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
Causes And Risk Factors
PD is idiopathic, meaning that a doctor does not know why a person has the condition. However, according to Johns Hopkins Medicine, early-onset Parkinsons disease has links to genetic inheritance from a parent.
Researchers have identified several risk factors that may make a person with Parkinsons disease more likely to experience dementia.
These risk factors include:
- advanced age at time of diagnosis
- experiencing excessive daytime sleepiness
- hallucinations before the onset of other dementia symptoms
- having a specific Parkinsons symptom that causes a person to have difficulty starting to take a step or to halt mid-step while walking
- a history of mild thought impairment
- more severe movement impairment symptoms than most people with Parkinsons disease
However, researchers do not know why some people with Parkinsons disease develop cognitive difficulties as well as movement problems.
How Is Lewy Body Dementia Diagnosed
There isn’t one test that can diagnose LBD. It is important to see an experienced doctor to get a diagnosis. This would usually be specialist such as a neurologist. The doctor will
- Do a medical history, including taking a detailed account of the symptoms. The doctor will talk to both the patient and caregivers.
- Do physical and neurological exams
- Do tests to rule out other conditions that could cause similar symptoms. These could include blood tests and brain imaging tests.
- Do neuropsychological tests to evaluate memory and other cognitive functions
LBD can be hard to diagnose, because Parkinson’s disease and Alzheimer’s disease cause similar symptoms. Scientists think that Lewy body disease might be related to these diseases, or that they sometimes happen together.
It’s also important to know which type of LBD a person has, so the doctor can treat that type’s particular symptoms. It also helps the doctor understand how the disease will affect the person over time. The doctor makes a diagnosis based on when certain symptoms start:
- If cognitive symptoms start within a year of movement problems, the diagnosis is dementia with Lewy bodies
- If cognitive problems start more than a year after the movement problems, the diagnosis is Parkinson’s disease dementia
There Are Many Different Dementia Typesalzheimers Disease Lewy Body Dementia Vascular Dementia Its Easier To Keep Them Straight If You Think About Dementia Thats Reversible And Dementia That Isnt
There are many different dementia types, some that can be reversed.
Various dementia types can be caused by medical or psychiatric conditions, among them high fever, vitamin deficiency, head trauma, or depression. These are the so-called reversible dementias. Other dementia types are irreversible andif youre wondering, Is dementia hereditary?can be caused by family genes.
Lets look at reversible dementia first. Its important to see a doctor if youre experiencing sudden memory-loss symptoms, especially if your health has recently changed.
The following are among the more common causes of reversible dementia:
- Excess alcohol consumption
- Vitamin deficiency
Tip : Make It A Priority To Be Socially Engaged
The more socially active you are, the more you connect face-to-face with others, the stronger your memory and cognition is likely to be. You dont need to be a social butterfly or the life of the party, but you do need to regularly connect with people who care about you.
Connecting with others is the most effective means of relieving stress which left unchecked can exacerbate symptoms of Parkinsons disease. Staying socially engaged also stimulates immune function that may slow the progress of disease. While many of us become more isolated as we get older, its never too late to meet others and develop new friendships.
Tips for meeting new people
Hotlines and support
UK: Call the helpline at 0808 800 0303 or visit Parkinsons UK to find support
Australia: Call the info line at 1800 644 189 or visit Parkinsons Australia for links to state organizations that provide support and services.
Canada: Call 1 800 565-3000 for information or referrals or visit Parkinson Society of Canada for regional resources and support.
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Behavioral And Mood Symptoms Of Lewy Body Dementia
Changes in behavior and mood are possible in LBD and may worsen as the persons thinking abilities decline. These changes may include:
- 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
Parkinson’s Disease Dementia Surgery And Gene Therapy
- Great strides have been made in the surgical treatment of Parkinson’s disease. Several different procedures are now available, and they are successful in many patients in relieving movement symptoms. Unfortunately, surgery has no effect on cognitive symptoms. In fact, most people with dementia are not candidates for surgery.
