Parkinson’s and Dementia
Dementia is a set of cognitive impairments that progressively develop to the point of interfering with daily activities. It can affect people living with or without Parkinson’s disease. Not everyone with mild cognitive impairment will develop dementia.
Nearly one-third of people with Parkinson's disease will eventually develop dementia.
The risk of developing dementia increases significantly after the age of 75, with or without Parkinson’s disease. However, people living with the disease are at greater risk.
The onset of dementia is subtle and its progression is usually slow. During the first few years, people maintain their independence. Their memory is compromised, but less so than in Alzheimer’s disease. Later on, their judgment may be affected, making it difficult to manage daily activities. Managing complex concepts or several tasks at once becomes impossible. The ability to visualize objects in time and space gradually decreases, which explains why people affected get lost easily. Finally, their general mood and personality may change.
Dementia takes different forms in different people, on different days, and even within the same day.
Dementia in Parkinson’s disease is the result of the spread of Lewy bodies that cause the death of neurons, far beyond the substantia nigra that controls movement. At this stage, neurons in the cortical areas that manage cognitive functions and the hippocampus responsible for memory are affected by neuronal degeneration.
Factors that increase the risk of developing dementia include:
- Age (> 65 years old)
- A family history of dementia
- How long you have had Parkinson’s disease
- Vivid dreams
Dementia can also be the result of Lewy body dementia, a condition often confused with Parkinson’s disease.
If your cognitive impairments progress, tell your neurologist. They can evaluate your situation or refer you to see a specialist.
Your neurologist, a psychiatrist or a geriatrician could help you assess the progression of your cognitive impairments using standardized questionnaires.
Be lenient with yourself and try to accept the situation. Find strategies with those around you to manage your various symptoms. Specialists, such as physiotherapists, speech therapists and occupational therapists, can also give you advice to manage your daily activities to the best of your ability.
A dementia diagnosis may also lead you to make important decisions about your future finances, your will and your future health care wishes. You may also want to choose someone you trust to make these important decisions when you are no longer able to do so.
The areas of the brain affected at this stage of the disease do not have dopaminergic neurons. Dementia in Parkinson’s disease therefore does not respond to antiparkinsonian drugs.
Some medication used to treat Alzheimer’s disease, such as rivastigmine and donepezil, can be prescribed to improve memory problems. Memantine, another drug commonly prescribed for cognitive impairment in Alzheimer’s disease, is sometimes used in patients living with Parkinson’s disease or those with Lewy body dementia.
Your loved one has to continue using their strength and abilities for daily tasks as long as possible. Do not try to do everything for them, even if some tasks become difficult. Encourage them to continue their hobbies and interact with those around them.
Discuss strategies you can use to effectively manage the symptoms of Parkinson’s disease and the cognitive problems associated with dementia.
- Try to maintain a regular daily routine.
- Use familiar words, phrases, and even objects.
- Avoid unfamiliar places.
Taking care of someone with dementia is demanding. Take care of yourself, both physically and mentally, and above all, ask for help if you need it. This will help you take good care of your loved one.
A dementia diagnosis should also prompt you to make important decisions about your loved one’s future finances, will and health care wishes. You should also discuss the possibility of choosing someone to make these important decisions when your loved one is no longer able to do so. This person can be you or another person they trust.
Dementia usually occurs in the advanced stages of Parkinson’s disease in patients over 65 years of age. The extent of symptoms usually increases over time.
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