People with Parkinson’s disease (PD) are two times as likely to fall as other people their age. And while healthcare professionals recognize the extent of the problem, there is still a lot to learn about why they happen and what can be done to prevent them. Dr. Sotirios Parashos, Director of Research at the Struthers Parkinson's Center in Golden Valley, Minnesota, a Parkinson’s Foundation Center of Excellence, explains that preventing falls involves a team of professionals, including physicians as well as occupational and physical therapists. He describes the magnitude of the problem in Parkinson’s, what is being done to minimize the risk of falls, and what people with PD should ask of their healthcare team.

Released: December 19, 2017

Changes in thinking are common in Parkinson’s disease (PD). Thinking may feel slower or it may be harder to focus. As PD advances, some people develop dementia, which means thinking problems begin to interfere with daily life.

It’s normal to feel worried, frustrated or scared about dementia. Resources and support can help you understand these symptoms and manage day-to-day challenges.

Quick Facts

• In Parkinson’s dementia, attention and problem solving are often affected before memory.

• Thinking problems usually develop gradually over time.

• Other health or medication issues can worsen thinking.

Signs of Dementia in Parkinson's:

• Thinking problems that affect daily living

• Changes in alertness and attention

• Depression, anxiety or irritability

• Trouble interpreting what is seen, especially in low light

• Trouble finding words or following conversations

• Getting lost, even in familiar places

• Hallucinations (seeing or hearing things that are not there)

• Delusions (strong beliefs not based in reality)

• Sleep problems

Types of Dementia in Parkinson's

There are two main types of dementia that involve PD symptoms. Both are linked to abnormal protein buildup in the brain called Lewy bodies. These conditions can look similar, which can make them hard to tell apart. The key difference is timing.

Parkinson’s Disease Dementia (PDD)
Dementia develops a year or more after movement symptoms start — often many years later.

Dementia with Lewy Bodies (DLB)
Dementia and movement symptoms start at the same time or within a year of each other. DLB may also include changes in attention and alertness that come and go.

How Dementia Is Diagnosed

Doctors diagnose dementia by reviewing symptoms, medical history and medications. They may also use brain scans or thinking tests. Neurologists and psychologists can also play a role in diagnosis.

Other issues, such as depression, infections or sleep problems, can cause similar symptoms or worsen thinking and need to be ruled out. Dementia usually develops slowly. Sudden thinking changes often point to another cause, such as a urinary tract infection.

Treatment Options

There is no cure for dementia, but treatment and support can help people manage symptoms and stay engaged in daily life. Treatment often focuses on thinking changes and other symptoms that can come with dementia, such as mood changes or hallucinations.

Medications

• Some Alzheimer’s medications may help PD-related dementia.

• Antidepressants may help with mood symptoms.

• Certain antipsychotic medications may help with hallucinations.

Some medications can worsen thinking or cause hallucinations. These include PD drugs that boost dopamine (especially at higher doses), anticholinergics, older antidepressants and some allergy medicines, such as Benadryl. A doctor may adjust or stop these if needed.

Non-Medication Strategies

• Thinking and communication support: Psychologists and speech therapists (also called speech-language pathologists) can offer thinking exercises and help with communication.

• Consistent routines: Regular times for meals, sleep, medication and activities can reduce confusion and stress.

• Safety and home changes: Occupational therapists can suggest ways to make the home safer and easier to move around in.

• Physical activity: Movement such as walking and stretching can support mood, sleep and thinking.

• Meaningful engagement: Music, art, puzzles, hobbies and time with others can help people stay engaged in activities they enjoy.

Tips for Living with Dementia

• Find new ways to connect. As thinking and communication change, look for different ways to spend time together, such as music, quiet activities, support groups or gentle touch.

• Plan ahead. Talk about routines, care preferences and legal matters, such as wills and powers of attorney. An elder law attorney can help guide this process.

• Support the care partner. Breaks, support groups, movement and help from trusted people can ease stress and reduce burnout.

Social isolation can have harmful effects on health and often increases with age because of loss of friends, acquaintances, or a spouse, hearing or vision deficits, or loss of mobility. In addition to being a risk factor for poor health, social isolation has been associated with an increased risk of death. Loneliness may lead to poor sleep and depression, two problems that already affect a proportion of people with Parkinson’s disease (PD). On top of all this, for more than a year social distancing to limit the spread of COVID-19 has added to problems of mental and physical health for many people.

