Carbidopa-Levodopa improves motor functions as well as a secondary effect of improvement in cognitive function. More research needs to be done on this.
With PD, it is important to consider cognitive fatigue. By using a compensatory approach, it is important to schedule more taxing/stimulating/engaging events in the morning or afternoon when you having more energy compared to the evenings.
Neuropsychologists use instruments based off normative data, these are tests that are administered to hundreds and hundreds of people and we figure out what the average score should be, then we have these domains or scales that range from average to below- or above-average
Within this, we try to compare you with other individuals who have very similar demographics or in a way to account for all extraneous variables (age, gender, education) so we have a pretty good idea of how someone should perform no matter their age
But we do compare your score with the average score for your age group
May be better on some scales and worse on others, also may look for patterns
Based on this, can comfortably group into normal aging or if it’s something else like MCI
Partner with HCP first, whether that’s the PCP or treating neurologist, address your concerns, then you can both work on a strategy together (but this depends on family member and if they are receptive or in denial/deflective)
Doesn’t hurt to bring it up
PCP can screen to guide to see if further workup is needed
On the flip side, just bringing it up may be a tension releaser as maybe the PwPD and CP have noticed, and it’s nice to finally address what both have been thinking
Always bring it up in non-judgmental way, non-accusatory
No it does not
These medications do not cause neurodegeneration
Each person is different, one risk factor for neurodegeneration is age so the assumption would be younger age and shorter diagnosis duration is associated with better cognitive outcome compared with older age and longer diagnosis duration
Pill box – something you can set up to take your medications Monday through Friday
Auditory reminder or smart devices – e.g., Alexa to remind you to take medications
Having an organizational strategy is the best way to not miss any doses
Depends on individual
There are going to be risk factors for cognitive changes post-DBS surgery
There is some evidence to suggest STN could potentially decrease verbal fluency and other aspects of EF but also shows quality of life doesn’t change
This means, although there may be a “hit” to cognition, but not a meaningful enough “hit” to drastically QoL
Some risk of cognitive changes with DBS but DBS in itself is not going to accelerate the dementia process
This is called apathy
Apathy could be an early warning sign that there may be some cognitive decline
Apathy could be purely neurogenically-driven or a component of depression – should see a neuropsychologist to explore this further
The apathy might be outside of the scope of depression but if it is within the context of depression and the depression is addressed/treated, the apathy, initiation, and motivation will improve as well
Assessment needs to be done to determine the cause of the apathy state
If depression, there’s several options of treatment: CBT, medication, behavioral activation/effective routine
This is a very common complain, word finding difficulties, whether early or late stages of the disease
Depends on how bad it is
Restorative techniques – looking up word online with description, then making cue cards with associated definitions (you can quiz yourself on these words as sometimes it may just be the same word you keep forgetting)
Compensatory techniques – thinking of a simile or different word to say that has the same meaning (talk around it)
SLP referral to help you communicate more effectively
Bring it up to your doctor – this is not something you have to deal with everyday or live in silence about – there are many options to treat your symptoms
Lewy body dementia is in the family of PD but it doesn’t have the same course
General rule: if you have motor and cognitive symptoms within the first year of diagnosis → may be indicative of LBD (may also have hallucinations, delusions, waxing and waning of cognition, and may not effectively respond to PD cognition as typically)
Therefore, management with be different
You may bypass the MCI stage and go right to the dementia stage
It’s a very difficult question to answer
They are all probably different diseases along the same spectrum
Knowing where one ends and the other begins is sometimes difficult/artificial
This isn’t always conveyed in the literature so it can get confusing for people
OT
Dual task
Stay cognitively engaged
Use your brain or you’ll lose its functioning
Engagement / communication / trying new things – all good for an active lifestyle and brain to keep you thinking sharp
Mental exercises that use EF – e.g., working through plans, imagine going on trip and planning for packing / travel / transportation
Dysarthric apraxia of speech
Can come on with worsening motor symptoms like tremor
This is not typically what comes to mind when thinking of MCI, it’s more of word finding
This sounds more like secondary motor aspects of speech
Hard to say, better than doing nothing but the jury is still out on that – more research needs to be done to prove how effective they may be
Computer-based cognitive interventions is a new research topic that is gaining traction (VR-based intervention)
These focus more on dual tasking, meaning both GM movements and cognitive components rather than cognitive alone (which is found in most of these online programs)
There is evidence that repetitive exposure to stimuli increases attention but it may be hard to generalize learned information to other parts of the brain
We all know if your mood is affected then your cognition can be affected too
About 40% of those with PD are likely to develop a depression
About 75% of those with depression are likely to have a comorbidity of anxiety
Therefore, mood related issues are common and it’s hard to tease those out
Depression and anxiety can reduce your capacity to live up to your day to day cognitive potential
If you can say you have good days and bad days and can rule out Lewy Body dementia, then may be dealing with depression or anxiety or something mood related
But if you’ve hit your ceiling and you can’t go beyond that, it may be more cognitive related
Partnering with your care provider will always be recommended for routine check ins and to monitor cognition
We are still waiting on evidence through a RCT study that says these are beneficial
All claims that manufacturers have are based on small sample sizes and there’s not enough evidence to recommend anything at this time
It will always go back to stay cognitively engaged and physically active
Most of those supplements you will get those nutrients anyways through a healthy diet
Vitamin D and other vitamins like that should be fine but anything that promotes “take this and it will boost your brain functioning” I would be very hesitant to take (it probably just has a lot of caffeine in it)
“A whole is worth more than the sum of its parts” – e.g., a Mediterranean diet, eating the rainbow, you get all the vitamins and nutrients you need that way
A full workup involves neurology, lab work, imaging, cognitive testing
From these data points, will give you a better sense of what is going on with you
E.g., dementia with lewy bodies vs. PD
If there’s any concern, go to doctor and bring it up
Driving is a complex cognitive endeavor – requires complex thinking, working memory, reaction time, problem solving, and motor movements and reaction time
There are driver rehab programs that will test your driving skills in a safe environment (the passenger/evaluator has a break and controls on their side)
We know that alcohol in excess can increase quantity of falls
As a general rule, drinking is permissible in moderation
Always ask your doctor this and they can check your blood to see which levels you may be low on
As a general rule, have a healthy diet high in fiber and low in saturated fats to decrease cardiovascular risk
At least 30 minutes of walking a day
Even better would be incorporating moderate to high-intensity exercise 6 days a week, changing type of exercise: HIIT, Power Moves, biking, cycling
Take multivitamin
3 gratitudes a day can help reduce depression in about 2 months
Scientists may engineer a bacteria for the gut to treat PD and any abnormalities in intestinal metabolism
Initial studies show improvements in non-motor symptoms
More research is needed
