Dementia In Parkinson's Disease

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Dementia In Parkinson's Disease
Dementia In Parkinson's Disease

Video: Dementia In Parkinson's Disease

Video: Dementia In Parkinson's Disease
Video: Dealing with Dementia in Parkinson's Disease 2024, March
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Parkinson's Disease & Dementia

About 40 percent of Parkinson's patients develop what is known as Parkinson's dementia (PDD) in the course of the disease. Only older people are affected, the average age is 72 years.

In contrast to other forms of dementia, Parkinson's dementia does not focus on memory and memory problems, but on other cognitive limitations. The course of the disease is - as with Parkinson's disease in general - very individual.

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  • How does Parkinson's dementia develop?
  • What are the symptoms?
  • How does Parkinson's dementia work?
  • How is the diagnosis made?
  • How is Parkinson's dementia treated?

How does Parkinson's dementia develop?

The decline of nerve cells in Parkinson's disease progresses steadily. As a result, in the course of the disease many patients experience not only motor symptoms but also increasingly cognitive impairments. These include attention disorders, impaired problem-solving ability, or cognitive slowdown. As long as the person concerned is not significantly impaired in everyday life, the symptoms that occur are referred to as “mild cognitive impairment” or mild cognitive disorder. If the person concerned is increasingly dependent on help in everyday life due to their reduced cognitive abilities, this is called Parkinson's dementia.

The individual risk of developing dementia as a Parkinson's patient depends primarily on age and less on the duration of the illness. From the age of 70, the risk increases sharply. In addition, other risk factors seem to play a role (e.g. the extent of motor symptoms, the type of disease or the response to certain therapies).

Note Not every forgetfulness or confusion is automatically dementia. Only when the symptoms persist for a period of six months and everyday life can no longer be managed can one assume dementia. More on the topic: dementia

What are the symptoms?

In contrast to the most common form of dementia, Alzheimer's dementia, Parkinson's dementia does not focus on memory and memory problems, but on other cognitive limitations. These include:

  • Disturbances of attention,
  • cognitive slowdown, reduced reaction time,
  • visual-spatial disturbances,
  • Impairments when planning, organizing, following a sequence,
  • Loss of mental flexibility and multitasking ability,
  • disturbed verbal fluency,
  • Problems with spatial orientation,
  • Personality changes,
  • Behavior disorders,
  • Apathy (indifference, indifference),
  • later in the course of the disease also memory disorders: the disturbed retrieval of information is in the foreground. Those affected are still able to learn new things, but have difficulty accessing the newly stored information. Recognition is well preserved, which is why notepad, for example, can be very helpful in everyday life.

It is not uncommon for other psychological problems such as depression, anxiety or hallucinations to occur.

Lewy body dementia ("dementia with Lewy bodies", DLB)

The so-called Lewy body dementia is another form of dementia that is similar to Parkinson's dementia. Those affected have special protein deposits in the brain, so-called Lewy bodies, which are partly responsible for characteristic disease symptoms. The same deposits can also be found in the brain of Parkinson's patients, but in different brain regions. How these deposits come about is not fully understood.

The main symptom of Lewy body dementia is - as is the case with dementia in Parkinson's sufferers - the decline in mental abilities in everyday life, although memory is initially retained. In addition, psychotic symptoms such as hallucinations or delusions occur accompanying both forms of dementia, while Lewy body dementia is somewhat more common.

The main difference between the two forms of dementia is the point at which it occurs: While the symptoms of dementia develop late in the course of the disease in Parkinson's patients, the symptoms of Lewy body dementia occur in people who have never had Parkinson's symptoms or who have them develop long after the onset of dementia.

The distinction between the two forms of dementia is not always easy. However, they need to be differentiated from Alzheimer's dementia and other forms of dementia in order to tailor treatment accordingly. More on the topic: Dementia: drug therapy

How does Parkinson's dementia work?

Parkinson's dementia is primarily noticeable in everyday life when performing complex tasks, e.g. driving a car. Later on, difficulties arise even with less complex tasks, such as taking regular medication. Hallucinations can also indicate the onset of dementia. There is a loss of social and professional performance and the beginning of personality changes.

Patients with moderate dementia need help in everyday life, they lose their independence and neglect everyday tasks.

People with severe dementia require supervision and care around the clock. As cognitive disorders increase, there is usually an increase in confusion.

How is the diagnosis made?

In order to diagnose Parkinson's dementia, it is important to take a detailed medical history. Relatives are also included, as possible changes in personality or hallucinations in particular are reliably perceived by those affected.

Note The diagnosis of Parkinson's dementia is not possible without a previous diagnosis of Parkinson's disease.

In addition, special tests can be carried out to assess cognitive impairments. In the medical practice, the clock test (patient is asked to draw a clock with a certain time) or verbal fluency exercises (maximum number of words per minute) are very easy to carry out. Traditionally, the mini-mental status test (MMST) is often carried out, in which memory, temporal and spatial orientation, attention, language, following instructions as well as reading, writing and drawing are tested.

The PANDA test (Parkinson Neuropsychometric Dementia Assessment) was specially developed for the diagnosis of Parkinson's dementia. Attention, working memory, fluency as well as mood, drive and interest are specifically tested.

Laboratory, neuropsychological and electrophysiological examinations as well as imaging procedures can be carried out as support.

More on the topic: Dementia: Diagnosis

How is Parkinson's dementia treated?

Parkinson's dementia, like Parkinson's disease, is progressive and incurable. The aim of therapy is to maintain the independence and quality of life of those affected for as long as possible.

In the development of Parkinson's dementia, it seems that the lack of dopamine in the brain rather than the lack of the messenger substance acetylcholine plays a role. This is important for attention and learning processes, among other things. So-called acetylcholine esterase inhibitors (rivastigmine, donepezil) can be used to alleviate the symptoms. These inhibit the breakdown of acetylcholine, which increases its concentration. This can alleviate the clinical picture.

Depressive moods that occur in connection with dementia can be treated with antidepressants. Hallucinations and restlessness often require the use of so-called atypical neuroleptics.

Cognitive training (“brain jogging”) is often helpful, especially in the early stages of dementia. Regular physiotherapy, exercise in the fresh air, adequate fluid intake and a balanced diet are also important. A psychosocial therapy plan (e.g. day clinics, family counseling, vacation care, mobile support services, etc.) is also of crucial importance. More on the topic: Parkinson's disease: Therapy.

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