Cognitive Abilities in Parkinson’s Disease

Cognitive disturbances, as well as mood and behavior alterations, can be as traumatic and frustrating as any physical problem, both for the patient as well as the caregiver. Cognitive deficits can be present even in the early stages of Parkinson’s disease, gradually worsening as the disease progresses, and may ultimately lead to dementia. A person with PD is at a greater risk of developing dementia and this risk gradually increases in proportion to the duration of the disease.

Cognition relates to higher level functions of the brain and may be defined as the mental process involved in gaining knowledge and understanding, which includes the process of thinking, knowing, learning, remembering, decision making, judging and problem solving. Language, imagination, perception and planning are the necessary components.
People with PD often have trouble processing two cognitive acts simultaneously. Mild cognitive impairment may be present in most people with PD. Stress, depression, sleep disturbances, or medication can lead to such changes.

The cognitive deficits seen in PD patients (subcortical dementia) are similar to those caused by frontal lobe damage. Due to the degeneration of the cells of the part of the brain known as substantia nigra in the basal ganglia, there is deficiency of the chemical transmitter dopamine. As a result, there is dysfunction of the circuits connecting the frontal lobe of the brain and the basal ganglia, causing problems with memory, language, concentration, attention, visuo-spatial functions, and executive function of the brain.

Memory Loss in Parkinson’s Disease

Anything that affects cognition can affect memory too. However, sometimes it becomes difficult to differentiate memory loss or impairment due to PD from that due to normal aging process.

Subcortical cognitive deficits, as seen typically in PD patients, are characterized more by problems with memory recall (especially of recent events) than by memory formation, decrease in mental speed or slowed thinking (bradyphrenia), and apathy. It is not that PD patients suffering from bradyphrenia are unable to think. It is only that their thinking process is slow, so they need time to answer questions or make decisions.

Executive impairment may be more pronounced than language deficit. Executive functions involve higher level thinking skills such as logical thinking, prioritizing, organizing, planning, and executing. Dementia may be accompanied by psychosis, agitation, and sleep disturbances.

Personality Changes in Parkinson’s Disease

Personality changes occur frequently in people with PD. Frontal cortical damage could account for some of the behavioral and personality changes that are seen in PD patients, such as depression, mental lethargy, mood swings, and irritability. On the other hand, obsessive compulsive behavior such as binge-eating, hypersexuality, and pathological gambling may be related to some drugs used to treat PD.

A Parkinson’s personality is often mentioned in relation to PD patients. Certain personality traits have been noted in people with PD which includes being hard-working, ambitious, serious-minded, dogmatic and honest. They are less likely to have any addictions to alcohol, tobacco or drugs. These traits may be present even before the development of PD. One theory that may explain this is that loss of dopamine (which is thought to be responsible for these personality traits) starts long before the manifestation of motor symptoms.

]]> http://pdring.com/brain-functioning-and-personality-changes-in-parkinson%e2%80%99s-disease.htm/feed 7 http://pdring.com/parkinsons-self-help.htm http://pdring.com/parkinsons-self-help.htm#comments Tue, 12 May 2009 15:22:18 +0000 Dr. P.D. http://pdring.com/?p=59 Understanding Parkinson’s disease

There are many things a person can do to help both themselves and their doctor when suffering from Parkinson’s disease, joining a support group, taking a regular form of exercise plan and maintaining a healthy diet are just some of the possibilities.

Support groups

Support groups can play a crucial role in the emotional aspect of a sufferer’s life and how they cope with living with the disease. Support groups provide a way of asking questions, sharing stories and experiences of the disease and for developing friendships with people in the same predicament as you.

In addition to live support groups several forums can be found online which provide help, support and advice for those suffering from Parkinson’s and the family of those suffering.

Exercise

Although exercise cannot stop the advancement of Parkinson’s disease it can help with the alleviation of symptoms of the disease. A regular form of exercise is crucial in improving flexibility, mobility and balance; exercise can also help with psychological aspects in that it gives the sufferer a sense of achievement and accomplishment in taking an active role in their own care.

Diet

Many people suffering from Parkinson’s have problems with their weight due to loss of appetitive brought on by depression, some people have found that the treatment Levodopa is affected by proteins in foods which then limits their intake of protein which can cause problems in their diet. A full healthy diet which takes in all the necessary nutritional requirements is recommended including eating extra fruit and vegetables to help with one of the symptoms of the disease, constipation.

Speech therapy/occupational therapy

These therapies can offer invaluable aid to the sufferers being able to control their symptoms, physical therapy can help to increase the strength of muscles, increase flexibility and decrease the risk of falls due to imbalance. Speech therapy can help the patient in the pronunciation of words and increase the volume of the voice.

