Parkinson’s Disease Dementia: Symptoms and caregiver tips

Parkinson’s Disease is a degenerative disease in which brain cells (neurons) are affected. While it is most commonly associated with motor symptoms such as tremors, rigidity, postural instability, difficulty walking, etc., Parkinson’s is also accompanied by non-motor symptoms such as disturbances in the sense of smell, sleep problems, depression, anxiety and cognitive changes.

In many cases of Parkinson’s Disease, a substantial decline in cognitive functioning also results. These cognitive changes often lead to deterioration in memory and thinking. When problems in memory and thinking are severe enough to interfere with daily living activities, then the syndrome is called Parkinson’s Disease Dementia (PDD).

Symptoms of Parkinson’s Disease Dementia

The acronym ‘TRAP’ summarizes the common symptoms of Parkinson’s Disease:

• T = Tremor (specifically resting tremor)
• R = Rigidity (difficulty moving / stiff arms & legs)
• A = Akinesia (or slow movements)
• P = Postural Instability (problems with postures)

The following are some of the symptoms that develop as a person develops Parkinson’s disease dementia:

• Changes in memory, concentration and judgment
• Trouble interpreting visual information
• Muffled / slurred speech
• Visual hallucinations
• Delusions, mostly paranoid thinking
• Mood swings with depression, irritability and anxiety
• Sleep disturbances, more daytime drowsiness, disorder of rapid eye movement (REM) sleep
• Changes in appetite and energy levels
• Confusion
• Loss of interest
• Sleep disturbances

The difference between Alzheimer’s and Parkinson’s

People with Alzheimer’s always develop Dementia over time. However, people with Parkinson’s may or may not develop Dementia. When people with Parkinson’s do develop a dementia, it can be even more debilitating. This is because people with Parkinson’s suffer from a combination of motor and cognitive impairments. In terms of cognitive effects of dementia, Alzheimer’s affects more of language and memory, whereas Parkinson’s affects more of problems solving, thinking speed, memory and even mood.

What Causes Parkinson’s Dementia?

The chemistry of the brain changes in all dementia’s including Parkinson’s Disease Dementia. Parkinson’s dementia is caused by sticky clumps of protein alpha synuclein that malfunction and deposit in the brain. Deposit of alpha synuclein in the brain is also a common cause for Lewy Bodies Dementia.

Commonly, dementia develops 10 to 15 years after a diagnosis of Parkinson’s. When the diagnosis of dementia precedes or is given at the same time as the diagnosis of Parkinson’s, it is known as Dementia with Lewy Bodies. However, when a diagnosis of Parkinson’s comes first and dementia develops at least a year after Parkinson’s, it is known as Parkinson’s Disease Dementia. Some people may develop Lewy Bodies Dementia independent of Parkinson’s Disease but Parkinson’s Disease Dementia happens only to people who already have Parkinson’s.

Some factors that increase a person’s risk of getting Parkinson’s Disease Dementia are mentioned below. While they may not individually be a high risk, presence of a greater number of these factors can increase the risk:

• Being a male
• Older age at the time of onset of Parkinson’s
• Family History of dementia
• Relatively severe motor symptoms
• Presence of visual hallucination
• Older age

Tips for Caregiver of people with Parkinson’s Dementia

As a caregiver you try to love and support your loved one with Parkinson’s Dementia in the challenges they face. One task is to improve their quality of life. Educating yourself about the symptoms, available treatment options, and what to expect in the time to come will aid you in creating a better support system.

Behavioural symptom management

• Make a structured schedule with medication & meal time, personal care tasks and activities
• Motivate them to retain independence in daily care tasks as far as possible
• Be patient and give them time for each task. Break down a task into smaller and simpler tasks.
• Simplify the environment by reducing clutter (too much furniture, less space to walk)
• Reducing distractions such as paintings, sounds of household items, etc.
• Make sure they know that you love them and care for them.
• If they have paranoid delusions, remember that any accusations they make towards you or your loved ones are a result of their disease and are separate from them

Bathing

• Install handrail and grab bars where required. Do not use other fixtures like tap, towel rack, other bars instead as they may not be sturdy enough.
• Use anti slip mats in the shower / bathing area.
• Use shower gel instead of soap as soaps can slip and make the floor slippery.  You can also tie up the soap bar on a rail inside a pair of stockings.
• Ensure that there is sufficient lighting.

