Parkinson Society British Columbia hosted a webinar on Dementia in Parkinson’s.  The speaker was geriatrician Naaz Parmar.

Just because you have PD doesn’t mean you can’t also have dementia. In this talk Dr. Parmar covered the definition of dementia, when should you have an assessment and what does that look like, the different types of dementia and finally, treatments.  Her argument about getting an early, accurate diagnosis​ for cognitive or memory changes is compelling.

Many people are of the opinion that you can’t do anything about dementia so why bother to get an assessment, much less a diagnosis. Dr. Parmar shared three reasons why early and accurate diagnosis is crucial.

• First, not everything that looks like dementia actually is.  Many causes of cognitive change or memory loss are treatable or reversible.  Why allow someone to suffer when they can be effectively ‘cured?’

• Second, early treatment with Cholinesterase Inhibitors slows the progression of all dementias.  It allows the average person to live at ​home five to seven years longer than they might without treatment.
  
  In fact, with proper management of high blood pressure, high cholesterol, and high blood sugar, Cholinesterase Inhibitors can stabilize vascular dementia, preventing further damage to the brain and progression of the disease.

• Third, it is easier to live with and care for someone with dementia if you know what type they have and are prepared for the types of behaviors you will likely see.  

It is also easier to live with and care for someone with dementia with the support of others.

You can watch this webinar here.

Dr. Parmar compared cognitive changes of Parkinson’s and normal aging to that of dementia.  You can read more about the cognitive changes of Parkinson’s disease here:  

• Cognition and PD

She also referred to mood changes like anxiety and depression common to Parkinson’s and mood changes seen in dementias.  You can read more about that here:  

• Anxiety in PD
• Depression in PD

Lastly, she referred to Parkinson’s and dementia psychosis (hallucinations and delusions) and the treatments for them.  You can read more about Parkinson’s psychosis here:

• Hallucinations and Delusions in PD

And now, on to my notes…

– Denise

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Parkinson Society British ColumbiaDementia and Parkinson’s Disease

October 28, 2020

Speaker: Naaz Parmar, MD

Overview of Presentation

• Definition of Dementia
  • Medical terminology
  • Practical definition
  • How does this compare to normal aging?
• Assessment for the Diagnosis of Dementia
  • What to look for
  • When to be concerned and seek an assessment
  • What to expect with an assessment?
• Different Subtypes of Dementia
  • Common subtypes of Dementia in people with Parkinson’s Disease
• Treatment of Dementia
  • Lifestyle modification
  • Medication options
  • Resources
• Take Home points

Definition of Dementia

• Dementia is called Major Neurocognitive Disorder as per the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM V)
  • Requires evidence of progressive substantial cognitive decline from a previous level of performance in one or more of the cognitive domains, including:
    • Complex attention (multi-tasking)
    • Executive ability (planning, decision making)
    • Learning and memory (short term memory)
    • Language (using the correct names for people and objects, fluency of language use)
    • Perceptual / motor / visual ability (understanding what a tool is, what it’s for and how to use it, like a phone or microwave)
    • Social cognition (socially appropriate behavior)
      • Examples: answering waiters’ questions, but not asking him questions about himself, or being quiet in a library)
    • Other potential causes of symptoms such as medical illness (B12 deficiency, delirium) or depression have been ruled out

When a doctor is doing an initial evaluation of a person who may have dementia, they look at three things:

• Subjective deficits
  • Does this person or their loved one see that there is a change in their abilities?
• Objective deficits
  • Is this person’s score on a cognitive evaluation lower than you would expect from their education level, or
  • Is this person’s score on a cognitive evaluation lower than when they were last evaluated?
• Has this cognitive change affected day-to-day life?  Loss of function / ability is the key feature to diagnose dementia.
  • Is this person previously unable to do things they used to do, like manage bills & taxes, use the TV remote or microwave?

