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Is Parkinson A Form Of Dementia

What Are Parkinson’s Disease Dementia Medical Treatment And Medications

Murat Emre, MDS 2019 Dementia in Parkinson’s disease (PDD)

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.
  • The 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.

Number Of People Affected

Parkinsons disease is thought to affect about 2 percent of Americans over 65. Of those, about 50 to 80 percent will go on to develop Parkinsons-related dementia.1 The Parkinsons Foundation estimates that nearly 1 million Americans will be living with Parkinsons by 2020. The disease affects 1.5 times more men than women.7

Approximately 5.8 million Americans are currently living with Alzheimers disease. That number is expected to increase to 14 million by 2050.8 There is little difference between numbers of men and women who develop Alzheimers, but there are more women with the disease, because women tend to live longer than men.3

The Era Of Digital Cognitive Testing

The development of digital cognitive testing and the evolution of self-completed computerized assessments and wearable devices to assess cognitive functioning in daily life, provides an exciting opportunity to both improve clinical management and to obtain more sensitive outcome measures for clinical trials and will likely become a standard procedure in the future, given further technological improvements and increased access to the internet and digital devices. To reach this point, psychometric requirements , documentation and technical problems, as well as their relation to traditional tests, need to be well known.

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Early Signs And Symptoms Are Different

Parkinsons disease generally begins as a movement disorder. Early signs and symptoms include:2

  • Tremor, which often begins in the hand or fingers
  • Slowed movement, which may include foot dragging
  • Rigidity
  • Slowed automatic movements such as blinking, smiling, and swinging your arms when you walk

Alzheimers disease generally begins as noticeable memory loss. Early signs and symptoms include:3,4

Key Brain Changes Are Different

Dementia

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

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How Do Doctors Diagnose Lewy Body Dementia

Unfortunately, LBD is usually the most frequently misdiagnosed type of dementia. LBDA estimates that it often takes about three doctors and over a year and a half to diagnose LBD. Their survey of nearly 1,000 participants with LBD discovered that about 80 percent of them were misdiagnosed. In an article published in nature, Susan Schneider Williams, Robin Williams wife, writes about their struggle to get an accurate diagnosis and determine what was happening to his brain. My hope is that it will help you understand your patients along with their spouses and caregivers a little more. And as for the research you do, perhaps this will add a few more faces behind the why you do what you do, she writes.

People can either be diagnosed with dementia with Lewy bodies or Parkinsons disease dementia. If someone is experiencing symptoms that could be LBD, they should try visiting a neurologist, rather than a general physician, to try and get an accurate diagnosis. While LBD can still only be officially diagnosed by an autopsy, doctors use the following methods to determine if someone may have LBD:

They can look for biomarkers of Lewy Body Dementia, including abnormal proteins, with the following:

  • A SPECT or PET scan
  • cardiac scintigraphy, which looks at how nerves are functioning in the hearts blood vessels
  • Sleep tests that monitor brain waves

In addition, doctors may do the following:

What Causes Parkinson Disease

Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.

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Rarer Causes Of Dementia

There are many rarer diseases and conditions that can lead to dementia, or dementia-like symptoms.

These conditions account for only 5% of dementia cases in the UK.

They include:

  • problems with planning and reasoning

These symptoms are not severe enough to cause problems in everyday life.

MCI can be caused by an underlying illness, such as depression, anxiety or thyroid problems.

If the underlying illness is treated or managed, symptoms of MCI often disappear and cause no further problems.

But in some cases, people with MCI are at increased risk of going on to develop dementia, which is usually caused by Alzheimer’s disease.

Read more about how to prevent dementia.

Living With Parkinson Disease

Carol The Caregiver – Parkinson’s dementia

These measures can help you live well with Parkinson disease:

  • An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
  • High protein meals can benefit your brain chemistry
  • Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
  • If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.

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What Is Dementia With Lewy Bodies

Dementia with Lewy Bodies may account for 10-15 per cent of all cases of dementia. DLB can be diagnosed wrongly and is often mistaken for Alzheimers disease.

DLB is sometimes known by other names. These include Lewy body dementia, Lewy body variant of Alzheimers disease, diffuse Lewy body disease and cortical Lewy body disease. All these terms refer to the same condition.

