Does Parkinson's Cause Dementia and Alzheimer's

Cognitive impairment, Dementia, and Alzheimer’s.  In 1817, when James Parkinson first described the “shaking palsy” he said that, “the senses and intellect were uninjured.” While he was correct in many of his assertions, Dr. Parkinson missed the mark with this one. Statistics show that throughout the course of the disease 90% of people with PD will experience some form of very mild to acute cognitive change beyond what is normal for their age. Up to 50% will suffer from mild cognitive impairment and 40% will suffer from dementia but not all people with PD will experience them. Mild cognitive impairment does not affect one's ability to carry out activities of daily living whereas dementia refers to a person that has multiple cognitive problems that significantly impact activities of daily life and has trouble retrieving memories. Alzheimer's is the inability to encode new memories. PD researchers now believe that mild cognitive changes may be present even before diagnosis. Dementia usually develops many years after the initial onset of PD and is more common with advanced disease. Many people with PD fear cognitive impairment, dementia, and Alzheimer's more than the physical symptoms of the disease because they are seen as the end of meaningful life, loss of independence, and loss of self.

What is cognition? Cognition is a general term that refers to the mental abilities we use to process information and apply knowledge. These mental processes allow us to perform daily functions such as paying attention, solving problems, communicating, remembering, and how to perform certain tasks. When people talk about cognition, they often focus on memory but memory is only one aspect of cognition. Rather, the study of cognition recognizes "cognitive domains" which reflect different types of cognitive processes. Parkinson’s typically affects three main cognitive areas: Executive functioning which includes concentration and attention, multitasking, reasoning, problem solving, and complex planning; Language which includes difficulty finding the right word or feeling tongue-tied; Memory which involves trouble retrieving memories that have already been encoded. And then there is bradyphrenia, meaning slow brain, a cognitive impairment common to Parkinson’s. Slowing of the brains processing speed is especially noticeable when switching from one task to another. So be patient with people with PD, we may need a little extra time.

The causes of cognitive impairment in PD are not fully understood but are believed to be related to the same causes of PD motor symptoms namely the death of nerve cells which result in changes in brain chemistry. Psychological problems like depression and anxiety and some medications can also affect cognition.

Can cognitive impairment be prevented? Regular physical exercise, whether aerobic, resistance or balance activity is believed to reduce the risk of dementia, including Alzheimer’s, by as much as 50%. A review of academic studies by researchers at the University of Edinburgh states that more than three quarters of cognitive decline is accounted for by lifestyle and other environmental factors including level of education. The review also states that physical exercise is the most effective way to ward off cognitive decline in healthy older people and reduce the risk of dementia and Alzheimer’s. Exercise may turn out to be the best medicine available for PD.

How does exercise protect against dementia? The brain’s hippocampus and prefrontal cortex play critical roles in memory formation and complex thinking and are responsive to physical exercise. Their deterioration is a predictor for Alzheimer’s disease. Higher fitness levels correlate with an increase in size of the hippocampus and the prefrontal cortex. This means that exercise can help our brains continue to grow and head off cognitive decline.

The golden rules for reducing the risk of cognitive decline, dementia and Alzheimer’s:

1 Exercise regularly.

2 Maintain an active mind. 

3 Eat healthy and maintain a healthy weight.

4 Don't drink too much alcohol.

5 Don’t smoke.

6 Maintain a healthy blood pressure.

7 Be socially active. (I find that I am the sharpest and least aware of my PD when I am socially engaged with other people.)

The things that make our brain healthy are also good for the heart and overall health as well as the brain. It is, forgive me, a no brainer so just do them if you are  concerned about your health.

Can you tell if you are cognitively impaired? Sometimes. You can be painfully aware or not have clue and there’s the rub. You may not have enough awareness left to be able to know. Your partner, care giver, or friends may be more aware than you are so doctors often include information from a spouse or care giver in making a determination. The real question is do you have a cognitive problem that affects your daily life. You can be evaluated by a doctor and there are several tests available online. The Montreal Cognitive Assessment (MoCA) was created to identify people with mild cognitive impairment from normal elderly adults. It looks at the following cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. It takes five minutes and can be found online.