Often people normalize memory changes as part of aging but there is no normal memory loss with aging.  They will agree they have some memory loss but dismiss it because they are old.  Slowing of memory retrieval is normal, memory loss is not.  Here’s the distinction:

Normal Aging leads to Memory Slowing, Dementia results in Memory Loss

• An appropriate simile is if we had a computer that was 75 years old (age of a specific individual) and asked it to retrieve a file, we would think it is normal for that computer to take time to go through all 75 years’ worth of data to retrieve that one file.  That is memory slowing like having to pause to find a word in a conversation or taking time to remember why you walked into the bedroom.  So long as the information comes back to you that is normal given the vast amounts of information stored in a brain through the decades.  
  • Memory slowing responds to cueing, or having someone help you recall the memory by reminding you of a piece of the information you are trying to recall
• Dementia is if you ask that computer to retrieve the file and it whirls and whirls working away but comes back with “file not found.”  Losing that information is not normal.  
  • Example:  If previously you could always manage your own finances but now you’ve made mistakes with payments or investments.  Loss of function due to memory deficits.
  • Example:  You could previously work your TV remote to find the programs you want to watch but now you cannot.  This is a loss of function because of memory deficits.
  • Example:  You are unable to recall someone’s name and when they tell you their name you still don’t recall having met them before.  Cueing does not help recall of the information.

Assessment for the Diagnosis of Dementia

• When concerns regarding memory changes arise from a person themselves or their loved ones, it is appropriate and suggested to discuss them with your primary care physician.  
• Bringing up the topic of someone’s cognitive changes can be a sensitive topic and cause them to become defensive, accuse you of thinking they are crazy.  Nevertheless, the first step is to bring it up to the person’s doctor because dementia is a chronic brain disease, just like heart disease or diabetes.
  • Dementia isn’t meant to be a label; it is meant to be investigation of a medical concern. 
• It may be that there is another cause for the symptoms that requires treatment or, if this is Dementia, early diagnosis and treatment makes a significant impact on symptom management, independence, and quality of life
• If after discussion a Family Physician believes that further work up is needed, they can refer you to a Specialist Geriatric Medicine (Geriatrician), Geriatric Psychiatrist, or a Neurologist with extra training in Cognition Disorders.
• With the adaptations needed for the COVID-19 pandemic, specialists have been able to conduct consultations via virtual health using telephone or video conferencing.  Cognitive Consultation scan very easily be done via virtual health.  This has opened doors for those who live in remote area or those who are unable to travel from home to a doctor’s office to have an assessment done.

Q. Is someone with Parkinson’s more likely to suffer from dementia?
A.  Yes.  More statistics will be covered later in this talk.  Jumping ahead a bit, the incidence of dementia in Parkinson’s increases the longer you have the disease so that after 10 years your chances of developing dementia is about 80%.

What to expect from a Cognition ConsultationKnowing what type of cognitive changes, you are noticing helps your physician determine what type of pattern of memory change you have.  Subsequent slides will outline the subtypes of dementia.