Self-grooming tasks

• For tasks that take some time such as shaving, hair-drying, brushing, etc. the person should sit down to save energy and reduce the risk of a fall.
• You can put a chair near the sink for comfort. Make adjustment so that you can reach the sink.
• You may choose to use an electric shaver / toothbrush.

Toilet Visits

• Understand any incontinence problems they have by talking to the doctor about them. They may have frequency (wanting to go often) or urgency (sudden & difficult to control need to go).
• Use incontinence products such as adult diapers, when needed.
• Schedule visits to the bathroom for every few hours.
• Reduce intake of caffeinated beverages as they increase the frequency of the visits.
• Limit intake of fluid, 2 hours before bed, if it’s difficult to go at night.

Dressing

• Encourage them to warm up with some exercise to prepare muscles.
• Let them take their time and be patient.
• Get them to sit on a chair. Sitting on a bed as that can lead to losing balance.
• Choose clothes with fewer buttons and zips as they may be difficult to put on.

Eating

• Adjust meal time in a way that it is during those hours when the person’s functionality is better.
• A suitable upright posture is recommended.
• Food should be easy to cut into smaller bite size pieces and if they can’t cut them on their own, you may help with that.
• Individuals who have problem swallowing should avoid thin liquids and the use of straw.

Ambulation

• Assess need for a stick / walker / wheelchair, etc. if the person has difficulty getting around on their own.
• Let the person do as much on their own as is possible and give them time.

Handwriting

• Try out various pens of varying sizes to find the one that is easiest to grasp. Wider grips tend to help. You can use rubber band, pen grips, etc. with any pen.
• Practising writing, colouring, painting, drawing, will help retain and improve muscles.
• You can try writing letters in a different way so that you don’t have to lift the pen. For example, you can write the letter ‘D’ in one swift motion rather than making a line and a curve.

Exercise

• Help the person to choose some enjoyable activities for their physical stimulation such as walking in the garden or lobby, gardening, playing with children.
• Even easier activities such as sewing, playing catch, dance movements, painting, singing, etc. can have a powerful impact by reducing stress and they are also stimulating.
• Frankel exercises that help with ataxic conditions are useful in Parkinson’s.
• Yoga and brain gym exercises are also helpful.

We at Samvedna Care aim to help seniors live happy, active and independent lives, in the comfort of their home and community through interactive caregiving.

Samvedna Care was established in October 2013 with two complementary goals – firstly to provide quality home care services to seniors with limited mobility or dementia and hence social interaction, and secondly to facilitate stimulating community interaction and participation.

Our Dementia Care services are –

At-home services –
Dementia intervention activities by trained Care Specialists (already mentioned above). These services are available in Delhi NCR
More – Dementia Care
Please call us for more info – Delhi NCR – 98184 21446, 124 4229659

Dementia Support Group –
Our Dementia Support group in Delhi NCR is a platform for caregivers to share feelings and support each other.
Please call us for more info – Delhi NCR – 98184 21446, 124 4229659

Cognitive Wellness Programme, Sector 57  Gurgaon  –
Samvedna’s Cognitive Wellness Programme is designed for seniors with mild cognitive impairment, early dementia or Parkinson’s, and elderly lacking in enthusiasm and motivation. The aim is to stimulate the mind of the elderly to slow the progression of the disease or impairment. The sessions are 3 days a week, 11AM-1PM.

General Wellbeing:

With our General Well Being Services we aim to raise the quality of life of seniors, specially those who may have limited mobility and social interaction due to various constraints. Our interactive programme keeps them active and engaged through physical, mental and social activities, all in the comfort of their home.

More- Elder Care