Parkinson's Disease Dementia
Dealing with the disease of Parkinson’s is life-altering enough, but adding the complications of dementia can be devastating. Unfortunately, this scenario is far from rare. In fact, according to the Parkinson’s Foundation, most people with Parkinson’s will develop a measure of cognitive impairment over time. About 30% of individuals diagnosed with Parkinson’s will not develop dementia as their disease progresses.
What is Parkinson’s Disease Dementia?
With the onset of Parkinson’s disease, changes occur in the brain. Initially, this only appears as the symptoms commonly associated with Parkinson’s disease: muscle stiffness, shakiness, tremors, lack of facial expression, shuffling or a stooped posture. As the disease progresses, however, it works its way into other areas of the brain. It can negatively impact cognitive ability, mental functions and memory, leading to the development of dementia.
The primary changes ssociated with Parkinson’s disease and Parkinson’s disease dementia are the abnormal deposits made up primarily of the protein alpha-synuclein. This protein is found in various locations in the brain, and its primary purpose isn’t completely understood. These deposits are more formally known as Lewy bodies, named after the neurologist Fredrick H. Lewy M.D. who discovered them in the early 1900s.
Symptoms or Signs of Parkinson’s Disease Dementia
The signs of Parkinson’s disease dementia include the following:
- Trouble interpreting visual information
- Changes in judgment, concentration and memory
- Muffled speech
- Paranoid ideas and delusions
- Visual hallucinations
- Anxiety and irritability
- Appetite changes
- Disturbance in sleep, including rapid eye movement sleep disorder and excessive daytime drowsiness
While other types of dementia like Alzheimer’s impact language and memory, Parkinson’s primarily affects problem-solving and thought speed.
How Parkinson’s Dementia Disease Differs from Alzheimer’s Disease
There are Parkinson’s sufferers who will not develop dementia. If a person has Parkinson’s and then develops dementia, they may note a greater social impact than those people who have only Alzheimer’s. This is because the impairment affects both their cognitive and their motor skills.
There are some symptoms of Alzheimer’s and Parkinson’s disease dementia that overlap, but in most cases, as mentioned above, Alzheimer’s mostly alters a person’s memory and ability to communicate. Conversely, Parkinson’s dementia mainly impacts a person’s cognitive function, memory and the speed in which they can process thought.
Stages and Progression of Parkinson’s Disease Dementia
There are several stages of Parkinson’s disease that range from mild to advanced. On average, those diagnosed with Parkinson’s will develop dementia about ten years after their Parkinson’s diagnosis. The dementia aspect of the disease can greatly impact a person’s ability to live alone and affects their ability to concentrate, communicate or recall memories.
Causes and Risk Factors
While none of the following risk factors are known to cause dementia, if they are present, the chances of a person developing Parkinson’s disease dementia is greater. They are as follows:
- Advanced age: If a person is older when diagnosed with Parkinson’s their propensity to subsequently develop dementia is greater than if they were younger when initially diagnosed.
- Severe motor skill symptoms: If a person experiences a great deal of severe motor skill issues, they are more likely to develop dementia.
- Mild cognitive impairment (MCI): If a person has been diagnosed with MCI, they are at a greater risk for dementia. About 15 to 20% of all adults aged 65 and older have some degree of MCI.
- Psychiatric symptoms: The presence of various psychiatric symptoms like depression can indicate an increased risk of developing dementia.
- Postural instability and gait disturbance (PIGD): This is a notable Parkinson’s symptom that includes having difficulty initiating movement, the tendency to freeze mid-step, having problems with balancing, shuffling and falling.
- Excessive daytime sleepiness
- Hallucinations without other dementia-related symptoms
Diagnosis and Treatment
Unfortunately, there is not a test that can definitively diagnose Parkinson’s disease dementia. Instead, doctors use the following guidelines to formulate a Parkinson’s disease dementia diagnosis:
To diagnose Parkinson’s disease dementia, doctors consider the symptoms presented by a Parkinson’s patient a year or more after they were diagnosed with Parkinson’s. These will be dementia symptoms and those related to movement. In other words, if a person has been diagnosed with Parkinson’s a least a year prior and they begin developing dementia symptoms, it is often concluded that they have Parkinson’s disease dementia.
If specific symptoms are present, doctors might suggest having an MRI scan performed to examine the brain. This can show them any changes to the brain. It can also rule out other causes of the symptoms, such as a brain tumor. Therefore, while an MRI scan won’t necessarily diagnose Parkinson’s disease dementia, it can rule out other conditions and narrow down the list of potential causes of symptoms.
Just as there is no singular test to diagnose the condition, there are no singular treatments available to either slow or stop the damage done by Parkinson’s disease dementia. The main goal is to treat the symptoms of the disease and not the disease itself to improve the quality of life for those suffering from Parkinson’s disease dementia. The following are some types of medications that have been proven to help ease some of the symptoms associated with this debilitating disease:
- Cholinesterase Inhibitors:These medications are the current go-to treatment for any Alzheimer’s related cognitive symptoms. Although they have been primarily used to treat Alzheimer’s patients, they are considered helpful for people living with when treating symptoms like behavioral and thinking changes, sleep disturbances and visual hallucinations.
- Antipsychotic Drugs:This category of drug treats the behavioral issues in Alzheimer’s patients. While some may feel it’s worth the risk, it’s important to understand that these medications come along with serious side effects that affect nearly 50% of Lewy body dementia and Parkinson’s disease dementia patients who use them. These side effects include impaired ability to swallow, sudden changes in consciousness, episodes of delusions, hallucinations, confusion and even the increased severity of Parkinson’s symptoms.
- Selective Serotonin Reuptake Inhibitors (SSRIs):These drugs are mainly geared towards treating the depression aspect of dementia. Because depression is a common experience for many people with Parkinson’s disease dementia, an SSRI can help create a better quality of life.
Treating Parkinson’s disease dementia can be challenging. The primary drug used to treat Parkinson’s disease, carbidopa-levodopa, which is designed to treat movement-related symptoms, can increase confusion and hallucinations in patients with dementia. Therefore, patients with Parkinson’s disease dementia have to be extremely careful about how they approach treating their Parkinson’s symptoms.
In general, the only way to treat Parkinson’s disease dementia is as a team. Loved ones play a part, as do medical professionals like neurologists and other doctors. In many cases, medications and other therapies are used on a trial basis to see if they help or hinder a patient. Then, dosages can be altered to fit a patient’s needs.
How to Help a Loved One with Parkinson’s Disease Dementia
One way to help Parkinson’s disease dementia patients is to create a medical record or journal. This journal would note when they experienced which symptoms, the duration of those symptoms and a list of medications taken. Having this information available will greatly help a neurologist care for a patient who is unable to keep such records.
Parkinson’s Disease Dementia Care Options
If your family member or friend has been diagnosed with Parkinson’s disease dementia, the prospects can feel scary. You know they will eventually lose the ability to live independently. That time will require a difficult moment of moving them out of their home and into a community that can help care for them.
This moment can be liberating, however. With a high-quality, compassionate community, people with Parkinson’s disease dementia can actually experience a higher quality of life. At The Brielle at Seaview, we offer a variety of dementia care and Parkinson’s services designed with our dementia residents in mind. We will consider your family member’s Parkinson’s and their dementia and address symptoms of both diseases with various services and therapies all designed to promote wellness and an enhanced quality of life.