• When discussing memory changes with a Family Physician or a Specialist you can expect questions regarding: 
  • What types of memory change do you see?
  • How long have they been happening?  After a sudden illness or gradually?
  • Are they progressing gradually or in an abrupt manner?  Developed over months or years?
  • Have they led to safety concerns?  
    • Especially kitchen hazards, like leaving burners on
    • Locking yourself out
    • Driving safety, getting lost
  • Have there been any mood changes or behavioral changes?
    • More irritable or jovial
    • Lost social filter / behaving inappropriately
  • Any history of hallucinations or delusions?
  • Risk factors for memory impairment, including:
    • educational history
    • smoking
    • alcohol and/or drug use
    • history of heart attack, stroke, concussion, and family history of dementia (primarily parents and siblings)
• Changes in function are key in the diagnosis of Dementia.  Therefore, a “functional review” will also be done with the doctor asking specific questions regarding changes in ability to do tasks for the household.  
  • These are called the Independent Activities of Daily Living (IADLs) and are necessary to be able to live independently.  They include:
    • shopping
    • housekeeping
    • finances
    • cooking
    • driving or taking transit.  
  • They will also ask about how well the person is managing Basic Activities of Daily Living (BADLs), such as 
    • dressing
    • eating
    • walking
    • general mobility
    • toileting
    • personal hygiene.  
• There are other diseases that can present with similar symptoms to Dementia so you will also be asked questions specifically about anxiety, depression and other medical issues that might lead to a delirium.
• Based upon the history of memory changes, the history of other medical illnesses (Past Medical History), Medication list and risk factors, the doctor will then complete an exam.  This exam will involve memory testing with standardized tests such as the Mini Mental Status Exam (MMSE) and can also include a physical exam and depression screen.
• The most recent blood tests and any prior brain scans will be reviewed.  If there are tests that are missing the doctor will then order these for you to complete the work up.  Common tests ordered include a thyroid test and vitamin B12 level.  An image of the brain is also helpful, and a CT Scan or MRI may be ordered based upon the history and physical exam findings from the doctor.  These tests are helpful to rule out other causes of memory change, help identify reversible causes of memory changes, such as B12 deficiency, thyroid changes, electrolyte imbalance, and narrow down the subtype of Dementia.

Diagnosis of Dementia and Subtypes

When families ask for an evaluation of cognitive change, the diagnosis is often not dementia.  Other things, like depression can be causing symptoms.  Remember, depression is very common in people with Parkinson’s.  Sometimes, the changes are due to ‘normal aging,’ and the person can be monitored and re-evaluated if further changes are noticed.

• At your initial consultation you may get a diagnosis, or the specialist may need to wait for the results of blood work and a brain scan.  Once you have a confirmed diagnosis of Dementia the next step is to determine the subtype.
• Dementia is an umbrella term that means memory loss.  Beneath that umbrella are different subtypes of Dementia caused by different disease and following different paths.  
• Subtypes of Dementia (in the order most diagnosed) include:
  • Alzheimer’s Disease
  • Vascular Dementia
  • Parkinson’s Dementia
  • Lewy Body Dementia
  • Frontotemporal Dementia
  • Mixed Dementia 
  • Normal Pressure Hydrocephalus

Subtypes of DementiaAlzheimer’s Disease

• The most common subtype of Dementia, accounting for approximately 2/3 of all cases of Dementia
• Presents initially with short term memory loss, followed closely by language changes (difficulty recalling words)
• Disease process involves plaques and tangles and is different than Parkinson’s Lewy Bodies.
  • Neuron death and disease progression happens at a much higher rate than in PD 
• Pattern of disease begins in the temporal lobe which controls memory and attention, and this helps differentiate it from Parkinson’s Dementia
• It is possible to have both Parkinson’s and Alzheimer’s at the same time
  • This accounts for the 80% of those with PD showing signs of dementia after 10 years.

Vascular Dementia

• Second most common type of Dementia, also commonly seen in those with PD
• Results from poor blood flow to the brain, resulting in neuron death and functional loss
  • Think of damaged areas of the brain in random areas, like swiss cheese
• Can occur throughout the brain with consistent blood flow problems, due to untreated high blood pressure or diabetes
• Additional risk factors include being sedentary, untreated high cholesterol
  • Staving off vascular dementia is another reason those with PD should exercise, rather than being sedentary
• Can also occur with major sudden changes, such as a stroke
• Diagnosis is confirmed with an image of the brain, such as a CT or MRI.  
  • If vascular disease is detected as being the cause of cognitive change in early stages, doctors will work with you on controlling your blood pressure, cholesterol, or diabetes to forestall further damage and functional changes.

Q. What can be done to slow the onset of dementia?
A.  The biggest thing you can do is prevent these diseases from happening.  Prevent diabetes and stroke, treat high cholesterol and high blood pressure, and don’t be sedentary.  Cardiovascular exercise that increases your heart rate is crucial because it improves blood flow to the brain.  

