Parkinson’s Disease

“early stage dementia” with mild impairment of the mental status examination. They may have difficulty functioning in complex daily activities. There may be social withdrawal and personality changes that are most noticeable to people near them.

Moderate dementia involves progression of the disease. Patients may have severe impairment in activities of daily living, particularly complex ones and will have noticeable problems with the mental status examination. They can’t function outside a limited environment and cannot be left alone. Patients with late stage disease require 24-hour assistance and have difficulty with things like dressing, eating, and sleeping. They have frequent wandering behaviors and are at a risk of falling. Bladder and bowel dysfunction are common.

The major diagnostic testing in dementia include having a consistent history and physical examination, abnormal cognitive testing, and possible abnormalities in brain imaging. Screening is not recommended; however, patients with symptoms can be evaluated with the above diagnostic testing.

Dementia has no cure. For Alzheimer’s disease, patients can be treated with cholinesterase inhibitors (like donepezil and galantamine). Both donepezil and memantine are used in all stages of Alzheimer’s disease (AD). Rivastigmine is used in all stages of AD and galantamine is reserved for mild to moderate disease. Memantine is a N-methyl-D-aspartate (NMDA) blocker rather than a cholinesterase inhibitor. Non-drug treatments include behavioral interventions and things like proper diet and exercise can improve the state of the disease. Antipsychotics are commonly used for behaviors but aren’t actually recommended as they increase the risk of death.

The lifetime incidence of dementia is about ten percent, increasing with age. About half of people older than 85 years will have dementia. About 1.7 million people die from dementia every year, with an increased incidence because of an increase in the number of elderly people in the world. It is perhaps the most common mental disability in the aged population.

Parkinson’s disease or PD is a progressive neurodegenerative disorder of the CNS affecting primarily the motor system. The main motor symptoms include rigidity of the muscles (cogwheel rigidity), tremor, difficulty ambulating, postural instability, and slow movements (bradykinesia). It can affect both behavior and thinking, thus dementia is part of the advanced stages of the disease. Patients will have sleep difficulties, social and emotional problems, and some sensory difficulties. The collection of symptoms is referred to as “parkinsonism”. Other symptoms of PD unrelated to movement include daytime tiredness that can progress to narcolepsy, REM sleep disturbances, orthostatic hypotension, excessive sweating, gastric dysmotility, constipation, urinary incontinence, perceptive disturbances, and paresthesias.

The cause of PD is not known but is believed to be partially genetic and partially environmental. People with a positive family history of PD have an increased incidence of the disease. Exposure to pesticides and history of head injury increase the risk (as is seen in boxers and other athletes). The major part of the brain affected is the substantia nigra (part of the midbrain) resulting in a lack of necessary dopamine and a buildup of Lewy bodies inside the neurons.