Category Archives: Cognitive Health

Can you give any additional information about Othello Syndrome in the context of PD?


Othello syndrome describes a form of psychosis in which one has delusional thoughts about their partner having an affair or similar relationship that does not exist. They may misinterpret ‘clues’ to support this delusion.

Delusions and hallucinations can be seen with certain psychiatric disorders and in the setting of Parkinson’s disease with the following conditions:
-High dose dopamine medicines especially dopamine agonists, amantadine and selegiline
-Other medicines that can cause confusion such as anticholinergics, muscle relaxants and pain medicines (narcotics)
-Illicit (street) drugs)Cognitive problems suggestive of dementia
-Coexisting medical conditions such as thyroid disease, vitamin deficiency (B12),infection or dehydration

Treatment includes:
-Reducing medicines when possible
-Occupational therapy evaluation to analyze how someone is taking medicines and help family administer medicines in the event the person with PD is taking more than prescribed
-Antipsychotic medicines- namely clozaril or quetiapine
-Cognitive enhancing medicines such as rivastigmine
-Counseling and psychiatric evaluation to evaluate for other conditions
-There is little evidence to date about the effect of a new antipsychotic.
-A combined neurology and psychiatry evaluation may be needed for this difficult problem.

See related article on hallucinations

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Filed under Caregiving, Cognitive Health, Emotional Health, Medication Side Effects

What causes hallucinations?


Van GoghHallucinations are a side effect associated with dopaminergic medicines used to treat Parkinson’s disease motor symptoms. Hallucinations are an altered perception of how our brain interprets information it receives about our environment, surroundings, senses and/or body sensations. Hallucinations can be visual, auditory or tactile. The most common type of hallucinations in PD are visual in nature. They may range from the experience of a simple illusion such as ‘seeing’ a spot on the wall turn into a well formed object such as a spider or they me be more complex and actual visions that do not exist. Sights of people and animals are common hallucinations. A person can have insight into and reason through the fact that a hallucination is not indeed real. In more advance cases, insight is lost and hallucinations are interpreted as real without the ability to reason that they are not grounded in reality.

The risk of experiencing hallucinations if you have Parkinson’s disease  increases with the following:

  • High levels of dopaminergic medicines. Specific medicines such as dopaminergic agonists, anticholinergic medicines and amantadine are associated with a higher risk of this problem.
  • Additive effect of other brain active medicines such as sedatives, sleeping aids, muscle relaxants, narcotic pain medicines and some bladder medicines.
  • Cognitive problems, confusion and dementia increases risk of hallucinations associated with Parkinson’s medicines.
  • Visual problems such as cataracts, glaucoma and reduced night vision can increase the risk of developing hallucinations especially at night. (Hallucinations are not directly caused by eye problems but reflect how the brain interprets sensory information. However, poor vision does exacerbate this problem in susceptible individuals.)
  • Stress can increase the risk – whether emotional, physical or the stress on your body from a medical condition or surgery.

Treatment includes:

  • Change or reduction in Parkinson’s medicines and other brain active medicines described above.
  • Antipsychotic medicines. Only two antipsychotic medicines are recommended for PD-clozapine and quetiapine. Other antipsychotics can worsen movement problems due their dopamine blocking activity.
  • Cognitive enhancing medicines such as Aricept or Exelon if dementia is a problem
  • Medical evaluation to insure other medical conditions are not contributing to the problem. Examples include cardiopulmonary disease, thyroid problems, vitamin B12 deficiency, infection, dehydration and kidney disease.
  • Lifestyle changes with a focus on stress management and improved sleep.

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Filed under Cognitive Health, Emotional Health, Medication Side Effects, Non-movement Symptoms, Symptoms, Diagnosis and Progression

How does Parkinson’s affect cognition? What can be done about it?


Cognitive changes associated with Parkinson’s  are mostly a category of thinking skills called executive function. Although many people with Parkinson’s Challenge yourself to learn new things!experience some sort of cognitive change, dementia or signficant problem impacting daily life and function is less common – occurring in about 30%.  The more common thinking abilities are:
  • Speed of movement
  • Word finding and naming problems
  • Multitasking
  • Performing complex tasks or skills
  • Abstract thinking abilities
  • Visual-spatial skills

Behavioral problems that can be associated with cognitive problems include:

  • Apathy or loss of motivation
  • Depression

 Memory abilities with Parkinson’s may be less efficient, but are usually not affected as much as Alzheimer’s patients are affected. People affected by Parkinson’s usually benefit from reminders and memory prompts, but may recall moments or hours after it was needed.  

 
Cognitive changes are treatable. It is important to remember that medicines can worsen confusion and cause hallucinations in people with cognitive problems. When this occurs, it is important to balance the medicines that are most effective for movement with those that have greater thinking related side effects.  Amantadine, selegeline and dopaminergic agonists such as Mirapex (pramipexole), Requip (ropinirole), Neupro have a greater risk of associated i thinking problems and /or hallucinations.
 
Treatment of cognitive changes includes:
1. Review with your doctor all medicines that can impact thinking such  including Parkinson’s medicines, pain medicines, muscle relaxants, anxiety and depression medicines to be sure that they are all needed, reduce or eliminate theones that are not.
2. Check for other medical problems that can worsen thinking problems including strokes, sleep apnea, thyroid problems, vitamin D and B12 deficiency, poor diabetic glucose control, heart problems, low blood pressure.
3. Memory enhancing medicine such as Exelon (rivastigmine) can be tried.
4. Stay mentally active
5. Be mentally engaged
6. Get more exercise especially  higher intensity aerobic exercise if possible. 
7. Eat healthy including foods high in omega 3s (fish oil), vitamin B6 and B12.
8. Reduce stress
9. Simplify life tasks
10. Challenge yourself – learn new things, explore new experiences
11. Stay socially active
12. Do what you love
 
Most important get the help and professional advice you need. See your doctor and consider a referral to a Neuropsychologist and/or Occupational therapist
 
Learn more about hallucinations.

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Filed under Cognitive Health, Self-Care