Research recommends 150 minutes weekly of cardiovascular exercise in addition to usual daily activities (like climbing stairs with laundry).  You can break that into the time intervals that work best for you (20mins/day ; 30 mins, 5 days/wk ; 60 mins, 2-3 days/wk).  Chose activities you enjoy so you will do it.

Have your blood pressure checked regularly and bloodwork done annually to determine if diet changes should be done or medication added to prevent damage and changes in your brain.

Parkinson’s Dementia (PDD)

• Occurs in about 50% of people with PD
• Memory changes occur at least a year after the onset of PD motor (physical) symptoms
• Initially affects attention, reasoning and planning, problem solving, speed of comprehension, thought and mood.
• Due to the same disease process that causes PD, inclusion of Lewy Bodies that lead to neuron death.  This happens first in areas of the brain that affect physical function and then with time progresses into the temporal and frontal lobe where memory and problem solving are affected.
• Higher incidence of delusions, auditory and visual hallucinations, due to the impact on the occipital lobe, where visual input is processed, than in PD
• Higher incidence of mood changes, and paranoia due to memory loss (esp. blaming misplaced items on others), than in PD 
• More likely to occur with greater severity of PD symptoms and usually occurs 5-10 years after initial PD diagnosis.  Those with a quick onset and progression of symptoms (over just a few years) are more likely to develop Parkinson’s Dementia.

Q. Do people with Parkinson’s Dementia remember people’s names and relationships longer than those with Alzheimer’s?
A.  Yes, because different areas of the brain are affected in a different pattern.  In people with Alzheimer’s the disease process affects memory centers earlier than in those with Parkinson’s Dementia.

Q. Does Parkinson’s Dementia affect speech?
A. It does not affect speech production.  The Parkinson’s itself does.  PD affects the muscles that control speech so you will have slower speech and lower tone of speech.  Parkinson’s Dementia does affect word finding, but not speech production.

Q. Does celiac disease affect Parkinson’s Dementia?
A. There is no connection between celiac disease and PD.  Celiac disease is an autoimmune disease and PD is a neurodegenerative disease, so there is no connection between the two.

Q.Is it Parkinson’s disease or Dementia that brings on dysphagia (difficulty or discomfort in swallowing)?
A.  It is the Parkinson’s disease, not the dementia.

Lewy Body Dementia (LBD)

• Lewy Body Dementia is similar to Parkinson’s Dementia in that it is due to Lewy Body inclusion bodies, leading to neuron death.  Lewy Body Dementia is differentiated from Parkinson’s Dementia only in its timing.  Lewy Body Dementia occurs within the year of diagnosis of Parkinsonism (physical symptoms of PD)
• Lewy Body Disease progresses at a faster rate than Parkinson’s Disease and often has delusions as an earlier symptom.  Physicians should be very responsive with treatment of LBD
• Patients with Lewy Body Disease are also often sensitive to a class of drugs called Antipsychotics and can have severe side effects such as freezing with them.  This can be distressing for the person with LBD because there is no antidote.  The person must wait until the medication wears off to be able to move.

Frontotemporal Dementia (FTD)

• Follows a specific pattern of neuron death in the brain.  The temporal lobe, which houses memory and language, and the frontal lobe, which houses social behaviors and reasoning, are affected.
• Onset is usually at a younger age with people in their early 60s, but can occur at any age
• Familial inheritance for some types of FTD
• Language or behavioral concerns (socially inappropriate behaviors) are usually the first symptom.  With time, physical symptoms with falls and mobility issues occur.
• CT Scan is the best way to distinguish between Parkinson’s, Lewy Body and frontotemporal

Mixed DementiaMeans you can have the pathologies of multiple subtypes of dementia at the same time.