Occupational therapy can help the patient by showing them alternative ways of doing tasks which the patient can no longer do; this gives the patient a sense of achievement and a sense of taking some control back over their life.

Developing a healthy Doctor/patient relationship

Making an accurate diagnosis of the disease especially in the very early stages can be hard, however if the patient and Doctor can establish a healthy relationship from the onset diagnosis and treatment can be easier.

Depression is a serious illness that can affect anyone at anytime in their life, it brings about feelings of sadness, hopelessness, anxiety and fatigue, people who suffer from Parkinson’s disease not only have to contend with the disease itself but over 50% of people suffering will also have to contend with depression too.

There is no clear reason which determines why those suffering from Parkinson’s have depression, though Parkinson’s is a debilitating, progressive disease in itself which when first diagnosed many people find hard to digest.

Despite the advancements in medicine over the past few years many cases of depression go undiagnosed and are often mistaken for underlying symptoms of Parkinson’s disease itself as symptoms brought about by depression overlap those of Parkinson’s. However once depression has been diagnosed it can be treated successfully along with Parkinson’s.

Symptoms of depression are

• Persistent feelings of sadness and anxiety.
• Feelings of guilt and helplessness.
• A loss of interest in hobbies.
• A loss of interest in sex.
• A decrease in energy.
• Difficulty in remembering and concentrating.
• Problems with sleep.
• Changes to the appetite or weight.
• Irritability and restlessness.
• Suicidal or negative thoughts.

If you have five or more of these symptoms and they last for longer than two weeks you may be suffering from depression, it is important you visit your Doctor who can then asses you for depression and suggest any relevant treatment.

A lot of the symptoms listed above are very similar to symptoms which Parkinson’s disease will normally bring about in the course of time, however your Doctor should be able to distinguish between what are symptoms of your disease and those which may be down to depression.

Getting treatment for depression

Coping with Parkinson’s is hard enough on its own so it is very important that if you think you may be suffering from depression too you get it treated, treatment for depression when combined with Parkinson’s disease should always be controlled by a mental health professional.

This is critical especially when anti depressant medication is needed and prescribed, this will help to alleviate any potential drug interactions between the anti depressant and your Parkinson’s medication.

Recovery from depression is a long process especially if you have been depressed for some time without fully realising it and the medications which are often prescribed for depression can take several weeks to start working to their full potential.

The amount of medication needed for your depression will vary and the dosage may have to be altered to suit you, but no matter how advanced your Parkinson’s is, treatment for depression can be very successful.

Early disease

The biggest question once a correct diagnosis of Parkinson’s disease has been made is when to start treatment and the medication used for that treatment. Treatments can vary greatly depending on the age, condition of the patient and understanding of the disease and its treatment that the patient has. In the early stages of the disease depression and anxiety may also play a part in the debilitating symptoms and therefore will become one of the main objects of concern when deciding on initial treatment.

Neuroprotective agents If Neuroprotective agents are identified then they will obviously be the first treatment which is offered to the patient and treatment will commence as soon as possible. However no agent has been known to offer 100% neuroprotection, one medication that has a mild symptomatic effect is Selegiline and this is very often used in the early stages of Parkinson’s disease.

Starting symptomatic therapy

The decision of when to actually begin treatment is one that is made between the patient and their Doctor and several factors are taken into account, these are the degree of impairment, the effects the symptoms are having on the patient’s employment and the patient’s attitude towards taking medication. If the patient fully understands the limitations and benefits they can reap from the medication then their preference will count for a lot in the decision making process.

The patients understanding makes a huge difference because many times over the treatment period they will have to be re-evaluated and have their medication adjusted with the progression of the disease or the patients response to the therapy. It is therefore in the best interests of both parties that they develop a partnership from the very beginning.

The initial treatment options

The patient’s age and condition will make a huge difference to the choice of initial treatment; the drug Levodopa is usually the first choice of medication for those sufferers who are elderly. A dopamine agonist will usually be chosen for the younger patient as younger people are more tolerant of the side effects the drug can produce.

In the younger patients delaying of the onset of motor skills problems is also a huge concern with Selegiline, amantadine or anticholinergic medication being excellent initial treatments for mild symptoms of the disease, providing of course that the side effects most of these medications produce can be tolerated.

If depression and anxiety are one of the concerns then this will usually be treated with medications such as anti-depressants, it is thought that over 50% of all those suffering with Parkinson’s disease will also suffer from depression and anxiety.