Parkinson's Disease and Dementia -- Signs, Symptoms, an...

Parkinson's Disease and Dementia -- Signs, Symptoms, and Treatment

Parkinson's disease is a progressive disorder of the central nervous system that affects more than 1.5 million people in the United States. The main features of Parkinson's disease are slowness of movements, compromise of balance, muscle rigidity, and tremor. The disease is thought to be caused by low levels of a chemical called dopamine, which activates cells in our brains that let us move.


SYMPTOMS OF PARKINSON'S DISEASE

There are primary and secondary symptoms of Parkinson's disease. Not everyone with the disease experiences all of the symptoms and the progression of the disease is different from person to person. Most people who get Parkinson's are over 60, but recently there have been more identified cases in younger men and women.

Most of the symptoms of the disease involve disruption of motor functions (muscle and movement). However, lack of energy, mood and memory changes, and pain can also occur as part of the disease.

Primary symptoms of Parkinson’s disease

* Bradykinesia – slowness in voluntary movement such as standing up, walking, and sitting down. This happens because of delayed transmission signals from the brain to the muscles. This may lead to difficulty initiating walking, but when more severe can cause “freezing episodes” once walking has begun.
* Tremors – often occur in the hands, fingers, forearms, foot, mouth, or chin. Typically, tremors take place when the limbs are at rest as opposed to when there is movement.
* Rigidity – otherwise known as stiff muscles, often produce muscle pain that is increased during movement.
* Poor balance – happens because of the loss of reflexes that help posture. This causes unsteady balance, which oftentimes leads to falls.

Secondary symptoms of Parkinson’s disease

* Constipation
* Difficulty swallowing
* Choking, coughing, or drooling
* Excessive salivation
* Excessive sweating
* Loss of bowel and/or bladder control
* Loss of intellectual capacity
* Anxiety, depression, isolation
* Scaling, dry skin on the face or scalp
* Slow response to questions
* Small cramped handwriting
* Soft, whispery voice


DIAGNOSING PARKINSON'S DISEASE

There are no lab tests that can definitively diagnose Parkinson's disease. A systematic neurological exam will include testing your reflexes and observing things like muscle strength throughout your body, coordination, balance, and other details of movement. These tests are also necessary to rule out other conditions, such as nerve dysfunction, narrowing of the spinal canal, or other types of tremor, for which other treatments would be needed. Your doctor may be order tests, such as blood or urine tests or CT or MRI scans, to exclude the possibility of these other disorders.


TREATMENT OF PARKINSON'S DISEASE

There is no cure for Parkinson’s disease; however, there are several medications available to treat the symptoms of the disease.

Commonly used medications for Parkinson’s disease

* Levodopa/Carbidopa (Sinemet) - This is a combination of Levodopa (the chemical that patients with Parkinson’s disease lack) and Carbidopa (a chemical that helps the levodopa reach the brain). It works very well for controlling symptoms for most patients but can cause some side effects, especially after several years. Its effectiveness tends to decrease after several years.

* Entacapone (Comtan) - This is a medication that helps Sinemet work better when it starts to lose its effectiveness. It is also available together with levodopa and carbidopa in a combined product called Stalevo.

* Dopamine agonists - These include ropinorole (Requip) and pramipaxole (Mirapex). These are medications enhance your bodies natural production of dopamine by stimulating your brain to produce more dopamine. They do not have as much risk of long-term side effects as levodopa, and they have less chance of losing effectiveness over time in comparison to levodopa. However, they can cause dizziness and hallucinations, especially in the elderly or in patients with dementia. These factors make the agonists more suitable medications for younger patients. There is some theoretical evidence that the agonists may slow the progression of Parkinson’s disease, but scientists have not proven this definitively.

* Monoamine oxidase inhibitors - These include selegiline (Eldepryl and Zelapar) and rasagaline (Azilect). This is a less commonly used class of medications that increase the amount of dopamine available in the brains of patients with Parkinson’s disease. They can be very helpful in a small subset of patients with Parkinson’s disease. They often have fewer side effects than the dopamine agonists but can be harmful when used together with certain other medications, especially some types of antidepressants. Patients can also develop critically elevated blood pressure when patients take these medications and eat certain types of foods.

Surgical treatment for Parkinson’s disease

There are some surgical options for patients with Parkinson’s disease, the most common of which is known as Deep Brain Stimulation (DBS). This form of surgery is sometimes used to help reduce the severity of muscle rigidity and slowness of movements. This involves the placement of a wire into the brain connected to a pacemaker-type device implanted just below the skin in the chest.
Other helpful treatments for Parkinson’s disease

If you have been diagnosed with Parkinson’s, you can help keep yourself as healthy and safe as possible by taking certain precautions.

* Physical therapy is often recommended and almost always beneficial.
* Group wellness programs, such as the Parkinson’s Learning Lifelong Useful Skills, are very helpful. The involvement with others can help with the isolation and depression some Parkinson’s patients feel.
* Exercise can ease symptoms. Research shows that patients with Parkinson’s disease who exercise regularly do better than those who don’t. Any degree of exercise helps!


