Posted in Patients

Cognitive impairment in Parkinson’s Disease


Taken from

Cognitive impairment, disturbance of memory, thinking and/or language abilities, is a non-motor symptom that can be associated with Parkinson’s. Cognitive disturbances can arise at any time in the course of Parkinson’s disease (PD) and vary widely in severity. Some people don’t experience any problems; others have subtle changes only detectable on formal testing. Still others have issues they describe as mild or somewhat annoying, and some will go through more significant changes that interfere with the ability to perform daily activities.

Cognitive impairment in PD primarily impacts “executive function,” which can lead to difficulty with:

  • Multitasking
  • Planning and organizing
  • Problem solving

Attention, thought processing and word finding also are commonly affected.

  • What is mild cognitive impairment and how is it managed?
  • What is dementia and how is it treated?
  • Why do cognitive changes occur?
  • How are cognitive changes evaluated?
  • How is brain health maintained?
  • What is the current research surrounding cognition and Parkinson’s?

Managing Mild Cognitive Impairment

When cognitive problems are more than what is expected with normal aging but not enough to significantly interfere with daily activities, they may be due to mild cognitive impairment (MCI). This non-motor symptom occurs in about 30 percent of people with Parkinson’s. Those with MCI may complain of feeling distracted or forgetful, or losing their train of thought in conversation. Individuals in fast-paced jobs might find it more challenging to concentrate or manage multiple projects.

No medications are currently available to treat MCI. Adaptive strategies — making notes, relying on a calendar, keeping objects (such as keys) in the same location to avoid misplacing them — can help. Your doctor may recommend cognitive rehabilitation, in which a therapist teaches memory exercises through a structured program.

Mild cognitive impairment can, but doesn’t always, progress to dementia.

Diagnosing and Treating Dementia

Dementia is a decline in memory, thinking and/or language abilities severe enough to interfere with daily routines, job performance or social functions. The dementia associated with Parkinson’s disease (PDD) tends to impact executive skills; visuospatial function (interpreting where objects are in space); and, to a lesser extent, short-term memory. It may also affect motivation, mood and behavior, and can be associated with visual hallucinations (seeing things that aren’t there) or delusions (firm, false, often paranoid, beliefs). If dementia does develop, it is often in the later stages of Parkinson’s disease.

It can be difficult to differentiate PDD from Alzheimer’s dementia (since there is no specific test to diagnose either), although Alzheimer’s typically causes more pronounced memory loss and confusion, and also lacks the motor symptoms of Parkinson’s (although stiffness and slowness may develop in very late stages). When dementia starts at the same time or within a year of the onset of Parkinson’s motor symptoms, Lewy body dementia (LBD), a form of atypical parkinsonism, may be the cause. LBD is characterized by dementia and the motor symptoms of Parkinson’s as well as fluctuating levels of alertness and visual hallucinations. (Read more about LBD here.)

Medications may ease the symptoms of dementia. Exelon (rivastigmine) is FDA-approved for the treatment of mild to moderate levels of PDD. It works by blocking an enzyme that breaks down acetylcholine, a brain chemical that supports cognition. The drug may therefore improve cognition, lessen associated behavioral changes (such as agitation or aggression) and delay the need for alternative living situations, such as nursing homes. (Read more about this medication on the Non-motor Medications page.) In some situations, your doctor may prescribe other medications that work in the same manner, such as Aricept (donepezil), which is used for Alzheimer’s dementia.

Why Cognitive Changes Occur

The exact causes of cognitive impairment and dementia in PD are not fully known but are likely due to a combination of chemical and structural changes. In addition to dopamine, Parkinson’s affects a number of brain chemicals — acetylcholine, norepinephrine and serotonin — that support cognition, attention and mood. Parkinson’s also causes loss of and/or changes in cells in areas of the brain that are responsible for these functions.

