Parkinson’s Dementia: Symptoms, Treatment, Risk & Life Expectancy - MalaysiaChronic Conditions

Parkinson’s Dementia: Symptoms, Treatment, Risk & Life Expectancy

Parkinson’s dementia is a neurological brain disorder that affects an individual’s reasoning and thinking ability after their Parkinson’s diagnosis. Learn more about the symptoms, risk factors and treatment options available for this condition.

Parkinson’s Dementia: Symptoms, Treatment, Risk & Life Expectancy

Dementiais a syndrome that involves the deterioration of three human abilities: – memory, thinking, behaviour which results in the deterioration of the ability to perform daily activities, according to the World Health Organisation. Parkinson’s dementia (PDD) differs from normal dementia as it affects the patients as they progress with Parkinson’s. Some people who have Parkinson’s may not be havingdementia.

The cause of PDD is unknown. What is known thus far is there is a large build-up of a protein calledalpha-synucleinthat clumps together to form what is known as “Lewy bodies” in the brain. As more proteins clump in the nerve cells, the cells lose their ability to function and eventually die. PDD generally takes place within the first decade after one is diagnosed with Parkinson’s.

Dementia in PDD, Alzheimer’s and other diseases

So how does this condition differ from dementia experienced by those with Alzheimer’s disease? Alzheimer’s disease is characterised by dementia whereas those with PDD may have dementia as they progress further in Parkinson’s. Even then, not all with PDD from more severe symptoms that depreciates their mobility as their PDD progresses. Those with PDD would have dementia as their PDD progresses compared to those with Alzheimer’s.

They would requireround the clock careand have a higher risk of infection, incontinence, pneumonia, falls, insomnia, and choking.Language and memory are the two functions most affected for those having Alzheimer’s whereas those with PDD will face greater impact in their social and occupational functions.

Aside from Alzheimer’s and PDD, dementia also occurs inother syndromes and diseases. The second most common form of dementia is vascular dementia that is caused by a lack of blood to the brain. Lewy Body dementia (LBD) is caused by small round clumps of protein that disrupts neural signs and communication. There is one major difference between LBD and PDD. Dementia that develops after an established motor disorder is classified as PDD whereas dementia develops before or at the same time as the motor disorder is LBD.

Pick’s disease or frontotemporal dementia affects the front and side of the brain. Creutzfeldt-Jakob disease is the rarest form of dementia that leads to mortality within a year due to rapid progression. The Wernick-Korsakoff syndrome is not a form of dementia but has similar symptoms. It is a combination of Wernick disease and Korsakoff syndrome.

Normal-pressure hydrocephalus (NPH) is a condition that triggers a fluid build in the brain’s ventricles, affects brain tissues and leads to dementia symptoms. Huntington’s disease is a genetic condition involving a premature breakdown in the brain’s nerve cells among young adults. Mixed dementia is a condition of having more than one form of dementia. The most common form of mixed dementia is Alzheimer’s disease and vascular dementia.

Symptoms

While there are five stages in Parkinson’s Disease the same cannot be said for PDD. At the initial stage, one would experience memory loss and difficulties in executing daily activities.Those with PDD also have issues with forgetfulness and cannot concentrate. They are also unable to apply reasoning and make a judgment.

Other symptoms include:

• Delusions, hallucinations, depression and paranoid ideas. Up to50%of them experience these symptoms.
• Difficulties in learning new skills and recalling information.
• Disorientation, confusion, agitation and impulsivity
• Changes in appetite and energy levels.
• Sleep disturbances or rapid eye movement (REM) disorder.
• Heightened levels of anxiety, mood swings, loss of interest and slurred speech.

Treatment

Unfortunately, there is no treatment for PDD as researchers are still in the phase of understanding them. There are, however, medications to reduce the symptoms. In addition to that clinical tests on prospective treatments are being carried out.

Cholinesterase inhibitors– A key drug to treat cognitive changes in patients with Alzheimer’s aids in those with PDD symptoms such as visual hallucinations, sleep disturbances and changes in thinking and behaviour. Examples of cholinesterase inhibitors includedonepezil, rivastigmine and galantamine.

Carbidopa-levodopaare prescribed to treat Parkinson’s movement symptoms. It is a combination of two medications. Levodopa transforms into dopamine in the brain and aids in controlling movement. Carbidopa ensures levodopa is intact in the bloodstream so that more of it can reach the brain. It also reduces the side effects of levodopa such as nausea and vomiting. The downside of this medication isit may aggravate hallucinations and confusion in those with PDD.

Serotonin reuptake inhibitors (SSRIs) are generally used to treat depression for those suffering from PDD. With that,electroconvulsive therapyhas proven efficacy as antidepressant therapy in patients with Parkinson’s and by extension, PDD. This therapy involves administering brief electrical stimulation to the brain while the patient is under anaesthesia. It is commonly used for patients with severe depression and bipolar disorder.

Clonazepam and melatonin are used to treat (REM) disorders. REM disorder is prevalent among those with Parkinson’s. Their sleep/wake cycle is usually disrupted. Apart from the drugs, they should have a fixed light out routine at night. During the day they should be kept occupied and avoid having naps.

Aside from drugs, other forms of therapy would slow down the effects of the symptoms. Routine exercise helps keep muscles flexible and mobile as it releases natural brain chemicals that also improve one’s emotional wellbeing.

