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What Is Parkinson’s Disease Dementia

What Are The Complications Of Parkinson Disease

Parkinsons Disease Dementia

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
  • Forgetfulness
  • Paying attention

If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.

Experts don’t 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 Alzheimer’s disease, another type of dementia.

The Last Year Of Life In Parkinson’s Disease

The study also examined nearly 45,000 hospitalizations in people with terminal Parkinson’s, meaning their end-of-life period.

Of those with terminal PD, the most common reasons for being in the hospital were:

  • Infection
  • Heart disease
  • Lung disease that was not from an infection

Less common causes for hospitalization were problems related to the stomach or intestines, muscles, nervous system, or endocrine system .

It is not surprising that infection was the most common hospitalization before death, as people with Parkinson’s are vulnerable to developing a number of infections as a result of their disease. For example, bladder dysfunction in Parkinson’s increases a person’s risk of developing urinary tract infections, which can become life-threatening if not detected and treated promptly.

In addition, research suggests that aspiration pneumonia is 3.8 times more common in people with Parkinson’s as compared to the general population. It has also been consistently reported to be the main cause of death in people with Parkinson’s.

Aspiration pneumonia results from underlying swallowing difficulties, which leads to stomach contents being inhaled into the lungs. Immobilization and rigidity, which can impair phlegm removal, also contribute to the development of pneumonia in people with Parkinson’s.

Relation Of The Neural Network Perspective To The Neuropathology Of Parkinsons Disease Dementia

At the neuropathological level the consensus from most studies to date is that the amount of Lewy-related pathology in neocortical and limbic areas is the most important factor in the development of PDD . However, the significance of Lewy-related pathology occurrence in particular cortical areas is debated, for example one retrospective autopsy study found that severity of cognitive decline in PDD correlated with Lewy-related pathology in the frontal and cingulate gyri , while another found no significant correlations in these regions but did find one in relation to temporal lobe Lewy-related pathology . Meanwhile some patients with Parkinsons disease with cortical Lewy-related pathology do not develop dementia at all . The significance of concurrent Alzheimer-type pathologies is hotly debated , although a recent study quantitatively assessing cortical Lewy-related pathology and Alzheimer-type pathologies found that a combination of both correlated most robustly with development of PDD . The relative contributions of other pathologies including microvascular disease, cerebral amyloid angiopathy, argyrophilic grains and TARDBP remain unclear .

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What Are The Signs And Symptoms Of Parkinsons Disease Dementia

Parkinsons disease dementia cant be diagnosed conclusively by a single test. Instead, doctors may use multiple tests and consider a range of Parkinsons disease dementia criteria, including symptoms like:

  • Feelings of disorientation or confusion
  • Agitation or irritability

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Not all cases of cognitive impairment are severesome people with Parkinsons disease can still manage their work and personal life just fine. But once a person has Parkinsons disease dementia, it usually means that they can no longer go about their daily life as they once did.

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Behavioral And Mood Symptoms Of Lewy Body Dementia

Pin on Parkinson

Changes in behavior and mood are possible in LBD and may worsen as the persons thinking abilities decline. These changes may include:

  • Depression
  • Apathy, or a lack of interest in normal daily activities or events and less social interaction
  • Anxiety and related behaviors, such as asking the same questions over and over or being angry or fearful when a loved one is not present
  • Agitation, or restlessness, and related behaviors, such as pacing, hand wringing, an inability to get settled, constant repeating of words or phrases, or irritability
  • Delusions, or strongly held false beliefs or opinions not based on evidence. For example, a person may think his or her spouse is having an affair or that relatives long dead are still living.
  • Paranoia, or an extreme, irrational distrust of others, such as suspicion that people are taking or hiding things

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Do You Die From Pd Dementia

People with Parkinsons-related dementia often want to know how the disease can impact their lifespan. While people with Parkinsons can expect a similar lifespan to the general population, studies show both Parkinsons disease dementia and Lewy body dementia can shorten lifespan, generally due to medical complications from the disease, rather than the disease itself.

Future Directions And Treatment Strategies

As this review has shown, the dysfunctional neural networks underlying the cognitive symptoms of PDD are diverse and distributed throughout the brain. There is overlap between network functions, each of which depend on differing primary neurotransmitters. In addition, evidence suggests that neurotransmitters can modulate the functional effects of one another , and thereby damage to one network during the pathogenesis of PDD may in turn influence dysfunction in another . Furthermore, as discussed in detail above, the cellular-level pathology causing damage to these networks in PDD is heterogeneous, while the effects of different genes on the pathophysiology of the disorder is only now being slowly unravelled.

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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.

What Are The Symptoms Of Parkinson Disease

Dealing with Dementia in Parkinson’s Disease

Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:

  • Tremors that affect the face and jaw, legs, arms, and hands
  • Slow, stiff walking

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Independent Dysfunction In Posterior Visual Processing Networks Underlies Visual Hallucinations

The mechanism underlying the generation of visual hallucinations in PDD is more complex and likely represents interacting dysfunction between several different brain networks. Since the presence of hallucinations is closely correlated with visuospatial and visuoperceptual deficits in PDD , dysfunction in associative visual cortices within the dorsal and ventral processing streams has long been implicated in their generation. This is supported by neuropathological studies which have demonstrated strong correlations between Lewy body burden in parietal and temporal lobes and the presence of hallucinations in PDD . Nevertheless, MRI studies comparing brain atrophy patterns between patients with Parkinsons disease with and without visual hallucinations have not consistently supported these pathological associations, differentially implicating medial temporal , insular , pedunculopontine nucleus and frontal atrophy . All may play a part in generation of hallucinations however, the degree of cognitive impairment between patients with and without hallucinations was not controlled for in these studies, meaning that atrophy patterns may have related to cognitive differences rather than the presence of hallucinations per se. In addition, the use of differing classification criteria for PDD further complicates interpretation of these results.