Evaluating Cognitive Problems

The first step to evaluating cognitive impairment is letting your doctor know that you’re concerned. It may be normal aging, Parkinson’s or a separate medical condition, but you can’t figure it out unless you bring it up. Doctors will ask about mood disturbances, such as depression or anxiety, and sleep problems, as these can impact memory and require different evaluation and management strategies. They’ll review your prescription and over-the-counter medications to ensure that these aren’t contributing to cognitive problems. (Anticholinergic and pain medications commonly contribute to memory and thinking issues.)

No brain imaging or blood tests can specifically diagnose MCI or PDD, but tests may exclude other conditions, such as thyroid problems or vitamin B12 deficiency, which also can affect cognition. Your doctor may recommend formal detailed memory testing — neuropsychological testing — to determine exactly what problems might be present and establish a baseline for future comparison.

Maintaining Brain Health

While there is no definitive practice or therapy to prevent cognitive impairment, there are actions you can take to promote a healthy brain, including regular exercise and healthy diet. Some studies suggest that by adopting an “active cognitive lifestyle,” individuals may be able to slow cognitive decline. Practice mentally challenging tasks such as completing crosswords or puzzles, learning to speak a foreign language or playing a new instrument to “work out” your brain. Attend a get-together where you’ll have to remember the names of new acquaintances and make conversation about current events. This has the added benefit of keeping you social.

Ongoing Research in Cognition and Parkinson’s

Researchers are trying to learn more about why cognitive dysfunction occurs in Parkinson’s. At the same time, they are looking for better ways to diagnose, monitor and treat these problems. Several therapies, including aerobic exercise, physical therapy, medications and cognitive rehabilitation programs, are currently being studied to determine if they can treat cognitive problems in Parkinson’s. One drug, which works on the serotonin chemical pathway, is recruiting for a Phase II trial for PDD, which brings us one step closer to potentially addressing an unmet need in Parkinson’s.

Posted in Patients

Nine ways to build emotional strength

Image result for emotional strength

There may come a time in your life when your emotions have been depleted, and you need to find ways to recharge yourself so you can continue to lead a good life. When you are emotionally exhausted, it is difficult to get anything done. Here are some tips to help you reenergize your emotional being.

  1. Realize where you are. We all have transition times in our lives, and when we are in the middle of one of them, it can be hard to see what is really going on. You may be feeling disconnected from your work, or perhaps you are mentally exhausted, which is an uncomfortable emotional experience.
  2. Get some counseling. When you are not feeling yourself, it may require an outside perspective to give you the information you need to take action or to stop doing something that is no longer benefiting you. It can be hard to see that even though you may love something, it might not be good for you at this time.
  3. Calm yourself. Whatever self-soothing techniques you have learned or used in the past, now is the time to dust them off and start your process again. Building emotional strength requires daily exercise, just like building physical strength. Whether you meditate daily, or journal, or simply have a quiet cup of tea in the backyard, it will help to recharge you.
  4. Hang out with people who love you. This may actually be difficult if you are in a wounded place and don’t want your loved ones to see you this way, but it really is a great healer. You could say, “Hey, I’m kind of low energy today and need a break. How would you feel about just hanging out?” This will let them know where you are without giving details, and you can have a relaxing day.
  5. Get a complete physical. There may be a physical cause to your emotional depletion, and I recommend you get a medical doctor to look you over. Sometimes just the reassurance from a licensed practitioner is all you need to start getting your strength back.
  6. Try something different. It has been proven that doing new things increases your connection with life and those close to you. If you have never been camping, now may be a good time to sleep under the stars and commune with nature. Just reviewing your bucket list will help you decide what adventure you want to take.
  7. Write down your worries. Getting your pain on paper can give you some perspective on what is going on. Don’t rush through this, but give yourself a couple of days to make a complete list. Then start crossing off things as you take care of them.
  8. Write down what is working for you in your life. Also list what you know about who you are: your good points. Compare your worry list with your list of what’s working, and hopefully the balance is in your favor. If not, then use what you have on the good list to shrink the worry list.
  9. Take a break. It’s possible you just need a staycation for a few days (or a couple of months) to let things settle or discover an answer to your issues. People who don’t take vacations tend to burn out, so save yourself from that pain by taking a rest when you need to, even if you don’t really think that you do.