In the face of a lack of research on social isolation in PD, Dr. Indu Subramanian, Director of the Parkinson’s Disease Research, Education and Clinical Center at the West Los Angeles Veterans Affairs Medical Center, conducted a survey of people with Parkinson’s to see if social isolation is associated with the severity of their symptoms and with their quality of life.

The survey was done before the pandemic. It showed that people reporting loneliness had 55% higher symptom severity, but individuals with a lot of friends had 21% fewer symptoms as compared with people reporting having few or no friends. (These are associations, and one should not assume a cause-and-effect relationship.) These results support the need for people with Parkinson’s to be socially engaged to prevent loneliness. In this podcast, Dr. Subramanian discusses loneliness and social isolation and offers suggestions for keeping them at bay.

Released: August 10, 2021

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Two important issues regarding Parkinson’s medications are when to initiate them in the early phases of the disease and how to ensure that people use their medications on time, every time. Myths and misconceptions have surrounded the controversial question of when to start taking medication. Fortunately, research has provided some answers, indicating that early initiation of levodopa or other medications does not diminish their usefulness later on. In this episode, Dr. Indu Subramanian, Director of the Parkinson’s Disease Research, Education and Clinical Center at the West Los Angeles Veterans Affairs Medical Center, discusses what has been learned about the timing of the initiation of therapy.

She also provides strategies for getting the most benefit from medications, from taking them at the right time every time, to establishing other regular schedules, to working with your doctor at every visit to optimize benefits and minimize side effects. And as a neurologist who is also board certified in integrative medicine, Dr. Subramanian advocates for incorporating mind-body, movement, and breathing techniques, as well as connecting with nature when using medication and other traditional Western medical practices.

Released: July 27, 2021

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Most people with Parkinson’s disease (PD) first seek medical care when they recognize or are troubled by symptoms – often stiffness, slowness of movement, or tremor. They may go on drug therapy at the time of diagnosis or, typically, within six to twelve months to relieve those symptoms.

In order for researchers and drug developers to test and ultimately find drugs that can slow the progression of the disease, they need to test those drugs in people who are not already on medications to alleviate symptoms and compare them to similar people taking a placebo. Currently there is no blood test or other biomarker to measure progression, so the most common and straightforward way for drug trials to judge progression is to observe signs and symptoms in people not receiving symptomatic medications such as levodopa, dopamine agonists, or other drugs that make symptoms less apparent.

Dr. Robert Hauser, Director of the Parkinson’s Disease and Movement Disorders Center at the University of South Florida in Tampa, urges people early in the course of their disease to enter a clinical trial as soon as they receive a PD diagnosis and before they go on medication. The longer that they can be observed before taking a potential disease-modifying medication, the greater the ability of researchers to detect changes, or in the case of a drug in development, if successful, not to see changes. However, patients who can go up to a year without medication are in short supply, in part because patients often wait to seek medical help until they want medication. As Dr. Hauser wrote in a medical publication a few years ago, “… why see a doctor when you don’t need treatment?”

But the answer is because people very early in the course of their disease are vital to finding drugs that can slow progression. Dr. Hauser terms the critical period of about one year between the time of first motor symptoms appearing to initiating symptomatic therapy the “Golden Year” for participation in disease modifying clinical trials. So, he wrote, “It is critical that care providers and patients don’t unknowingly waste this golden year.” In this episode he lays out the problem, has messages for patients and providers, and tells how such a system of referral to entry into clinical trials can work.

Released: July 13, 2021

La estimulación cerebral profunda (DBS, por sus siglas en inglés) es un tratamiento neuroquirúrgico para los síntomas de la enfermedad de Parkinson (EP, o PD, por sus siglas en inglés). El procedimiento ha sido realizado en miles de pacientes. ¿Es este procedimiento adecuado para usted?

Si usted o un miembro de su familia con Parkinson está considerando la estimulación cerebral profunda, hay varias medidas importantes que debe adoptar. La primera es aprender todo lo que pueda sobre este procedimiento. Lea mucho, reúna opiniones y hable con su médico. Además, sería conveniente que hablara con alguien que ya se haya hecho una.

Después de aprender más sobre la estimulación cerebral profunda, la siguiente medida es pedir una cita en un centro que se especialice en el tratamiento quirúrgico de la enfermedad de Parkinson. Es importante que cualquiera que esté considerando esta cirugía sea evaluado por un neurólogo que esté familiarizado con el procedimiento, los beneficios esperados y los posibles riesgos.