- Gene therapy is in its infancy there are ongoing human and animal trials with various methods to insert genes into neuronal cells to reduce or stop Parkinson’s disease symptoms by causing cells to produce dopamine coded by the newly inserted genes. Early results with the treatment termed ProSavin are encouraging. However, it is not clear if such therapy could prevent or reverse Parkinson’s disease dementia.
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Wait So What Is Parkinsonism
Parkinsonism refers to the motor symptoms that are typically associated with PD, such as tremors, stiffness, and walking/balance problems. Both PD and LBD are forms of Parkinsonism, meaning that PD patients and LBD patients may experience these motor symptoms.2 Because the Parkinsonism motor symptoms of PD and LBD can be very similar, it can be difficult to differentiate between the two conditions.
What Are The Symptoms
The symptoms of dementia with Lewy body disease include:
- Difficulty with concentration and attention
- Extreme confusion
- Difficulties judging distances, often resulting in falls.
There are also three cardinal symptoms, two of which must be present in order to make the diagnosis:
- Visual hallucinations
- Fluctuation in mental state so that the person may be lucid and clear at one time and confused, disoriented and bewildered at other times. Typically this fluctuation occurs over a period of hours or even minutes and is not due to any underlying acute physical illness.
Some people who have Lewy body disease may also experience delusions and/or depression.
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Dementia With Lewy Bodies
A less common type of dementia can also affect those with Parkinsons. This is called Dementia with Lewy bodies. It is different from the classic Parkinsons Dementia because dementia comes on at the same time as the movement problems like tremor, stiffness and slowness. On occasion, dementia can actually develop without any other symptoms or signs.
Like Alzheimers and Parkinsons Dementia, Dementia with Lewy bodies causes memory loss, problems with language and impaired concentration. It can also affect the ability to recognise faces, perform simple actions and to judge distances and movements.Vivid visual hallucinations, are particularly common in this type of dementia and can start fairly early on in the disease.
Although there is still no cure for Parkinsons or the dementia associated with the disease, the symptoms may be eased a little with medications and specialist therapies. So, it is important to get advice from your GP, specialist or Parkinson’s nurse if you are worried, or if you are experiencing problems with your memory.
Life with dementia can be challenging, but getting treatment and support early may improve symptoms and help you maintain your independence, function and wellbeing for longer. With the right care and disease control you really can continue to love, laugh and live with Parkinsons.
Find out more about Parkinsons disease:
Dementia Caused By Huntingtons Disease
Huntingtons disease is an inherited degenerative brain disease that affects the mind and body. It usually appears between the ages of 30 and 50, and is characterised by intellectual decline and irregular involuntary movement of the limbs or facial muscles. Other symptoms include personality change, memory disturbance, slurred speech, impaired judgement and psychiatric problems.There is no treatment available to stop the progression of this disease, but medication can control movement disorders and psychiatric symptoms. Dementia occurs in the majority of people with Huntingtons disease.
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Dysfunction In The Fronto
Volitional shifts of attention are thought to depend on top-down signals within a fronto-parietal network comprising prefrontal cortical areas and posterior parietal cortices , wherein prefrontal regions modulate activity in the network according to task demands .
The major cortical neural networks affected in PDD. Areas of cortical atrophy associated with visuospatial and visuoperceptual deficits in PDD are based on the data presented in . Areas of cortical atrophy specifically associated with the presence of visual hallucinations in PDD are based on the data presented in . Functional cortical regions comprising the fronto-parietal attention network are based on the data presented in . Cortical regions are identified according to the Allen Brain Atlas for the human brain, and manually drawn onto the corresponding 3D brain image. In this representation the same cortical regions are affected symmetrically in both hemispheres, however in the original studies above the extent of atrophy in these regions was not symmetrical between hemispheres, and varied between individual patients. In the inferior view of the cortex the cerebellum has been removed to expose the fusiform gyri more clearly. DLPFC = dorsolateral prefrontal cortex PPC = posterior parietal cortex VLPFC = ventrolateral prefrontal cortex.