Parkinson's Birthday

And so it’s my birthday. Happy birthday to me. Another year older and I’ve lived another year with Parkinson’s. At first I thought I could handle it but sometimes it has its way with me and developed a little faster than I would have liked. At those times I don’t have Parkinson’s, it has me. So I shake a little more and I’m having some problems with balance. It could be worse. Happy three quarters of a century plus one to me. 

PD is seen as a physical disease, defined as a movement disorder, but it really is a fight for the control of the mind and emotions. A healthy mind is the greatest asset in fighting the disease. It helps me accept the reality of what is, neither making more of the disease nor less. I will probably lose the physical battle with PD even though I exercise every day but I am not giving up the fight for my mind and emotional well being.

I don’t know if I should credit PD or thank aging or both or neither but

Parkinson's Vocabulary Lesson

Isn’t it wonderful how my vocabulary has increased since getting PD. I’ve learned new words and new meanings to words. Here are a few.

PARKINSON’S (PD) as in: Do you have Parkinson’s, the neurodegenerative brain disorder marked by tremors, muscular rigidity, movement problems, and postural instability associated with a deficiency of the neurotransmitter dopamine? Yes, I have PD.

SINEMET as in: Do you take Sinemet a combination of carbidopa and levodopa for the treatment of Parkinson's disease? The symptoms it treats are tremor, stiffness, and movement difficulty. Possible side effects are hallucinations, dizziness, fainting, depression, twitching, twisting,  uncontrolled repetitive movements, and many more.

Dopamine: Dopamine is a neurotransmitter that helps regulate movement and emotional responses. The deterioration of neurons in the brain that produce dopamine is believed to cause Parkinson's Disease.

Tremors: Tremors are the shake in the shake, rattle, and roll of Parkinson’s. They

can occur in any part of the body but are mostly present in the hands and can make eating, dressing, and life really difficult.

Rigidity: 90 to 99% of PWP experience rigidity. Rigidity keeps muscles in an involuntary state of continual tension and can be caused by neurological damage or as a side effect of medications. Should I take my meds or not? Damned if you do, damned if you don’t

Bradykinesia: Bradykinesia is slowness of movement and can be caused by PD or as a side effect of medicine prescribed to treat PD. You lose either way.

Bradyphrenia: Literally slow mind. Who knows if it is due to PD or due to aging but fear of cognitive impairment is a major concern of many PWP.

Dystonia as in: Try not to stare at people who have dystonia. It’s a neurological movement disorder caused by incorrect signals from the brain resulting in sustained muscle contractions which cause twisting of body parts, repetitive movements and abnormal postures.

Retropulsion: Involuntary backward movement that often cannot be controlled or stopped and may result in falling.

Anxiety and Depression: Mood disorders like anxiety and depression are real clinical symptoms of Parkinson's just like tremor and rigidity.

Despair: The fact that PD is progressive and cannot be slowed, stopped or reversed causes me to sometimes lose hope and give in to despair. 

Hope: Class is over for the day. I hope a cure is found soon and I don’t have to experience additional PD related words like akinesia, dysarthria, micrographia, freezing, postural instability, and so many more.

Parkinson's Dating Sex Love

Dating, sex, and love are names we assign to different types of relationships. Parkinson’s can have a strong impact on relationships. Everyone reacts differently. Some couples become closer and more caring, others remain the same and go on as if PD is just another thing in life, and some distance themselves and grow apart. The quality of the relationship is more important than the type. With that understanding in mind everything is exactly the same as it was before I had Parkinson’s. Nothing has changed and everything is completely different.

DATING

Tell them on the first date. Come right out with it. Let me tell you about myself. I like to read and dance, I’m often late, always hungry, and have Parkinson’s. I have the disease, I am not the disease. Don’t sit on your hands to hide your tremors. You will have to pick up the fork and eat sometime. If your date can’t handle that you like to read and dance then move on.

Soft sensual sex

Nipples harden on her breasts

Phoenix enters nest. 

