Is it common for patients with Parkinson's disease to develop psychological problems?
In my experience, it is often common for people with Parkinson's Disease to develop psychiatric symptoms, especially as the disease progresses. The most common problem tends to be depression, as both the disease itself and the loss of function can lead to this. Fortunately, antidepressants often help with this and are easily tolerated.
Many times, people present as having some Parkinson's disease symptoms, but they can have other symptoms as well. This can include visual hallucinations (especially children) that accompany a dementia. This is called Lewy Body Dementia, and it is very common for these patients to develop psychiatric symptoms. Fortunately, medications can help this as well, but usually an expert guidance is needed, as they tend to be complex patients.
I'd be interested to know which medications help - that aren't contraindicated by the meds already being taken for PD symptomatic relief.
My dad is one of those complex patients. His doctors are trying to reduce and change his meds because of so many psych reactions he's been having. He has progressive dementia too, and it seems like any little change in his meds causes issues. We have a great geriatric specialist too, and it's still very difficult and time consuming to try and get him stabilized. Seems like a lot of drugs to help one symptom really mess up others. Feels like a losing battle some days. Good luck to you.
My husband has Lewy Body Dementia and normal pressure Hydrocephalus, both are ugly neurological diseases. Everyone has told me that usually it is about 5 years into Lewy Body when things get worse, well, we are nearly there and on Thursday he had a stroke and things are even worse. It feels like a losing battle to me many days, especially now.
My husband has been diagnosed w/A-Typical Parkinson's Disease (2006) which bascially means it's not good. He is now in the advanced stage where I must take care of all his basic needs: bathing, dressing, sometimes feeding, assisting to wheelchair and in and out of bed. This week he has accused me of being a slut because I hug everyone (men and women) at the Parkinson's support group, having an affair with my neighbor who gave me a kind and caring hug in our driveway, accused one of my best supportive girlfriends of being gay which made him very angry of suspicious of our friendship.
Soooo.... does Parkinson's Disease cause phychological issues/problems? I say yes!
I have to agree with you about the personality and cognitive decline which occurs in Parkinson's disease when there is a dementia aspect.
My husband became dehydrated because of his concern over his incontinence and uninary frequency issues. He told me he was drinking water but in truth he was not.
The cognitive decline (a dehydration symptom) occured essentially overnight but took almost a week to diagnose.
The point is that during the ensuing weeks, he would ask me who the man or men were who were coming to the house - no, that was me calling the dogs in from the yard - and questions on that order. The implications are the same and things can get kind of ugly.
He's pretty much recovered now and taking medication for an enlarged prostate. (Yes, herbals had kept it under control for a few years but he had stopped taking them although he told me that he was.)
The other result is that I had to take control of his meds and the nutritional supplements and recently switched from a 28 day organizer (which can be used for 4 days with 7 slots per day sorted by meds and time) I now use a weekly (7 slot) pill organizer for one day's meds and supplements because he often switched rows and was taking overdoses by going down rather than across. Even though he is better, the fact that he tried to conceal the fact that he wasn't drinking fluids was enough to really scare me.
Eventually there will be cognitive losses for all PwPs with or without the dementia.
It is difficult at times to relate to this different person who is not the same person one knew for so many years. And that in itself is hard on all parties.
Is there a point at which it is a trade-off between easier movement and psychological side effects (delusions)? We took my 92 yr old Dad in to neurologist and told him about severe cognitive decline and increasing visual hallucinations and confusion ... thinking he would adjust meds. Dad is mostly wheelchair bound and in a nursing home. But the dr just noted "advancing Parkinsons and dementia" and said stay with Sinemet 3x/day and an antidepressant and aricept. Since he's lost 25 lbs in the past year, I wonder if he's over medicated! At this point we all want some quality to his days if possible,and do not have hopes of him living many more years.
To Sally C,
Sometimes you have to be more aggressive in speaking to both your own health care and that of a loved one.
How long has your father been in a wheel chair? Does he get physical therapy? Exercise? Has his PD progression gotten worse?