• Usually refers to a presentation of Alzheimer’s Disease and Vascular Dementia at the same time
• Symptoms of both diseases overlap and can be difficult to distinguish, but a CT or MRI scan can show signs of both, leading to this diagnosis.

Normal Pressure Hydrocephalus (NPH)

• Commonly considered, along with PD and LBD, during initial assessment
• Diagnostic triad for NPH is simultaneous onset (within a few months) of:
  • New onset of Dementia
  • Changes in walking with shuffling type of gait called a “Magnetic Gait”
  • New Urinary Incontinence
• The walking changes and memory concerns are similar to PD and LBD, therefore investigation for NPH is often done to rule it out.  An MRI can clearly rule in or out NPH as there are specific imaging criteria for this diagnosis.
• Uncommon to have both NPH and PD simultaneously, but it can happen

Treatment of Dementia

• The first thing to remember with a diagnosis of Dementia is that though the word carries a taboo or weight in casual conversation, it does not mean all hope is lost.  It is not a comment on your intelligence of psychological state.
• It means that, like diseases that affect other organs of the body (heart failure or kidney failure) that the memory centers are affected and need treatment.  You need to follow up with your medical team, just like you do with PD.
• Like heart disease, there are no cures to reverse the effects of Dementia, but there are strategies to prevent the worsening of the disease.
• The earlier we have a diagnosis the sooner we can stabilize the condition.  Stability with Dementia means that functional ability is preserved and that a person can maintain their independence and quality of life for years.  Hopefully, that means remaining in your own home and not moving into a care facility at any point.

Lifestyle StrategiesThe most important part of Dementia treatment is activity.  Both physical and mentally stimulating activities help to slow the progression of all types of Dementia and are the first step in treatment, regardless of subtype

• Cardiovascular exercise with a minimum of 150 minutes per week has been shown to slow the rate of progression of Dementia, delay the need for a higher level of care and improve quality of life.  Cardiovascular activity does not need to be onerous with a walk at a normal pace being sufficient.
  • Increases blood flow to the brain
  • The exercise does need to be more than regular daily activity, household chores such as laundry or mowing the lawn do not count towards the exercise time.  “Exercise has to be extra” activity that you do.
• Mentally stimulating activities are also important for the treatment of Dementia
  • Staying mentally engaged helps prevent symptoms of anxiety and depression and helps to challenge the memory
• Using hobbies you already enjoy is important.  Starting new ones in the setting of Dementia will only lead to frustration.
  • sports
  • card games
  • reading
  • painting
  • knitting, crafts
• Best practice: watching or reading the news or a story can be helpful, especially if you talk about what you watched or read a few hours later, challenging your memory.  This stimulates production of neurotransmitters and strengthens the memory centers of your brain.  The exercise works best as part of normal conversation as opposed to drilling someone about what they remember.
• Brain games, like Lumosity, have never been shown to make a significant difference.  If you didn’t do them before, don’t bother starting them after a diagnosis

Treatment of Dementia with Medications

• Physical Activity and Mental Activity are the foundations of treatment.  Medications can also help.
• The medication choices suggested will depend on a person’s medical history, the subtype of Dementia and the severity of Dementia
• For those with mild to moderate Dementia a class of drugs called Cholinesterase Inhibitors can be used.  They improve the amount of the neurotransmitter, acetylcholine, in your brain.  This preserves memory and helps your brain function at a higher level.
• These drugs are the second generation of Dementia Drugs.  There are three readily available in Canada:
  • Donepezil (Aricept)
  • Galantamine (Razadyne)
  • Rivastigmine (Exelon)
• In British Columbia, based upon a MMSE score, Donepezil is covered first line by PharmaCare.  If there are severe intolerance symptoms to Donepezil, your doctor can apply for coverage for Galantamine or Rivastigmine.
• All 3 Cholinesterase Inhibitors are equivalent in their effectiveness so the recommendations to start with Donepezil does not pose a concern of “losing out” on the other choices
• The medications are small pills and are taken by mouth.  
  • They are not easily crushed
  • Rivastigmine does have a patch form as well, for those with difficulty swallowing pills, though unfortunately is not covered by PharmaCare (Canadian program).
• Donepezil is taken once daily and is usually well tolerated.  The most common side effect is upset stomach.  If you are prescribed it and your family doctor or Specialist will go through other common side effects with you as well.
• Cholinesterase Inhibitors have been shown to slow the progression of disease in mild to moderate Dementia.  For those with moderate to severe Dementia they have proven ineffective.
• For those with moderate to severe Dementia an alternative medication called Memantine (Namenda) is used.  It does not alter the progression of the disease but does help deal with behavior concerns that may arise.  This usually occurs in total care (nursing home) situations.  These people are often frightened due to memory deficits and can be quite tearful or aggressive.

