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Cognitive Issues in PD

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Cognitive Issues in PD Non-Motor Symptoms of Parkinson’s Disease Samantha Holden, MD University of Colorado Movement Disorders MOTOR SYMPTOMS Bradykinesia Tremor Rigidity Gait Imbalance NON-MOTOR SYMPTOMS Urinary frequency Dementia Depression/Anxiety Psychosis Apathy Drooling Sexual dysfunction Runny nose Fatigue Constipation Orthostatic hypotension Pain Insomnia Decreased Restless Leg Syndrome Nausea/Vomiting sense of smell Non-Motor Symptoms of PD Under-recognized and under-treated Can be more disabling than motor symptoms Not every person gets every possible symptom Smell & Taste Dysfunction Hyposmia or anosmia: decreased or loss of sense of smell Can be one of the first symptoms of PD Can lead to decreased appetite No treatment Drooling Not due to overproduction of saliva, instead due to impaired mouth movements and swallowing If mild, occurs during sleep or with meals Can progress to be nearly constant Embarrassing, can cause choking or aspiration Rhinorrhea Runny nose Can be like a “leaky faucet” for some people Embarrassing, annoying Can treat with Atrovent nasal spray Choking and Swallowing Difficulty Slowness of movement of the mouth and throat muscles Can lead to malnutrition, aspiration pneumonia CAN BE LIFE-THREATENING – LET YOUR DOCTOR KNOW ASAP Can be tested with a Swallowing Evaluation Nausea & Vomiting Common side effect of PD medications Usually improves over time Can also occur without medications Slowed stomach emptying Constipation Extremely common Fewer than 3 BMs per week or straining to pass stools Can be one of the first signs of PD Slowed transit in the bowels Bladder Dysfunction Urinary urgency, frequency, incontinence, nocturia In men, can be confused for prostate issues Pain Can be directly due to PD Stiffness, cramping, spasms Commonly in neck, back and calves Can occur during “off” periods Early morning dystonia – toe cramping and curling before first levodopa dose in AM Dementia Up to 80% of people with PD will have some cognitive trouble during their life Slowness of thought, impaired attention and memory, visuospatial dysfunction Should be screened at least once a year by doctor Psychosis Hallucinations, illusions, delusions More common if dementia present Can be side effect of medications or due to medical illness Especially if sudden onset Depression Very common – related to underlying disease, not just reaction to getting/having the diagnosis Can be a very early sign of PD Sadness, lack of pleasure in things you used to enjoy, hopelessness Anxiety Frequently occurs with depression Panic attacks, phobias, generalized anxiety Can be a very early symptom of PD Can occur with “wearing off” Apathy Lack of interest, initiative, motivation and emotion Indifferent, no goals for the future No longer enjoy activities Impulse Control Disorders Increase in compulsive or impulsive behaviors Shopping, gambling, binge eating, cleaning, hypersexuality Punding – repetition of useless tasks, like organizing objects Dopamine dysregulation syndrome – addiction to Sinemet, taking more and more pills Sexual Dysfunction Erectile dysfunction, decreased libido, decreased sensitivity, trouble reaching orgasm Hypersexuality, or increased sex drive or inappropriate sexual behavior Can be due to dopamine agonists More common in men than women Orthostatic Hypotension Drop in blood pressure when changing positions Especially lying to standing Can also occur after large meals Symptoms: Lightheadedness, fatigue, malaise, headache, shoulder ache, cognitive slowing, passing out Fatigue Nearly universal symptom in PD Lack of energy, lethargy, feeling “drained” Not necessarily sleepiness or needing a nap Excessive Daytime Sleepiness Different from fatigue Falling asleep in the middle of the day During meals or conversations, in public places, while driving “Sleep attacks” with dopamine agonists Not necessarily due to poor sleep at night Overactive sleep drive Insomnia Two types: Trouble getting to sleep Trouble staying asleep – more frequent in PD Waking up too early (3-4am) Disrupted circadian rhythm and sleep-wake cycle REM Behavior Disorder Acting out dreams – talking, screaming, kicking, punching Can fall out of bed, injure yourself or your bed partner Can be the very first sign of PD (even 20-30 years prior) Take-Home Points Parkinson’s disease affects much more than just movement Being aware of possible symptoms makes them easier to recognize and to obtain appropriate treatment Every person with PD is different Questions? .
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