What a short video about dementia with Lewy bodies:

Palliative Care In Dementia

The first evaluated palliative care program specific to dementia was described in 1986 . The volume of research has grown exponential after 2000 . There are few randomized controlled trials, and therefore, there is still little evidence on effectiveness . However, many western countries have funded observational studies resulting in numerous publications describing patient, family and professional caregiver needs .

Research specific to dementia is important because the course of the disease is highly variable and uncertain. Because of the progressive dementia, patients themselves often cannot remain involved in decision making. Also, health services and changes such as transfer to a hospice, do not necessarily represent optimal care for people with dementia . Palliative care in dementia needed a clear conceptualization, and the European Association for Palliative Care along with experts agreed to a distinct concept in terms of eleven domains, different from usual palliative care .

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Causes Of Vascular Dementia

Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.

This can happen as a result of:

  • narrowing and blockage of the small blood vessels inside the brain
  • a single stroke, where the blood supply to part of the brain is suddenly cut off
  • lots of “mini strokes” that cause tiny but widespread damage to the brain

Not everyone who has a stroke will go on to develop vascular dementia.

Read more about vascular dementia.

Is The Dementia Caused By Parkinsons Or Something Else

Parkinson

Indications that dementia may be caused by something other than Parkinsons disease include agitation, delusions , and language difficulties. If the onset of cognitive symptoms is sudden, theyre more likely due to something other than Parkinsons diseaseeven reversible causes such as infection, a vitamin B12 deficiency, or an underactive thyroid gland.

Depression can mimic dementia by causing similar symptoms such as apathy, memory problems, and concentration difficulties. Since depression is very common in Parkinsons patients, its important to recognize the signs and symptoms of depression in older adults.

Parkinsons disease dementia vs. other dementias

Other types of dementia that can be commonly mistaken for Parkinsons disease dementia include:

Lewy Body Dementia is characterized by fluctuations in alertness and attention, recurrent visual hallucinations, and Parkinsonian motor symptoms like rigidity and the loss of spontaneous movement. In this disorder, cognitive problems such as hallucinations tend to occur much earlier in the course of the disease and often precede difficulties with walking and motor control.

Alzheimers disease and Parkinsons disease are both common in the elderly, especially in those over 85. Patients with Parkinsons who develop dementia may even develop Alzheimers dementia as well. Therefore, its important to be aware of the signs of Alzheimers Disease and how its treated.

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Lewy Body Dementia: A Common Yet Underdiagnosed Dementia

While its not a household word yet, Lewy body dementia is not a rare disease. It affects an estimated 1.4 million individuals and their families in the United States. Because LBD symptoms can closely resemble other more commonly known disorders like Alzheimers disease and Parkinsons, it is often underdiagnosed or misdiagnosed. In fact, many doctors or other medical professionals still are not familiar with LBD.

Why Do Protein Deposits Form In The First Place

Researchers want to know why these protein aggregates form in the first place, how they distribute in the brain, how their signalling works, and how they and their precursors cause neurodegeneration.

A range of theories have been put forward to explain what kickstarts damaging protein aggregation. In the case of Alzheimers, this includes problems with the way oxygen is metabolised in brain cells and the movement of internal cell contents. The brains response to inflammation, and its systems for clearing waste could also play a role.

One main theory is that once amyloid-ß begins to accumulate, it then promotes the build-up of tau. But the relationship is not simple, because tau also has a role in influencing the toxic effects of amyloid-ß.

Although some genetic risk factors for dementias have been identified, particularly for Alzheimers disease , we still dont know how these act to influence protein aggregation and cause degeneration. This is a key area of research focus, and knowing the answers to these questions is crucial to the prevention and treatment of dementia.

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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.

Dementia With Lewy Bodies And Parkinson Disease Dementia

Types of Dementia – An Overview for Med Students

, MD, PhD, Department of Neurology, University of Mississippi Medical Center

Dementia with Lewy bodiesParkinson disease dementia

Dementia is chronic, global, usually irreversible deterioration of cognition.

Dementia with Lewy bodies is the 3rd most common dementia. Age of onset is typically > 60.

Lewy bodies are spherical, eosinophilic, neuronal cytoplasmic inclusions composed of aggregates of alpha-synuclein, a synaptic protein. They occur in the cortex of some patients who have dementia with Lewy bodies. Neurotransmitter levels and neuronal pathways between the striatum and the neocortex are abnormal.