I’ve only scratched the surface here. There are so many other tools. The most important thing is that you are aware of what you are going through at this stage of your life. Your feelings may make complete sense, but if not, you now have some tools to move your life forward.

By Barton Goldsmith, Tribune News Service


Posted in Patients

MIND Diet Repeatedly Ranked Among Best (this is helpful for PD patients)

Included seven times in U.S. News & World Report’s ‘Best Diets’

By Nancy DiFiore
January 5, 2016

A diet created, studied and reported on by researchers at Rush University Medical Center has been ranked the easiest diet to follow and the second best overall diet (tying in both categories) for 2016 by U.S. News & World Report. The MIND diet also tied for third for best diet for healthy eating and was ranked in the top five in five categories and the top 20 in seven, as follows:

  • Easiest Diets to Follow: No. 1 (tie)
  • Best Diets Overall: No. 2 (tie)
  • Best Diets for Healthy Eating: No. 3 (tie)
  • Best Diets for Diabetes: No. 4 (tie)
  • Best Heart-Healthy Diets: No. 4
  • Best Weight-Loss Diets: No. 16 (tie)
  • Best Fast Weight-Loss Diets: No. 21 (tie)

Now in its sixth year, the annual “Best Diets” list provides the facts about 35 chosen eating plans and ranks them on a range of levels, from their heart healthiness to their likelihood to help with weight loss. To create the annual rankings, U.S. News editors and reporters spend months winnowing potential additions to the diet roster and then mine medical journals, government reports and other resources to create in-depth profiles. Each profile explains how the diet works, whether or not its claims are substantiated, scrutinizes it for possible health risks and examines what it’s like to live on the diet, not just read about it.

Eating away at Alzheimer’s risk

The MIND diet is a research-based diet developed by Martha Clare Morris, ScD, a Rush nutritional epidemiologist, and her colleagues. In recent studies, the MIND diet showed that it helped lower the risk of Alzheimer’s disease by as much as 53 percent in participants who adhered to the diet rigorously, and by about 35 percent in those who followed it moderately well.

“One of the more exciting things about this is that people who adhered even moderately to the MIND diet had a reduction in their risk for Alzheimers,” Morris says. The researchers also have found that adhereing to the diet may slow cognitive decline among aging adults, even when the person is not at risk of developing Alzheimer’s.

The name of the MIND diet is short for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay. The diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets.

Both diets have been found to reduce the risk of cardiovascular conditions, like hypertension, heart attack and stroke. Some researchers have found that the two older diets provide protection against dementia as well.

Morris and her colleagues developed the MIND diet based on information that has accrued from years’ worth of research about what foods and nutrients have good, and bad, effects on the functioning of the brain.

A wine and no cheese party

The MIND diet has 15 dietary components, including 10 “brain-healthy food groups” and five unhealthy groups — red meat, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

To adhere to and benefit from the MIND diet, a person would need to eat at least three servings of whole grains, a green leafy vegetable and one other vegetable every day — along with a glass of wine — snack most days on nuts, have beans every other day or so, eat poultry and berries at least twice a week and fish at least once a week. In addition, the study found that to have a real shot at avoiding the devastating effects of cognitive decline, he or she must limit intake of the designated unhealthy foods, especially butter (less than 1 tablespoon a day), sweets and pastries, whole fat cheese, and fried or fast food (less than a serving a week for any of the three).

Berries are the only fruit specifically to be included in the MIND diet. “Blueberries are one of the more potent foods in terms of protecting the brain,” Morris says, and strawberries also have performed well in past studies of the effect of food on cognitive function.

“The MIND diet is a modification of the Mediterranean and DASH diets that highlights the foods and nutrients shown through the scientific literature to be associated with dementia prevention,” Morris says. “There is still a great deal of study we need to do in this area, and I expect that we’ll make further modifications as the science on diet and the brain advances.

“We devised a diet and it worked in this Chicago study,” she adds. To establish a cause-and-effect relationship between the MIND diet and reductions in the incidence of Alzheimer’s disease, “The results need to be confirmed by other investigators in different populations and also through randomized trials.”

From Rush University Medical Center News Features