SEX

How PD affects sex can be all over the map. The disease can lower libido. The psychological and physical toll of the disease and the side effects of the meds can cause impotence and depression. Studies show that 70 to 80 percent of people with PD experience some form of sexual dysfunction. Conversely the meds can make you hyper sexual and sexually obsessed. I don’t think I’ve changed emotionally. The mechanics suffer a little, but the passion and pleasure remain the same, and I think I’ve become a little more caring. As I said above, everything is the same and everything is different. Something to know is that the brain increases oxytocin and dopamine production during sex.

LOVE

Love is the best medicine. It’s a chemical reaction in the brain that releases the feel good hormones oxytocin and dopamine. Yes dopamine, music to a PWP ear because Parkinson’s is thought to be caused by a loss of dopamine producing neurons. Dopamine and oxytocin work together like  … well like a couple in love. Oxytocin promotes bonding and is referred to as the love hormone, the hug hormone, the cuddle chemical. It is produced during intimacy and makes the receptors in the brain more receptive to dopamine which stimulates desire and triggers intense pleasure. They function together as a one two punch. Oxytocin helps enable dopamine to be released during sex and to run wild during orgasm. I can almost see it. Parkinson’s pick up bars. Hi there, I have PD and would love to make sweet dopamine with you. Or how about, you stimulate my oxytocin. Let’s go somewhere and make great dopamine together.
 Ok, my mood is good, my dopamine must be flowing so let’s have a little fun. Oxytocin and dopamine go together like … 

love and marriage, a horse and carriage, birds and bees, bees and honey, a hug and a kiss, kiss and tell, men and women, boys and girls, male and female, night and day, the sun and moon, yin and yang, two peas in a pod:

like Adam and Eve, Tristan and Isolde, Romeo and Juliet, Bogey and Becall, Fred and Ginger, Lucy and Ricky, Laurel and Hardy, Flat and Scruggs, Ralph and Norton, Abbott and Costello, Mork and Mindy, Mickey and Minnie, Ozzie and Harriet, Cheech and Chong, Barbie and Ken, Bonnie and Clyde, Thelma and Louise, Tarzan and Jane, Batman and Robin, the Lone Ranger and Tonto, Ben and Jerry, Bert and Ernie, Jack and Jill:

like peaches and cream, bread and butter, peanut butter and jelly, meat and potatoes, potatoes and gravy, biscuits and gravy, bacon and eggs, mac and cheese, meatballs and spaghetti, pork and beans, fish and chips, chips and dip, soup and salad, lox and bagels, sugar and spice, salt and pepper: like fun and games and on and on. 

And you … always you my love.

Sarah's Parkinson's Story.

Periodically I post things written by friends because Parkinson’s affects each of us differently and we learn from each other. The following was written by my friend Sarah. She was diagnosed with Parkinson’s in 2010. Her title for this post is Do I Have Parkinson’s Or Does PD Have Me. I call it Sarah’s PD Story.

I look at other Parkies and compare their symptoms to my own.  If I see someone who looks like they

 have PD I really want to ask them If they do.  I once asked a stranger’s wife if her husband had PD as I held the door for them.  She said yes, I said, me too.  She said, “God bless you”.  Another time I told a former coworker (both of us are retired) that I thought we had something in common.  What’s that?  PD, I said.  He asked if it was that obvious.  I said, no, I’ve just learned how to recognize it. 

I don’t want pity or attention.  Some people feel it’s important to ask first if someone wants help.  I’ll take all the help I can get!  I started wearing a PD bracelet when I go out so that people might see it and understand why I’m so slow handling money and fumbling with bags, etc.  How petty/vain I am!  Somebody always has it worse than I do.  I’m still getting used to the idea that I have PD and all the baggage that comes with it.  I always say we’re like snowflakes - - no two Parkies are alike.  We don’t experience the same symptoms, speed of progression, etc., so we’re in uncharted water.  

I’ve been asked to come back to work for a special project lasting about 6 months.  How many hours can I work without getting tired?  Will my hands and brain hold up?  A nap at lunchtime may suffice.  I’ll let you know how that goes.

I’ve got the PD “masked face”.  People think that I’m mad or sad or sick.  I try to smile more to compensate.  I try to stand up straight and not shuffle when I walk.  I catch myself walking by the mirror moving like a zombie with my mouth agape.

