By Stephen Des Georges
Desert Haven Home Care and Apollo Residential Assisted Living provides residents with high-quality supervision and treatment reflective of its proprietary three cornerstones of managed care for seniors: meaningful, patient-centered care, best-class service and passionate advocacy. Healthcare professionals at each residence are knowledgeable and respected servants, familiar with the latest evidence-based research and outcomes. It is our privilege to regularly share with you timely and topical insights into issues that impact elderly loved ones. In this installment, Parkinson’s disease is reviewed – particularly its causes and treatments.
“I don’t have any choice whether or not I have Parkinsons, but surrounding that non-choice are a million other choices that I can make.”
Michael J. Fox, actor, philanthropist, Parkinson’s advocate
Understanding Parkinson’s
Pope John Paul II. Muhammed Ali. Rocker Ozzy Osbourne and U.S. Attorney General Janet Reno. Evangelist Billy Graham, Rev. Jesse Jackson and President George H. W. Bush. Michael J. Fox. Each, and millions of other Americans, has battled or is currently battling Parkinson’s disease. Each has battled or is battling this neurodegenerative disease, one characterized by motor and non-motor symptoms, both of which negatively impacting patients’ quality of life.
Parkinson’s disease affects the body’s nervous system, causing movement issues. It is believed that the signs and symptoms of this disease manifest because of low dopamine levels in the brain.[1] (Low levels of dopamine can make one less motivated or excited about things, and is associated with a number of metal illnesses, including depression, schizophrenia and psychosis.) Parkinson’s is characterized by movement changes, fatigue, dementia, delusions and hallucinations.[2]
The trouble with Parkinson’s
The effects of Parkinson’s disease (PD) on the central nervous system are both chronic (meaning they persist) and progressive (meaning the symptoms grow worse over time). By the time a diagnosis is made, PD has typically already progressed to a point where people have difficulty controlling the movement of their bodies due to tremors (involuntary shaking), bradykinesia (slowness of movement and reflexes), stiffness in their limbs or trunk of the body and impaired balance. As these symptoms progress, walking, talking, swallowing and completing other simple tasks can become challenging.
In addition to these motor-related symptoms, non-motor symptoms such as cognitive impairment, mood and behavioral problems, sleep disorders and constipation can significantly impair quality of life and require careful symptom-based treatment. Some non-motor symptoms, such as hyposmia (reduced ability to detect odors), REM (rapid eye movement) sleep-behavior disorder (acting out vivid dreams) and constipation, typically precede the motor symptoms by several years. Other non-motor symptoms such as cognitive impairment commonly appear after the onset of motor symptoms.[2]
Parkinson’s disease dementia
Parkinson’s disease is a form of dementia. There are several types of dementia, including PD dementia, Alzheimer's, frontotemporal dementia, vascular dementia and mixed dementia. According to one estimation, 50 to 80 percent of people suffering from Parkinson's disease will eventually experience Parkinson’s disease dementia.
Causes of Parkinson’s disease dementia
Parkinson’s disease affects the dopamine-producing cells in the brain. Dopamine is an important neurotransmitter that controls and coordinates muscle movement. The decline in dopamine levels causes a loss of muscle function. As Parkinson's disease spreads further into the brain, it also affects the areas of the brain responsible for memory, thinking and judgment. This leads to PD dementia.
Parkinson’s disease dementia and behavior
With the progression of dementia, irritability, confusion and disorientation begins to occur in the patient. Delusions and hallucinations are experienced by some patients – as many as 50 percent of those diagnosed – which are often debilitating and frightening.
Symptoms of Parkinson’s disease dementia
PD dementia is characterized by the following common symptoms:
Confusion
Depression[4]
Hallucinations
Paranoia
Mood swings
Disturbance in sleep
Speech is slurred
Interest is lost
Appetite is affected
Energy levels are affected
Delusions
Anxiety is increased
Difficulty in concentration
Reasoning and judgment are affected
Difficulty in memory-recalling and forgetfulness
Later stages of Parkinson’s disease dementia
The later stages of this PD dementia require constant care. The symptoms become more aggravated, and assistance is required to help the patient move around his or her environment. A decline occurs in the quality of life. There is an increased risk of pneumonia, falls, insomnia and infection. Hospital care and support counselors prove helpful in the later stages of this disease.
Parkinson’s disease dementia and life expectancy
It is important to know that PD dementia is not considered a fatal condition.