Si su neurólogo piensa que usted es un buen candidato para la cirugía, y usted decide seguir adelante, su siguiente medida será conocer al neurocirujano para informarse más y prepararse para la cirugía. El típico paciente que se somete a una cirugía de estimulación cerebral profunda ha tenido Parkinson durante ocho a dieciséis años. Los mejores candidatos para la cirugía tienden a estar dentro de dos categorías. Una es la de los pacientes con temblores severos o discapacitantes, que no responden a la medicación antiparkinsoniana. La segunda es la de las personas que experimentan graves fluctuaciones motoras que no se logran controlar con ajustes a los horarios de medicación. A lo largo del día, tienen muchos momentos de discinesias importantes intercalados con desgastes rápidos y crisis de “off”.

No todo el mundo es un buen candidato para la cirugía. Es importante reconocer que algunos de los síntomas del Parkinson responden bien a la estimulación cerebral profunda y otros no. La decisión de someterse a la cirugía depende de una evaluación crítica de los síntomas específicos de cada persona. Los síntomas que responden bien a la intervención incluyen el temblor, la rigidez, la bradiquinesia, la distonía y las discinecias. Los síntomas que no responden bien a la estimulación cerebral profunda incluyen los trastornos del equilibrio, los bloqueos (“freezing” en inglés) y las caídas, la postura encorvada y las alteraciones del habla

El resultado de la cirugía estará influenciado por varios factores. Uno de los mejores pronósticos de un buen resultado es la respuesta que la persona tenga a la levodopa, es decir, las personas cuyos síntomas aún responden bien a las dosis individuales del medicamento y que tienen movilidad durante sus períodos “on”, pueden esperar beneficios de la estimulación cerebral profunda.

Usted puede haber escuchado que la estimulación cerebral profunda no debe ser considerada hasta que los medicamentos del Parkinson se hayan vuelto completamente ineficaces. Esto no es verdad. Cuando los medicamentos dejan completamente de funcionar, la estimulación cerebral profunda tampoco funcionará. La cirugía promete más eficacia para aquellos pacientes que experimentan complicaciones con sus medicamentos, por ejemplo, discinecias, pero que continúan respondiendo bien a las dosis individuales de levodopa.

Los mejores candidatos para esta cirugía son personas que tienen un Parkinson típico con temblor, que responden a la levodopa, que están en buen estado de salud, que tienen la mente ágil, y que poseen una buena red de apoyo de familiares y amigos. La edad avanzada no excluye a quienes de otra manera son personas sanas que pueden ser un posible candidato para la estimulación cerebral profunda.

Los peores candidatos para la cirugía son las personas que no tienen un Parkinson típico y no responden bien a la levodopa. Los pacientes con demencia, apatía, depresión, mala salud y escaso apoyo familiar no deben someterse a una cirugía de estimulación cerebral profunda.

Cada persona es única, y para cada una, los objetivos de la cirugía van a ser diferentes. Para algunos, la necesidad más apremiante podría ser controlar el temblor discapacitante. Para otros, podría ser la necesidad de reducir las discinecias. Es muy importante que cada persona que esté contemplando la cirugía tenga una idea clara de lo que puede o no lograrse con esta intervención.

El rol del neurólogo, en colaboración estrecha con el neurocirujano en un centro médico especializado, es hacer una cuidadosa evaluación de cada persona que esté considerando la estimulación cerebral profunda. Basándose en una cuidadosa historia clínica y examen neurológico, el equipo puede determinar quién debería (o no debería) someterse a esta cirugía y predecir con precisión el resultado que se espera.

Es importante recordar que la estimulación cerebral profunda es un procedimiento electivo. Los neurólogos y los neurocirujanos harán sus recomendaciones, pero serán los pacientes y sus familiares los que tienen la responsabilidad de la decisión final. La estimulación cerebral profunda no es una cura para el Parkinson y no retrasa su avance, pero para muchos, puede reducir dramáticamente algunos síntomas del Parkinson y mejorar significativamente la calidad de vida de la persona.

Seis medidas a considerar

1. Hable con su neurólogo
2. Consiga información sobre la estimulación cerebral profunda
3. Hable con alguien que ya se haya hecho una estimulación cerebral profunda
4. Visite un centro que se especialice en cirugía para la EP
5. Haga una cita con un neurólogo del centro
6. Conozca al neurocirujano

La impresión ha sido posible gracias a una subvención educativa otorgada por Medtronic. El contenido ha sido creado independientemente por la Parkinson's Foundation.