I take dance and chorus classes for people with PD.  By the way, why is it called a disease?  It’s not contagious.  Why not call it a syndrome?  Then we’d have to call it PS.   But I digress.  I walk 3 miles every morning.  It takes an hour.  Sometimes toward the end of the walk, if I’m tired, I list or lean to the left.  I’ve fallen 2-3 times, but no real injuries.  

When your symptoms get visible you can’t be private about PD any more.  A lot of Parkies become shut-ins, not wanting to eat in front of people, for example.  I like my PD groups where everybody knows your name and they’re always glad you came.  

Why did I get Parkinson’s?  I don’t know.  Nobody knows.  My maternal grandfather had it plus I grew up and lived on a farm for 17 years with DDT and other chemicals.  My father died of pancreatic cancer at age 75, my mother - - colon cancer at 93 and my brother - - brain cancer at age 35.  My sister-in-law who lives on the farm has had breast cancer.  Who knows what - did what - to whom.  I fear for my siblings and provide them with a list of symptoms to watch out for.

Have you done a will and health directive?  I’m working on it.  I’ve decided they can keep me alive for a week before unplugging me.  Willing my brain to science sounds so righteous but I don’t know if I can do it.  I’ll let you know.

I scan the obits to see who died of Parkinson’s and Lewy Body Disease.  I started doing that upon diagnosis because I was curious how long we live after diagnosis and at what age people die.  The verbiage is usually “a long struggle with PD” or “a brave fight” or “a 10 year-battle”.  I cut out the obits and glue them onto a cardboard portfolio like you would use for a school project.  I must have collected 300 by now.  Do you want to see them?

I’m obsessed/curious about death now, especially since my Mom died on “my watch”.  It was about 3 years ago, she was 92 and at her home in hospice care.  I’ve been reading books about death and dying, trying to figure it all out.  The latest is “Dying Well” by Ira Byock, M.D..  

I have a great fear of what will happen to me.  I’m really scared. I suppose it’s natural to feel that way.  I’m trying to face that fear.  I’ll probably move back east to be near my siblings.  My two sisters say they’ll take care of me but they’re both older and may need me to take care of them!  Back to the DDT farm?  Maybe I’ll get cancer and not have to worry about the end stage of PD.  My husband is 5 years older than I am and has had cancer. I may outlive him, my caregiver.  I’m 62 years of age, diagnosed 6 years ago.  I take Mirapex, 1.5 mg three times a day.  Hardly anyone else I know takes Mirapex because of the side effects such as compulsive gambling, shopping, sex, etc.  I don’t gamble.

As I write this I’m lying flat in bed on ice and Ibuprofen due to hurting my back pulling weeds.  By the bed I have a walker, a “footed (quad?) cane, a grab-it apparatus, a TV tray and a collapsible cane.  These items are getting a test drive and I’m getting an inkling of what life might be like for me in a few years.   I finally got my husband to install grab bars in the shower.  I hold on for dear life, knowing that it only takes a second to fall.  I’ll let you know if the shower chair is worth the money.

I try to stay positive.  “Live in the here and now” people tell me.  What does that mean? Don’t think about the past or future?  Stick your head in the sand and make believe what has befallen you is not an elephant in your brain?  I can only change my attitude, not my predicament.  I’ll get back to you on that.

What is Important to you?  What makes you happy/smile?  Here’s my list, some frivolous, some cliché.

A good haircut            Care giver               Cat                       Chocolate chip cookies        Chorus

Clean sheets              Cleanliness             Clothes that fit     Clothesline            Comfortable shoes

Dance class                Dignity                    Driving a car        Electric blanket      Electric toothbrush

Family                         Fiber                       Friendship           Happiness              Heirlooms

Helpful salespeople    Home-grown tomatoes  Hot shower   House guests         Husband

iPhone                        Ices                        Jack Johnson       Jewelry                   Meds

Mobility                       Money                    My neurologist      Politeness              Practical jokes

Puzzles                      Rod Stewart           Sharp scissors      Snapple iced tea    Sunsets

The house I grew up in    Thrift stores      Walking                 Warm feet & hands

Will you get back to me on that.