The Interaction Between A And Iron
Iron has not only been shown to bind to A, but also to regulate APP production. Iron levels affect APP translation through iron-responsive elements in APP transcript 5-UTR . Iron overload conditions can increase the protein expression of APP in the brain . APP also plays a role in maintaining neuronal iron homeostasis. Cell surface APP stabilizes the iron export protein, ferroportin , and allows cellular iron to flow out through the porin . Choi et al. demonstrated that treadmill exercise promoted -secretase-dependent APP processing through low iron-induced enhancement of furin activity to reduce cognitive decline and A-induced neuronal cell death, accompanied by a decrease in the levels of lipid peroxidation products and an increase in the ability of antioxidant defense enzymes. However, APP modified after translation, such as phosphorylation and glycosylation, can change its transport to the cell surface, and then affect its binding to FPN, which leads to imbalanced iron homeostasis . In addition, the intracellular processing of APP may impair iron output by destabilizing cell surface iron transporters. By contrast, non-amyloid processing of APP on the cell surface promotes the stability of iron transporters and thus reduces iron levels in neurons . Therefore, changes in intracellular transport that are related to changes in APP processing may lead to neuronal iron level increases and oxidative stress in dementia pathology.
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Whats The Difference Between Lewy Body Dementia Parkinsons Disease And Alzheimers Disease
Lewy body dementia is an umbrella term for two related clinical diagnoses: dementia with Lewy bodies and Parkinsons disease dementia. These disorders share the same underlying changes in the brain and very similar symptoms, but the symptoms appear in a different order depending on where the Lewy bodies first form.
Dementia with Lewy bodies is a type of dementia that causes problems with memory and thinking abilities that are severe enough to interfere with everyday activities. It specifically affects a persons ability to plan and solve problems, called executive function, and their ability to understand visual information. Dementia always appears first in DLB. The motor symptoms of Parkinsons such as tremor, slowness, stiffness and walking/balance/gait problems usually become more evident as the disease progresses. Visual hallucinations, REM sleep behavior disorder, fluctuating levels of alertness and attention, mood changes and autonomic dysfunction are also characteristic of DLB.
Finally, Alzheimers is characterized by different abnormal clumps called amyloid plaques, and jumbled fiber bundles called tau tangles. These microscopic structural changes in the brain were discovered by Dr. Alois Alzheimer in 1906. These plaques and tangles, together with loss of connections between nerve cells, contribute to loss of coherence and memory, as well as a progressive impairment in conducting normal activities of daily living.
Differences Between Pdd And Dlb
So, how are PDD and DLB different from each other? That depends on whom you ask. Some clinicians feel that these two conditions are simply different versions of the same disorder. In fact, some professionals use the terms interchangeably. Yet, according to currently agreed-upon diagnostic guidelines, there are some differences.
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What Are The Symptoms Of Parkinson 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
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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How Is Parkinson Disease Treated
Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
Prognostic Factors For Development Of Parkinsons Disease Dementia
In the clinic the diagnosis of PDD is based upon the Movement Disorders Society Task Force criteria , which incorporates detection of the cognitive features described above. However, it is recognized that early identification of patients at risk of developing PDD is useful in order to monitor them more closely so that therapeutic and supportive strategies can be implemented at a stage of the disease when they are likely to have greatest efficacy. Detailed neuropsychological testing, although able to detect early subclinical deficits, is not widely available, and therefore identification of clinical features with high predictive value for PDD has pragmatic value for clinicians. Large longitudinal cohort studies have demonstrated that inability to copy the intersecting pentagons figure on the MMSE, impairments of semantic verbal fluency and recognition memory, and development of a postural instability and gait difficulty motor phenotype are significant predictors for PDD . Errors on the Pill Questionnaire and presence of REM sleep behavioural disorder are also associated with later development of PDD, although their positive predictive values are lower .
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