TIPS FOR LIVING WITH PARKINSON'S DISEASE

Exercise tips for people with Parkinson’s disease:

* Before starting an exercise regime, you should always check with your doctor.
* Pursue physical and occupational therapy.
* Exercise your face and jaw whenever possible.
* Practice bending, stretching, and breathing exercises.
* Try exercising in bed; it may be easier than on the floor.
* Build your walking skills, even if that means having to hold onto something.
* Try exercising in the water; it is easier on the joints. Many fitness centers, hospitals, colleges, and YMCA’s or YWCA’s have water exercise programs.

Safety tips for Parkinson’s disease:

* Ask your doctor to arrange a home safety evaluation.
* Use grab bars in the tub and shower.
* Use a bath chair or stool in the shower.
* Keep your floors smooth but not slippery.
* Store supplies in easy to reach cabinets.
* Make sure stairwells are lit.
* Get nightlights for bathrooms and hallways.
* Keep walking areas free of clutter.
* Wear low heeled, comfortable shoes when walking around. Avoid walking in slippery socks and slippers.
* Make sure carpets are fully tacked to the ground, and avoid throw rugs.

Tips for diet and eating:

* Cut foods into smaller portions to avoid choking and to encourage digestion.
* Remain upright for 30 minutes after eating.
* For upset stomachs linked to medication, try eating a small amount of non-protein based food before taking medication.
* Protein may block your body’s ability to absorb levodopa (Sinemet), so you may need to avoid taking this medication within 30 minutes before to 1 hour after eating meat or other high-protein foods.


THE RELATIONSHIP BETWEEN PARKINSON'S DISEASE AND DEMENTIA

Dementia is a less common feature of Parkinson’s disease. Approximately 20% of people with Parkinson’s disease will develop Parkinson’s Disease Dementia (PDD). Parkinson’s patients who experience hallucinations and more severe motor control problems are at risk for dementia. For those patients with Parkinson’s disease who go on to develop dementia, there is usually at least a 10- to 15-year lag time between their Parkinson’s diagnosis and the onset of dementia.

Signs of dementia in Parkinson’s patients include:

* memory problems
* distractibility
* slowed thinking
* disorientation
* confusion
* moodiness
* lack of motivation
* hallucinations

Parkinson’s Disease Dementia (PDD) is different from a similar disorder, known as Dementia with Lewy Bodies (DLB). DLB 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, the cognitive problems, such as hallucinations, tend to occur much earlier in the course of the disease and often precede the difficulties with walking and motor control.

Is the dementia caused by Parkinson’s disease or something else?

Indications that dementia may be caused by something other than Parkinson’s disease include agitation, delusions (strongly held false beliefs), language difficulties, and early onset of memory symptoms. If these factors are present, your physician can test for other possible causes of dementia, such as a Vitamin B-12 deficiency or an underactive thyroid gland. Depression is also common in Parkinson’s patients and can mimic dementia by causing similar symptoms.

Additionally, Alzheimer’s disease and Parkinson’s disease are both common in the elderly, especially in those over 85. Therefore, patients with Parkinson’s who develop dementia may develop Alzheimer’s dementia as well. If a patient with established Parkinson’s disease develops signs of Alzheimer’s dementia, he or she will probably benefit from medications for Alzheimer’s dementia as well. The similarities in symptoms between Parkinson’s disease, DLB, and Alzheimer’s disease, can make it difficult to determine the cause of the symptoms. Thus, obtaining a thorough consultation with a neurologist may be necessary to make a definitive diagnosis and establish an appropriate plan of care.

There are other, much less common disorders with features similar to Parkinson’s disease with dementia. If patients do not respond to treatments for Parkinson’s disease or if they have unusual features, referral to a neurologist who specializes in Parkinson’s and related conditions is often helpful.


THE BOTTOM LINE ON PARKINSON'S DISEASE

Parkinson’s Disease is a disorder of muscle and movement control that is usually very manageable and controllable. About 20% of patients develop dementia, including loss of memory and other cognitive functions. If patients with Parkinson’s Disease develop behavioral or memory problems, a physician can help determine the cause of the problems and develop a good treatment plan.


RELATED LINKS FOR PARKINSON'S DISEASE

Parkinson's Disease Foundation
http://www.pdf.org/
Includes several interesting features, including 'Ask the Expert' for specific questions and answers about the disease; and ‘Parkinson's Community' to help you find regional, national and internet groups and support organizations. (Parkinson's Disease Foundation)

Parkinson's Disease Patient Information
http://www.apdaparkinson.org/userND/index.asp
Provides information about Parkinson's disease, current events, publication and video, fellowships and grants. (American Parkinson's Disease Association)

Medline Plus: Parkinson's Disease
http://www.nlm.nih.gov/medlineplus/parkinsonsdisease.html
A resource list of online articles and publications about Parkinson's including links to information about current research, specific medication and treatment regimens, support organizations and general information. (National Library of Medicine / National Institutes of Health)

Tracking Dementia in Parkinson's Disease
http://www.webmd.com/parkinsons-disease/news/20041213/tracking-dementia-in-parkinsons-disease?printing=true
Outlines a study that found Parkinson's disease patients with dementia can lose their mental abilities at almost the same rate as people with Alzheimer's disease. (Web MD)

This article created by Gina Kemp, M.A. with guest editors William Buxton, M.D., and Verna Porter-Buxton, M.D., of UCLA-Santa Monica Neurological Associates. Last modified: August 08