Q. If they are all equivalent, is it worth trying others if you had a severe side effect from Donepezil?
A.  This is something we discuss with our patients who have side effects from Donepezil.  If the side effect was severe like a sudden change in mood, agitation, or if sleep was disrupted, often we won’t try the other two.  If the side effects are more stomach based, we will try one of the others.  The upset stomach or sea sickness Donepezil can cause in about 10% of people can be drug dependent and not experience that with one of the others.

Q. Do medications lose their effect over time?
A. Over time the medications don’t lose their effectiveness.  When you have a neurodegenerative disease like Alzheimer’s the disease progresses whether you are on medications, or not.  After some time, the symptoms of the disease will progress to the point where the medication is not helpful anymore.  Doctors will stop medication at that point.  Studies show that these medications do slow progression of the disease so people taking the medications are able to stay in their own home an additional 5-7 years.
In vascular dementia, which is insult driven (uncontrolled blood pressure or diabetes), as long as those underlying factors are under control (normal blood pressure and blood sugar levels) Donepezil is effective for the rest of a person’s lifespan.

Q. Husband is 88 with PD.  Is forgetfulness caused by age or onset of dementia?  He forgets what he’s eaten.
A.  Difference with normal aging and dementia is whether it is memory slowing or memory loss.  If you give him some time and the memory of what he’s eaten comes back to him, that’s memory slowing.  If he is unable to recall what he has eaten, that is memory loss.  That would be dementia and he should be evaluated.

Q. Is there any research on the effect of CBD oil?
A. CBD oil is not a treatment of dementia.  It can be effective for some of the behaviors of dementia in people who become anxious or agitated.  

Q. Is REM Sleep Behavior Disorder (RBD) an indicator of dementia?
A.  RBD is not prevalent in dementia.  It is not considered a symptom of dementia as it is managed by different parts of the brain and different chemicals.  RBD changes are common in those with PD, LBD, etc. but not dementia per se.

Treatment of Behavioral Changes in Dementia

• Behavioral concern can occur with Dementia with time.  These are referred to as the Behavioral and Psychological Symptoms of Dementia.  With memory loss there is a feeling of being lost in time and space, which presents as anxiety, fear, or aggression in patients.  This can lead to the need for medications to deal with these behaviors.
• Antidepressants such at Citalopram (Celexa), Mirtazapine (Remeron), Sertraline and Trazodone are the first line medications suggested for behavioral concerns with Dementia.  They can also be used for mood changes that are common with Dementia as described above.
  • They are considered safe in the elderly population, safe to use with cholinesterase inhibitors, and safe in Parkinson’s Disease.
• Antipsychotics such as Quetiapine (Seroquel), Risperidone (Risperidal) and Olanzapine are used in patients with more severe behavioral concerns with Dementia when they present a danger to themselves or others. 
  • This is why it is important to distinguish between LBD and PDD.  In those with PDD these medications are safe, but in LBD they will cause a locked in syndrome, which is very disturbing to the patient.
  • In Parkinson’s Dementia and Parkinson’s Disease with another subtype of Dementia, however, they are not recommended as they are more likely to cause side effects including confusion and falls.