A customized healthy diet and therapies would also help. High protein meals would aid one’s brain chemistry. Physical, occupational and speech therapies help PDD patients in communication and self-care. Adequate sleep and limited alcohol intake also aid in having positive brain health. Routine exercise, diet, and a healthy lifestyle are also remedies for those with Parkinson’s.

Possible treatment

There are also studies to find treatment for PDD. Deep brain stimulation is currently being studied as a possible treatment. Recent reports indicated that dementia prevalence and incidents were not higher among those having PDD compared to those having Parkinson’s.

There are also clinical trials conducted on new possible treatments as recent as Sept 2020.ANVS401, also known as Posiphen, is designed to block the production of proteins linked to both PDD and Alzheimer’s. In PDD the protein is alpha-synuclein and in Alzheimer’s, beta-amyloid and tau proteins.

PDD risk factors

Several factors lead one with Parkinson’s to have PDD. Ageing is a risk factor for people living with Parkinson’s and by extension, PDD. The older one gets, there is higher the probability for one to be getting PDD. The probability of having PDD is higher among those who are older and having Parkinson’s.

PDD also occurs among those with advanced stages of diseases. Dementia is also more likely to occur among those who have a family history of this disease and the combination of Parkinson’s and dementia worsens it.

Astudyfound that males are more likely to be affected by PDD, at the ratio of 2:1 compared to women. It also confirmed the age and duration of having Parkinson’s as factors that lead one to have PDD. For patients above 85 years old, the duration of having Parkinson’s is a lesser important factor that determines their cognitive decline.

Life expectancy

Studiesconducted have found that the mortality rate of those with PDD is higher than those who are having Parkinson’s without dementia. Reports suggest that people with PDD have a higher mortality rate compared to people with Parkinson’s as the former had a higher hazard ratio.

Another study made similar findings. It found those with dementia are more likely to die over six years compared to those who are not having dementia.

PDD on its own doesn’t cause death. This characteristic is almost similar to HIV/AIDS and mortality. There were three major causes of death among PDD patients who spent their final years in hospital. The three are infection (21%), heart disease (18.5%) and lung disease that was not from an infection (close to 13%).

Even though there is no cure for PDD at the moment,around-the-clock careensures that the medication and therapy undertaken in due course would ease their pain. They need not suffer alone from PDD since there are organisations out there who would help and care for them.

Caregivers and immediate family members who are involved in caring for individuals with PDD also should understand more about PDD as it would be vital for them in caregiving as well as ensuring that they do not exhaust themselves.

While one cannot avoid death, adhering to treatment plants as well as a healthy lifestyle that includes specific diets and therapies would ensure patients with PDD have a longer life and reduce their pain.

PDD patients also should not give up hope on being cured. Medical science and technology have developed by leaps and bounds. New forms of therapies and medication are being developed. In short, they need to remain positive. It is true that currently medication is only provided to resolve the symptoms instead of the disease, one must not lose hope. The light is at the end of the tunnel.

References

Dementia(no date)Who.int. Available at: https://www.who.int/news-room/fact-sheets/detail/dementia (Accessed: June 27, 2021).

(No date)Parkinson.org. Available at: https://www.parkinson.org/sites/default/files/PD%20Dementia.pdf (Accessed: June 27, 2021).

Parkinson’s Disease Dementia(no date)Ucsf.edu. Available at: https://memory.ucsf.edu/dementia/parkinsons/parkinson-disease-dementia (Accessed: June 27, 2021).

Caring for dementia patients at home in Malaysia(2020)Com.my. Available at: https://www..com.my/services/dementia-care/ (Accessed: July 1, 2021).

Yaw, D. (2020)Dementia 101: All you need to know,Com.my. Available at: https://www..com.my/health/dementia-101/ (Accessed: July 1, 2021).

Divac, N.et al.(2016) “The efficacy and safety of antipsychotic medications in the treatment of psychosis in patients with Parkinson’s disease,”Behavioural neurology, 2016, p. 4938154.

Cholinesterase inhibitors for Alzheimer’s, side effects, and uses(no date)Medicinenet.com. Available at: https://www.medicinenet.com/cholinesterase_inhibitors/article.htm (Accessed: July 1, 2021).

NICE (no date) “Alzheimer’s disease – donepezil, rivastigmine, galantamine and memantine (review) – Final appraisal document Alzheimer’s disease – donepezil, rivastigmine, galantamine and memantine (review) – Final appraisal document.” doi:http://www.nice.org.uk/322952.

What Is Carbidopa/Levodopa Therapy?(no date)Parkinsonsdisease.net. Available at: https://parkinsonsdisease.net/medications/carbidopa-levodopa-therapy (Accessed: July 2, 2021).

Tom, T. and Cummings, J. L. (1998) “Depression in Parkinson??S disease: Pharmacological characteristics and treatment,”Drugs & aging, 12(1), pp. 55–74.

Melamed, D. (2020)First patients dosed in clinical trial investigating ANVS401 as,Parkinsonsnewstoday.com. Available at: https://parkinsonsnewstoday.com/2020/09/03/first-patients-dosed-clinical-trial-anvs401-treatment-parkinsons-alzheimers/ (Accessed: July 2, 2021).

Cereda, E.et al.(2016) “Dementia in Parkinson’s disease: Is male gender a risk factor?,”Parkinsonism & related disorders, 26, pp. 67–72.

Doherty, C. (no date)Life expectancy in Parkinson’s disease,Verywellhealth.com. Available at: https://www.verywellhealth.com/life-expectancy-in-parkinsons-disease-4129033 (Accessed: July 1, 2021).

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