multiple symptom atrophy, read this fact sheet.