Parkinson's disease (PD) can impact a person's ability to live safely and independently in their home. This presentation will provide people with Parkinson's disease, their care partners, and health professionals with information and ideas to help them manage home safety problems associated with PD. It will focus primarily on falls but will also address other potential safety problems related to the motor and non-motor aspects of Parkinson's disease. It will cover risk factors for home safety problems and strategies to prevent them.

At the end of this presentation, participants will:

1. Describe person, activity and environment-related risk factors and contributors to home safety problems associated with Parkinson's disease.
2. Understand the impact of home safety problems on daily function and quality of life among people with Parkinson's disease.
3. List potential strategies for managing home safety risks.

Presenter

Erin Foster, PhD, O.T.D., M.S.C.I., O.T.R./L
Assistant Professor, Occupational Therapy, Neurology and Psychiatry
Washington University School of Medicine

This series is made possible by educational grants from AbbVie, Inc., Sunovion and Lundbeck LLC.

The Parkinson's Foundation designs Expert Briefings in collaboration with the Dallas Area Parkinsonism Society (DAPS); the Houston Area Parkinson Society (HAPS); the Michigan Parkinson Foundation (MPF); Northwest Parkinson's Foundation (NWPF); Parkinson Association of the Carolinas (PAC); the Neuro Challenge Foundation (NCF); the Parkinson Association of the Carolinas (PAC); the Parkinson Association of the Rockies (PAR); the Parkinson's Association (PA); and the Parkinson Support Center of Kentuckiana (PSCKY).

When people think of Parkinson’s disease (PD), they often think of tremor, possibly because that is how the multi-talented English surgeon James Parkinson first described the disease in the early eighteenth century. In reality, tremor does not have to be present to receive a PD diagnosis. About 70% of people with PD experience this symptom sometime during the course of their disease, mainly affecting their hands and usually when the hands are at rest. Other sites of tremor are the lower lip, jaw, and leg. Obviously, tremors can interfere with daily activities, especially ones requiring fine motor control, such as shaving, dressing, writing, and various hobbies.

Several drugs can control tremor, with levodopa being one of the most effective. If levodopa alone is insufficient, it can be combined with other anti-Parkinson’s medications. Beyond drugs, various other treatments are available, including deep brain stimulation and focused ultrasound. But not to be forgotten, exercise is as important as medication, and stress management can be beneficial. In this podcast episode, movement disorders neurologist Dr. Muhammad Nashatizadeh of the University of Kansas Medical Center, a Parkinson’s Foundation Center of Excellence, discusses several ways to control tremor. Looking beyond today’s therapies, one of his research objectives is to identify new treatment options for debilitating movement disorders.

Released: June 15, 2021

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There is increasing interest in the Parkinson's patient and research community about the potential for cannabis-based products to treat PD. In this expert briefing we will review what cannabis is, how it works in the brain and why there is so much excitement about its potential in PD. We will then review animal and basic science studies suggesting some promise in treating motor symptoms and slowing the progression of PD. We will conclude by reviewing the evidence to date in human studies, suggestions for future research and practical advice for persons interested in trying cannabis-based products.

At the end of this presentation, participants will:

1. Define cannabis, cannabinoids and endocannabinoids
2. Review the basic science of the potential of cannabinoids to affect Parkinson's and other movement disorders
3. Understand the current state of the evidence of cannabinoids as a treatment for Parkinson's
4. Know the most common side effects of cannabinoid-based therapies

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Presenter

Benzi M. Kluger, M.D., M.S
Associate Professor
University of Colorado Hospital

La distonía es un trastorno del movimiento que causa contracciones involuntarias de los músculos. Estas contracciones llevan a posturas anormales de partes del cuerpo y a veces a movimientos repetitivos.

En este episodio, hablamos con la doctora Marta San Luciano, Profesora Asociada de Neurología en la University of California San Francisco, acerca de la definición y el manejo de la distonía. La doctora San Luciano nos explica que la distonía es un síntoma común de la enfermedad de Parkinson que puede aparecer al principio o a lo largo de la enfermedad.

Aprendemos que la distonía generalmente ocurre en los periodos “off”, cuando el cuerpo tiene poco medicamento para el Parkinson, pero también puede aparecer en el medio de una dosis, en un periodo “on”.

Además de las terapias que existen para controlar la distonía, como los medicamentos y la fisioterapia, la doctora San Luciano comparte ejemplos de actividades diarias que pueden ayudar a manejar la distonía.

Lanzado: 28 de junio de 2022