Does your family, perhaps your mother, father, or someone close to you suffer from Parkinson's disease? Has such a person gradually forgotten things, found it difficult to do things that used to be easy, or have you noticed a change in the way they think? In fact, there is a condition of memory and intelligence that can come with Parkinson's disease. Today we are going to talk about this condition called `(Parkinson's Disease Dementia)`. Don't be afraid, let's understand this simply.
What is Parkinson's Disease Dementia?
Simply put, Parkinson's Disease Dementia (PDD) is a decline in thinking and reasoning abilities that occurs in a person with Parkinson's disease, at least a year after the diagnosis of the disease (usually much longer).
Some people are scared when they hear the word "Dementia." But let's understand what it is. Dementia is a condition in which a person's mental functioning becomes less than it used to be, making it difficult to carry out everyday tasks. For this mental functioning to be impaired, at least two of the following must be impaired:
- Memory
- Thinking logically
- Language (speaking, understanding)
- Coordinating things
- Behavior
Often, before this major forgetfulness occurs, a condition called ``Mild Cognitive Impairment (MCI)`` can occur, which is characterized by minor memory problems or a slight decrease in the speed of thinking. This means that the memory is slightly impaired, although it does not significantly interfere with daily activities. However, not all ``MCI`` cases progress to ``Dementia``. Between 10% and 20% of people with Parkinson's disease may have only ``MCI`` throughout their entire life.
As you know, Parkinson's disease is a neurodegenerative disease, or a brain disease that gradually weakens nerve cells. It mainly affects body movements. Symptoms like shaking hands and slowness of walking (bradykinesia) are the first to appear. However, over time, this disease can also affect the parts of the brain that control thinking and actions. That's when dementia occurs.
How common is this condition?
The risk of developing Parkinson's dementia varies with age and the length of time you have had Parkinson's disease. For example:
- Between 16% and 20% of people between the ages of 60 and 75 have had Parkinson's disease for between 5 and 10 years.
- Between 20% and 30% of people between the ages of 60 and 75 have had Parkinson's disease for 10 to 15 years.
- This condition can occur in 50% to 60% of people over the age of 75 who have had Parkinson's disease for more than 15 years.
What are the symptoms of Parkinson's Dementia?
The way this condition affects each person can vary, but there are some common symptoms:
- Difficulty concentrating: Difficulty staying focused on one thing, easily distracted.
- Memory loss: Difficulty remembering new things, and sometimes even forgetting old things.
- Problems understanding visual information: For example, having difficulty finding one thing in a crowded place.
- Even a simple task can be difficult to plan, start, and finish.
- Language difficulties: Words get mixed up, names of things get forgotten, and complex sentences become difficult to understand.
- Speech becomes unclear, like stuttering.
In addition, behavioral changes may occur:
- Changes in mental state: increased sadness (depression), frequent irritability (irritability), and anxiety.
- Apathy: Not wanting to do anything, feeling bored with everything.
- Psychosis: Seeing things that are not real (especially visual hallucinations), or believing things that are not real (especially paranoid thinking).
If you or a loved one has these symptoms, it is very important to see a doctor for advice. You can understand the situation and take the necessary steps without panicking.
Why does Parkinson's dementia develop?
The main reason for this is the accumulation of abnormal proteins called `(Lewy bodies)` in the brain. These `(Lewy bodies)` are small clumps made of a protein called `(alpha-synuclein)`. When these accumulate inside the nerve cells `(neurons)` of the brain, those cells are damaged and die.
In Parkinson's disease, these `(Lewy bodies)` first deposit in the parts of the brain that control movement, especially in the `(basal ganglia)` area. That is why movement disorders such as tremors and slow walking first occur. Over time, these `(Lewy bodies)` can spread to higher-level parts of the brain that control things like thinking, memory, and language. That is when `(Parkinson's Disease Dementia)` occurs.
This condition is very similar to another type of dementia called Lewy body dementia (LBD). In fact, some scientists believe that both diseases are caused by the same type of brain changes involving the protein alpha-synuclein. The biggest difference is in the order in which symptoms appear. We'll talk about that in a moment.
Who is at higher risk of developing this condition?
The two main risk factors for developing Parkinson's dementia are:
1. Increasing age: This risk increases with age.
2. Increased duration of Parkinson's disease: The longer the disease is present, the greater the risk of developing dementia.
In addition, studies have found that people with certain symptoms of Parkinson's disease are also more likely to develop dementia. Such symptoms include:
- Having severe motor symptoms: If you have severe symptoms such as tremors and difficulty walking.
- Early in the course of Parkinson's disease , problems with the autonomic nervous system (for example, orthostatic hypotension, urinary incontinence) may occur.
- Movement disorders affect both sides of the body equally (symmetrical motor symptoms).
- Dopamine-containing medications for Parkinson's disease are not as effective as expected.
- Having a condition called ``REM sleep behavior disorder'' (in which you actually act out what you dream about).
How do you recognize this exactly?
Unfortunately, there is no specific test that can immediately confirm the presence of Parkinson's Disease Dementia. The doctor makes the diagnosis by considering several factors:
- They ask when your symptoms started and how they have changed.
