As we learnt in Parkinson’s disease early symptoms, Parkinson’s symptoms can be categorized into the 4 Cardinal Signs, Associated Symptoms and Neuropsychiatric Dysfunction.
Neuropsychiatric Dysfunction associated with Parkinson’s can be viewed in terms of a patient’s state of mental well-being, and possible issues related to Dementia.
Mental Well-Being
A number of factors (can be unrelated to dementia as described later) can affect the mental well-being of a Parkinson’s patient. These include:
- A reaction to the disease.
- Chemical changes in the brain e.g. research indicates acetylcholine is linked to a person’s mental state and serotonin to one’s mood.
- Side effects of medications used to manage the disease.
These can significantly affect the patients daily life, relationships and ability to socialize. Aspects of mental well-being include:
Behavior, Personality and Mood Changes
- Antisocial or becoming withdrawn.
- Apathy.
- Anxiety.
- Depression.
- Hallucinations and delusions occur in approximately 5% of patients.
- Impulse control issues e.g. cravings.
PARKINSON’S DISEASE AND DEPRESSION
Cognitive Disturbances
- Decreased attention span.
- Executive dysfunction – executive function deficit (EFD): Ability to plan and execute appropriate actions.
- Impaired memory and recall.
- Reduced mental:
- Agility.
- Clarity. Often described as a ‘dullness/dull thinking’
- Flexibility.
- Slowness (Bradyphrenia) including slow response to questions.
- Visuospatial difficulties including facial recognition.
PARKINSON’S COGNITIVE AND MEMORY ISSUES
Dementia
- Depending on the source of data:
- Between 30-40% of patients will experience some degree of cognitive impairment and memory problems. Some research suggests this rises to 80% after 8-10 years of the disease.
- Between 1/5 and 1/3 of Parkinson’s patients develop some form of Parkinson’s Disease Dementia (PDD). The figure commonly quoted is around 20%.
- The rate of progression and severity of dementia varies considerably between individuals.
- Parkinson’s Disease Dementia typically takes 10-15 years to develop from initial Parkinson’s diagnosis. It is therefore considered to occur towards the later stages of the disease.
- Parkinson’s disease patients have a 4- 6x greater risk of developing cognitive impairment or dementia than the general population.
- Various issues arise regarding Parkinson’s Disease Dementia including:
- Significant symptoms noted above in ‘Mental Well-Being’.
- Increased mortality rate.
- Reduced quality of life for patient and increased burden for family and carers/caregivers.
- Nursing home care more likely.
- It must be remembered that dementia symptoms can be caused by a variety of unrelated conditions and medications e.g. Vit B12 deficiency, underactive thyroid gland, depression, Alzheimer’s disease.
GENERAL OVERVIEW OF DEMENTIA : Description-Assessment-Types
The next article will consider the fundamental question of What is Parkinson’s Disease?