There are, however, complications associated with the disease. Aging Care, an agency that connects people caring for aging loved ones with senior care resources, notes that, like Alzheimer’s disease and other forms of dementia, complications and a patient’s comorbid conditions are more life-threatening than PD itself. Parkinson’s disease dementia can shorten the lifespan of a person by one to two years. Research shows an average survival rate of nine years after the onset of this disease. There is some relationship between dementia and the rate of mortality, but people can live for many years with the disease. [5]
Diagnosis of Parkinson’s disease dementia
PD dementia cannot be diagnosed by any combination of tests. The only process of diagnosis is the detection of Parkinson’s disease first; once detected, the attending physician will closely monitor the signs of Parkinson’s disease dementia based on the behavior and symptoms presented by the patient. The physician is likely to watch carefully a patient’s mental health, cognitive functions and memory recall.
What increases the risk of Parkinson’s disease dementia?
A person is more at risk of developing Parkinson’s disease dementia if:
The person is older
The person is male
The person already has PD with psychiatric complications, such as depression
The person is struggling with motor impairment, such as gait disturbance and rigidity
The person has a mild cognitive impairment
Treatment for Parkinson’s disease dementia
Researchers have yet to discover a cure for the brain damage caused by Parkinson's disease dementia. However, well-managed efforts can reduce its symptoms. Only a licensed physician should be consulted regarding medications as part of a treatment, as some over-the-counter medicines are known to dementia and its related symptoms. Medicines that have been proven to be of benefit in the fight against dementia are:
Clonazepam and melatonin: used in the treatment of REM disorder
Carbidopa-levodopa: used to treat movement symptoms of Parkinson's; can also help with hallucinations and confusion associated with PD dementia
Selective serotonin reuptake inhibitors (SSRIs): used in the treatment of depression, a symptom of PD dementia
Cholinesterase inhibitors: used to treat cognitive changes in Alzheimer’s disease; can help to relieve hallucinations, changes in behavior and thinking, and sleep disturbances caused by PD dementia.[6]
Conclusion
Parkinson's disease dementia can exponentially change one’s social as well as personal life. While a cure is elusive, a healthy diet, awareness of symptoms and regular consultation with a physician are important steps to take to provide the chance for early diagnosis.
At Desert Haven Home Care and Apollo Residential Assisted Living in Greater Phoenix, Arizona, professional healthcare team members are on hand to make certain the proper treatments for dementia are always in place and constantly practiced. Team members know the symptoms of the syndrome and its many variants, including Parkinson’s, and are prepared to ensure all appropriate measures are taken to ensure the good health and comfort of their residents.
Among the foundations of our care, as endorsed by the Alzheimer’s Association Campaign for Quality Residential Care, are:
Quality relationships shared with residents by professional team members; a supportive environment
Assessment of each resident’s abilities for proper acre and planning; recognition of special needs
Person-focused strategies; working with residents to ensure the best-possible quality-of-life results
Meaningful, daily social interactions
Formal and informal activities that provide personal meaning and sense of community and choices.
For more information about Desert Haven Home Care and Apollo Residential Assisted Living, visit www.deserthavenaz.com.
References
[1] Triarhou, L. C. Dopamine and Parkinson’s Disease. (2013).
[2] Parkinson’s Disease: Challenges, Progress, and Promise. National Institute of Neurological Disorders and Stroke (NIH). (2015) NIH Publication No. 15-5595. https://www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Challenges-Progress-and-Promise#about.
[3] Garcia-Ptacek, S., and M. G. Kramberger. Parkinson Disease and Dementia. J. Geriatr. Psychiatry Neurol. 29, 261–270 (2016).
[4] Divac, N. et al. The Efficacy and Safety of Antipsychotic Medications in the Treatment of Psychosis in Patients with Parkinson’s Disease. Behav. Neurol. (2016).
[5] Meireles, J., and J. Massano. Cognitive Impairment and Dementia in Parkinson’s Disease: Clinical Features, Diagnosis, and Management. Front. Neurol. 3. (2012).
[6] De Lau, L. M. L., et. al. Prognosis of Parkinson Disease: Risk of Dementia and Mortality: The Rotterdam Study. Arch. Neurol. 62, 1265–69. (2005).
[7] Goldman, J. G., and S. Holden. Treatment of psychosis and dementia in Parkinson’s disease. Curr. Treat. Options Neurol. 16. (2014).