Since you probably have permission to speak to the doctor about your father's care, you might want to ask him if this is the course of treatment he would follow for his own parents.
You also want to speak to the nursing home about toileting and fluid intake. You don't want your father to become dehydrated because it is inconvenient to address urinary problems.
I am sure that the doctor attributed some of the symptoms to advancing age. But a 25 lb weight loss is significant. We did write a couple of articles about weight loss and PD as well as dehydration. (just click the back button to return to Caring.com) http://parkinsonsfocustoday.blogspot.com/2009/06/weight-loss-and-parkinsons-disease.html[blogspot.com]
as well as http://parkinsonsfocustoday.blogspot.com/2010/01/dehydration-and-parkinsons-disease.html[blogspot.com]
How long has your father been on Aricept? Have you seen a change? How about the antidepressant? You didn't mention the antidepressant by name or calass but sometimes these can be problematic with the chemistry of PD and symptomatic medications.
You can actually check these medications online or with the pharmacist.
We would have no way to determine if he is overmedicated. Unfortunately, with the varied symptoms of PD, so many of which mimic accelerated ageing, there may often be a few medications and supplements. At our house we try to make sure that the medications have low or no negative interactions and that dosing is timed so that they do not conflict.
My husband is 56 and has had Parkinson's for seven years. We have discovered something called Dopamine Dysregulation Syndrome, which is something that should be researched if your loved one has psychological issues. I believe my husband's change in behavior stemmed from the Requip he was taking and now he's so used to "getting high" on his Sinemet that he's obsessed with his meds. He has mood swings and often refers to himself as Dr. Jeckle/Mr. Hyde and I would have to agree. He gets extremely agitated as the day progresses and then at night, when his meds have ebbed, he becomes very emotional. When he's high he's the king of the world and does things that are not rational.
I would have to say his behavior was tolerable for the first three years but now it's become so hard to live with. The caregivers of people who are not considered "seniors" don't have as many options and it is very difficult to know what to do next. All I can say is join a support group. No one understands us except others in the same boat.
Yes, I think there is a definite trade-off between easier movement and psychological side effects. It is a difficult decision to go off of Sinemet, but in my mother's case, she and I have found it a rewarding decision. My mother, who will be 80 in November, and who was mis-diagnosed with Parkinson's in March 2008 and re-diagnosed this past January with Progressive Supranuclear Palsy, and I, decided jointly, to remove her from Sinemet. Her mobility has decreased significantly, but she now has her wits and sense of humor about her once more. She now often uses a wheelchair, but has a much smaller risk of falling. If your father is already wheelchair-bound, why continue a drug that is, in all likelihood, contributing significantly to his delusions? My mother's mental health has improved significantly as has her quality of life. We have been talking with a palliative care social worker, who has helped and continues to help us work through this decision and others. Best wishes.
With my dad, his PD got progressively worse during the last month of his life and he passed away at age 93. As the PD became worse, he began to experience more and more delusions and hallucinations. I even brought him to a local hospital for psychiatric help twice in one weekend, and not ONE professional in the field came to calm him down. He begged and begged until they gave him xanax and he fell asleep.
For his last month of living (when he was finally at a nursing home with my mom), I made sure he was put on hospice (when his doctor told me it was time), and his team was the absolute best! He could no longer swallow so he could only have thickened liquids and he had so little of them each day. Hospice arranged through his medical doctor to take him off at least half of his meds., changed a couple also, and he became the calmest he'd been for months. It changed him from being totally agitated to being calm most of the time.
He knew he was dying as he told me so, but he was more comfortable in his "geri" bed (a nursing home version of a recliner) which was equipped with a fully cushioned cover. His mattress was changed also on his bed for more comfort and he had a social worker, a nurse and a chaplain on his team. They also provided him with a breathing tube when hospice began which made his breathing so much easier until the end.
I believe more people should consider hospice when they know there is no longer any hope for their loved one. At age 93, I knew he would never recover.