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Treatments For Parkinsons Disease Dementia And Dementia With Lewy Bodies

Treatments for DLB are similar to PDD and are aimed at symptom control. The motor symptoms of slowness, stiffness and walking difficulties can be treated with Levodopa. However, Levodopa can cause or exacerbate hallucinations, making it difficult to use it as a treatment for patients who have or are at risk of having hallucinations. Sometimes, clinicians will need to treat the hallucinations more aggressively in order for a patient to tolerate Levodopa given to help the motor symptoms. On the flipside, anti-psychotic medications to control hallucinations can worsen motor symptoms, so treating all the symptoms of LBD simultaneously can be a tricky balancing act.

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Treating Movement Symptoms In Lewy Body Dementia

LBD-related movement symptoms may be treated with medications used for Parkinson’s disease, called carbidopa-levodopa. These drugs can help make it easier to walk, get out of bed, and move around. However, they cannot stop or reverse the disease itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Because of this risk, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.

People with LBD may benefit from physical therapy and exercise. Talk with your doctor about what physical activities are best.

What Is Aggressive Parkinsons Disease

As written above, Parkinsons dementia aggression is that form of Parkinsons which makes the patient exhibit aggressive behavior. They vent out their aggression either verbally or physically, in the various forms that have been written above. Besides verbal and physical outbursts, PD Dementia patients are also prone to hallucinating caused by the medication administered. Hallucinations in PD Dementia patients primarily occur because of the effects of dopaminergic agents for motor symptoms.

Loss of dopamine neurons in the ventral tegmental area is one of the likeliest of all neuropathological causes as changes in serotonin and norepinephrine systems are not. For the uninitiated, the ventral tegmental area is the origin of the mesolimbic dopaminergic projection. Plenty of studies have gone into analyzing the cause behind the aggression in PD Dementia patients. Depression in PD Dementia patients has been identified due to changes in the medial frontal cortex and the anterior cingulate. Akinetic-rigid variants have been found in patients showing signs of major depression.

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Symptoms Of Cognitive Change

The cognitive changes experienced by people with Parkinsons vary from person to person. Possible cognitive symptoms linked with early-stage Parkinsons include:

  • Difficulty multi-tasking
  • Difficulty concentrating and becoming easily distracted
  • Difficulty learning new skills
  • Difficulty remembering certain things

As Parkinsons progresses these symptoms can worsen and new symptoms might appear. Possible impairments later in the course of the condition might include:

  • Difficulty with problem-solving
  • Difficulty judging distances and directions

Is The Dementia Caused By Parkinsons Or Something Else

Comparing Lewy Body Dementia and Parkinson’s Disease

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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Coping With Cognitive Changes

Some medications used to treat Alzheimer’s disease also may be used to treat the cognitive symptoms of LBD. These drugs, called cholinesterase inhibitors, act on a chemical in the brain that is important for memory and thinking. They may also improve hallucinations, apathy, and delusions. The U.S. Food and Drug Administration has approved one Alzheimer’s drug, rivastigmine, to treat cognitive symptoms in Parkinson’s disease dementia. Several other drugs are being tested as possible treatments for LBD symptoms or to disrupt the underlying disease process.

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.

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Advice For Carers Family And Friends

Living with or caring for someone with Parkinsons disease dementia can be challenging. Sometimes help and support will be relied on heavily but there will be times when it will be better to step back and allow the person with dementia to do things for themselves. This balance will be difficult to judge at first, but with time and patience new routines and approaches to day-to-day living can be established.

It is important to encourage, stimulate and help the person with dementia, but remember too that rest is important.

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Treatment Of Parkinsons Disease Dementia

Dementia caused by Parkinson

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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What Is Lewy Body Dementia

LBD is a chronic, neurodegenerative cognitive disorder, and is the 3rd most common form of dementia.3 Unlike most other forms of dementia, people with LBD have Lewy bodies in the brain. Lewy bodies are abnormally-folded proteins found in the nerve cells of the brain.2 Patients with LBD may experience memory/cognitive problems, visual hallucinations, and Parkinsonism symptoms.4

Caring For Your Health With Parkinson’s Disease

In addition to caring for your Parkinson’s health, it is also important to care for your overall health. This means visiting your primary care physician periodically for preventive care like the annual flu shot and cancer screeningsfor example, a mammogram for breast cancer screening and a colonoscopy for colon cancer screening.

A primary care physician can also evaluate for risk factors related to heart attacks and strokes, and provide counseling on exercise, smoking, alcohol use, depression, or other mental health concerns. Regular visits to your primary care physician or neurologist will also allow them to catch bacterial infections like urinary tract infections before they get serious.

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What Are The Signs And Symptoms Of Parkinson’s Disease Dementia

Parkinson’s disease dementia can’t be diagnosed conclusively by a single test. Instead, doctors may use multiple tests and consider a range of Parkinson’s disease dementia criteria, including symptoms like:

  • Feelings of disorientation or confusion
  • Agitation or irritability

RELATED: 7 Warning Signs of Dementia to Look For in Loved Ones

Not all cases of cognitive impairment are severesome people with Parkinson’s disease can still manage their work and personal life just fine. But once a person has Parkinson’s disease dementia, it usually means that they can no longer go about their daily life as they once did.

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