Lewy bodies also occur in the substantia nigra of patients with Parkinson disease, and dementia may develop late in the disease. About 40% of patients with Parkinson disease develop Parkinson disease dementia, usually after age 70 and about 10 to 15 years after Parkinson disease has been diagnosed.

Because Lewy bodies occur in dementia with Lewy bodies and in Parkinson disease dementia, some experts think that the two disorders may be part of a more generalized synucleinopathy affecting the central and peripheral nervous systems. Lewy bodies sometimes occur in patients with Alzheimer disease, and patients with dementia with Lewy bodies may have neuritic plaques and neurofibrillary tangles. Dementia with Lewy bodies, Parkinson disease, and Alzheimer disease overlap considerably. Further research is needed to clarify the relationships among them.

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Parkinson’s Disease Dementia Follow

A person with Parkinson’s disease and dementia requires regular checkups with his or her health care professional.

  • These checkups allow the health care professional to see how well treatment is working and make adjustments as necessary.
  • They allow detection of new problems of cognition, mood, or behavior that could benefit from treatment.
  • These visits also give the family caregiver an opportunity to discuss problems in the individual’s care.

Eventually, the person with Parkinson’s disease and dementia will likely become unable to care for himself or herself or even to make decisions about his or her care if the patient lives long enough with Parkinson’s disease and dementia.

  • It is best for the person to discuss future care arrangements with family members as early as possible, so that his or her wishes can be clarified and documented for the future.
  • A health care professional can advise patients and caregivers about legal arrangements that should be made to ensure that these wishes are observed.

Parkinson’s disease dementia prevention

There is no known way of preventing dementia in Parkinson’s disease. However, patients with Parkinson’s disease are urged to continue to exercise and live a healthy lifestyle as this may delay or reduce the onset of dementia, although there is no good data to indicate this will occur.

Parkinson’s disease dementia prognosis

Diagnosis: Parkinson’s Dementia Or Dementia With Lewy Bodies

During assessment, a specialist may look at when the dementia symptoms first appeared before reaching a diagnosis of Parkinson’s dementia or dementia with Lewy bodies.

If there have been motor symptoms for at least one year before dementia symptoms occur, specialists will often give a diagnosis of Parkinson’s dementia.

If dementia symptoms occur before or at the same time as motor symptoms, specialists will usually give a diagnosis of dementia with Lewy bodies.

However, it should be noted that in some cases of dementia with Lewy bodies, no motor symptoms develop at all.

Theres no single test – diagnosis is made through several different assessments, usually starting with an appointment with your GP or Parkinson’s nurse.

Some people find it helps to go to the appointment with someone who knows them well, who can give the GP or Parkinson’s nurse information about changes they’ve noticed.

Your GP can discuss your symptoms with you and carry out a physical examination, including blood and urine tests, to rule out other potential causes of the symptoms .

Your GP may also review your medication, in case your symptoms are side effects.

If your GP thinks you have dementia, they can refer you to a specialist, such as a neurologist, psychiatrist or geriatrician.

You might be referred to a memory clinic or memory service. In some areas of the country, you can refer yourself to these services.

But if you feel you need to see the specialist again, you can ask to be referred back.

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How Is Parkinson Disease Diagnosed

Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinson’s disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.

What Is The Link Between Parkinsons And Lewy Body Dementia

Dementia 101: Symptoms, Types, Stages, Treatment and ...

Being Patient: Are Parkinsons disease and Lewy body dementia related?

Dag Aarsland: Yes, theyre related in terms of symptoms and the brain changes. Many scientists consider Parkinsons and Lewy body dementia as a continuum of disease rather than two separate diseases. But there are very active and lively discussions about that. There are arguments for separating and combining them, but there are many similarities.

Being Patient: Do you group Lewy body dementia with Parkinsons disease in your research?

Dag Aarsland: From a research point-of-view, we try to separate them. We identify the specifics and categorize patients in different groups and study them carefully in order to see how they relate. In clinical practice, its different. I also see patients with Parkinsons and unfortunately, many of them develop dementia and hallucinations or memory problems. In clinical practice, its very much the same challenges for patients, carers and the doctor in terms of findings and the right therapy.

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