Treatment of Dementia – Supports

• Education and support for those with Dementia, caregivers and loved ones is also paramount.
  • It is common for families, including the person with Dementia to experience distress and grief over memory loss and functional changes.  Emotional support helps families cope with change.
• Education regarding symptoms of a particular subtype of Dementia and strategies for how to cope with functional and behavioral changes are invaluable after diagnosis of Dementia.  Your physician may connect you with a NeuroPsychologist, case manager through local health unit or the First Link Program of the Alzheimer’s Society (Canada).  
  • This is similar in the USA, although organization and programs names differ.  In the US it is the Alzheimer’s Association.
• Support to manage safety and functional decline are also key.  In British Columbia these are offered through public service from your local health authority.  Private supports through companies such as Home Instead or Nurse Next Door are also available.  You can discuss further with your physician which is best for you.
  • This is also true in the USA
• If you have questions about how to access supports please visit here, and scroll down to External Services (Canada)

Q. Some Parkinson’s meds are anticholinergic.  Are they a problem for the dementia medications?
A.  Yes, because they are counteracting what we want.  We want more acetylcholine, and the anticholinergic medications are preventing that.  They can cause confusion to be worse and worsen dementia symptoms because of that.  They will cause more of a barrier to Donepezil to work well because it has to overcome the anticholinergic effect of the Parkinson’s meds.  So you will have less benefit from Donepezil if you are on an anticholinergic medication.

Take home points

• Dementia is a common disease that occurs in 50-80% of people with PD
• The key to diagnosis for all Dementias is a loss of function.  A subjective change and deficits on memory tests is also part of diagnostic criteria.
• If you have concerns about memory it is best to discuss this early with your Family Physician who may refer you on to a Geriatrician, Geriatric Psychiatrist or Neurologist with Cognitive Training.
  • The Assessment for cognition can be done with Virtual Health so those living in remote area or with mobility concerns can also easily be assessed, even during COVID-19.
• There are many subtypes of Dementia and a person with Parkinson’s Disease may have Parkinson’s Dementia or have any of the other subtypes.
• The foundation of treatment is physical exercise and mentally stimulating activities.  Medications for memory and behaviors may also be recommended.
• Education and Supports in the home are key and available through your physician, home supports, local societies, and private support services.

Q. For someone who has dementia with Parkinson’s what changes should be made at home?
A.  Start with making a treatment plan.  That should include daily exercise and mental stimulation.  

Following that, focus on safety.  If they are likely to leave the stove on, maybe remove the knobs.  If they may go out without their keys, maybe leave an extra key in their favorite jacket so they can get back inside.  If someone is likely to wander, look into a GPS tracker so you can locate them quickly and easily.

Not as much needs to happen in terms of the physical changes to the home for Dementia.  Of course, for Parkinson’s there are physical changes that must happen for someone to live at home into the later stages when they are using a walker or wheelchair.

Q. If someone has severe dementia can they ever be alone?
A. Not if there is a safety concern.  Some people with dementia will become relaxed and sedate.  They will be happy to sit by themselves until someone prompts them to do something.  If that is a person’s basic nature, it will be heightened with dementia.  That sort of person may be safe to leave alone for short periods of time.

For someone who is naturally more active and will try to get up on their own or try to do things on their own and not realize that it is not safe.  In the moderate to severe stages of dementia they would not be safe to leave on their own.

Q. Does lack of sleep with Parkinson’s increase the chance of developing dementia?
A.  Poor sleep does have an effect on your blood pressure and cholesterol.  From a physical point of view, it can increase your chance of dementia.

From a psychological point of view, it can also increase your risk of dementia because it does cause more stress.  Lack of sleep is aggravating and can change the chemical balance of your brain, dropping your acetylcholine and serotonin levels, putting you at higher risk for dementia.