- Ask about your complete medical history.
- I'll look at what medications you're currently taking.
- Ask if anyone in your family has these diseases.
In addition, some tests may be done to help with the diagnosis. For example, blood tests, brain imaging tests (such as CT scans, MRI scans), and neuropsychological tests that test thinking skills.
As I mentioned before, the symptoms and causes of Parkinson's Disease Dementia (PDD) and Lewy Body Dementia (LBD) are very similar. So, there is a little method that doctors use to differentiate between the two:
- If dementia symptoms (such as memory loss) appear at least a year (usually several years) after the onset of Parkinson's disease movement disorders (such as tremors, slow walking), it is called Parkinson's Disease Dementia (PDD).
- If dementia symptoms appear before, during, or within a year of the onset of Parkinson's movement disorders, it is called `(Lewy body dementia - LBD)`. Some `(LBD)` patients may not develop Parkinson's movement disorders.
What are the treatments for this?
A question that many people ask is whether there is a cure for this, or if it can be cured. To be honest, there is still no cure that can stop or reverse the progression of Parkinson's Disease Dementia. That's a bit of a sad fact.
But don't give up hope! There are medications and treatments that can help control or reduce some of the symptoms. For example:
- Cholinesterase inhibitors: This class of drugs, such as donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®), can provide some relief from some symptoms, especially visual hallucinations, changes in thinking, and behavioral changes.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs): These are medications commonly prescribed for depression. They can help control mood swings such as sadness, anger, and fear.
- Cognitive behavioral therapy (CBT): This is a type of psychotherapy, which is a form of talk therapy. It can help manage things like behavioral problems and stress.
Your medical team will talk to you and decide what treatment is best for you. But remember one thing. Some medications can make dementia symptoms worse. For example, carbidopa-levodopa, a drug commonly used to treat the movement disorders of Parkinson's disease, can increase hallucinations and confusion in some people with Parkinson's disease dementia. So, don't start or stop taking any medication without your doctor's advice.
There may be clinical trials underway for new treatments for Parkinson's Disease Dementia. You can ask your doctor about that as well.
How is this situation going forward? (Prognosis)
The prognosis for someone with this condition depends on a number of factors. However, like Parkinson's disease, Parkinson's Disease Dementia tends to get worse over time. Although treatment can provide some relief from symptoms, quality of life can often be reduced.
How quickly can this increase?
The rate at which Parkinson's Disease Dementia worsens varies greatly from person to person, just as Parkinson's disease progresses. Your medical team can give you and your family some idea of what to expect based on your specific condition.
Can't this be prevented from happening?
Unfortunately, there is currently nothing that can be done to prevent Parkinson's Disease Dementia from developing. Also, there is no way to reduce the risk of developing it.
How do we help someone with Parkinson's dementia?
If your loved one has this condition, in addition to working with the medical team to provide them with the best care, there are several other things you can do:
- Learn as much as you can about Parkinson's Disease Dementia: The more you know about it, the easier it will be for you to cope with what lies ahead. And, you will be able to better advocate for your loved one.
- Simplify their environment: Remove unnecessary items from the house and keep them organized. This can reduce their mental confusion. Having a small light on at night can help reduce visual misperceptions.
- Establish a regular routine: Having a regular routine, such as eating, bathing, and sleeping at the same time every day, can help people with Parkinson's Disease Dementia feel more comfortable and secure.
- Join a support group: Get your loved one and yourself involved in support groups for Parkinson's patients and their families. These groups can provide valuable information, advice, and sharing of experiences. This is a great strength during this journey.
Is Parkinson's dementia different from other common dementia conditions?
There are many causes of dementia, and the symptoms are varied. Alzheimer's disease is the most common type of dementia. According to scientists, the symptoms of Parkinson's disease dementia are slightly different from those of Alzheimer's disease dementia. For example:
- People with Parkinson's Disease Dementia are more likely to experience apathy and difficulty concentrating than those with Alzheimer's.
- People with Alzheimer's disease dementia may have earlier language difficulties than those with Parkinson's disease dementia. Also, people with Alzheimer's have more difficulty remembering new things than those with Parkinson's disease dementia.
Are there different stages of Parkinson's dementia?
Doctors have accepted methods for classifying Parkinson's disease into different stages. However, there is no specific way to classify Parkinson's Disease Dementia. This is because the way it affects everyone and the rate at which it worsens varies greatly. Therefore, it is difficult for scientists and doctors to categorize it into specific stages.
Finally, things to remember
It's not easy to learn that you have Parkinson's disease, a condition that affects your memory and can affect your ability to function. It's normal to feel sad, frustrated, and afraid of what the future holds. Remember that you are not alone in this time. Get the support you need from your loved ones, family, friends, and especially your medical team.
Remember, although treatment cannot completely cure this condition, it can help control symptoms and improve quality of life to some extent. So, don't give up hope and continue this journey with the support you receive.
Parkinson 's , dementia, memory loss, brain diseases, Lewy bodies, neurological diseases, geriatric care
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