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Differential Diagnosis in Dementia

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Differential Diagnosis in Dementia

By: M.K

Parkinson Disease

Parkinson's disease is a movement disorder that can cause your muscles to tighten and become rigid, making it difficult to walk and engage in daily activities. People with Parkinson’s disease also experience tremors and, in some cases, may ultimately develop cognitive problems, including memory loss and dementia.

Parkinson's disease was first characterized extensively by an English doctor, James Parkinson, in 1817. Today, we understand Parkinson's disease to be a disorder of the central nervous system that results from the loss of cells in various parts of the brain, including a region called the substantia nigra. The substantia nigra cells produce dopamine, a chemical messenger responsible for transmitting signals within the brain that allow for coordination of movement, learning ability, reward feeling, and placebo effect. Decreased dopamine production causes neurons to fire without normal control, leaving patients less able to direct or control their movement and contributes to mood and cognitive disturbances later in the course of the disease. Parkinson's disease is one of several diseases categorized by clinicians as movement disorders.

Parkinson's disease Triggers

In Canada alone there is over 100,000 Canadians affected by Parkinson's disease. It is the second most common neurodegenerative disease (after Alzheimer’s disease). Parkinson’s disease is most commonly found in people who are older than 50; the average age at which it occurs is over 60. But some younger people may also get Parkinson's disease younger than 40, it's called early-onset Parkinson's disease. You may develop early-onset Parkinson's disease because someone in your family has it. The total causes of Parkinson’s disease are unknown; there is no scientifically validated preventive course to reduce the risk of its onset. The single biggest risk factor for Parkinson’s disease is advancing age. Lack or loss of dopamine is also a factor, a chemical that helps the nerves cells communicate within the brain. As the dopamine producing cells die, the brain does not receive the necessary messages about how and when to move. Men have a somewhat higher risk than women.

Parkinson's disease is a chronic and progressive disease. That means that it's a disease that doesn't go away and continues to get worse over time.

Experts don't know what triggers the development of Parkinson's disease most of the time, although some people may be genetically disposed to it.

Symptoms

Parkinson's disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people may not seek medical attention initially. These are common symptoms of Parkinson's disease:

Motor Symptoms of Parkinson Disease

• Tremors that affect the face and jaw, legs, arms, and hands

• Slow, stiff walking ( Bradykinesia)

• Difficulty maintaining your balance

• Problems with coordination

• A stiff feeling in your arms, legs, and torso area

• Changes in handwriting

• Cognitive difficulties

Eventually, Parkinson's disease symptoms get worse and include:

Non-motor Symptoms of Parkinson Disease

• Depression

• Gastrointestinal problems (like constipation)

• Problems with urination

• Difficulty chewing and swallowing food

• Memory loss

• Hallucinations

• Decreased sense of smell

• Dementia

Dementia from Parkinson's disease

Initially, Parkinson's disease causes physical symptoms. Problems with cognitive function, including forgetfulness and difficulty with concentration, may arise later. As the disease gets worse with time, many people develop dementia, which causes profound memory loss and makes it difficult to maintain relationships with others.

Parkinson's disease dementia can cause problems with:

• Speaking and communicating with others

• Being able to solve problems

• Understanding abstract concepts

• Forgetfulness

• Difficulty paying attention

If you have Parkinson's disease and dementia, eventually you probably won't be able to live by yourself. Dementia affects your ability to care of yourself, even if your Parkinson's disease allows you to physically perform daily tasks.

Experts don't understand how or why dementia often occurs with Parkinson's disease. It’s clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson's disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson's disease dementia may be treated with medications also used to treat Alzheimer's disease, another type of dementia.

Diagnosis

Parkinson's disease can be difficult to diagnose, as there isn't one single test that can identify it. It can be easily mistaken for another health condition. A doctor will usually take a medical history, including a family history to find out if someone else has Parkinson's disease, and perform a neurological exam. Sometimes, an MRI or CT scan of the brain can identify other problems or rule out other diseases.

Treatment

Parkinson's disease can't be cured. But there are different therapies that can help control symptoms. Many of the medications used to treat Parkinson’s disease help to offset the loss of the chemical dopamine in the brain. Most of these drugs do help to manage symptoms quite successfully.

A procedure called deep brain stimulation may also be used to treat Parkinson's disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson's disease symptoms, as well. Exercise may have a protective effect by enabling the brain to use dopamine more effectively and improve motor, coordination, balance, and tremors.

Music therapy offers hope for Alzheimer’s, Parkinson’s

Patients with cognitive impairment benefit from singing

More recently Frank Russo, a cognitive scientist doing research at Ryerson University in Toronto, is using new technology to probe the link between sound and the parts of the brain that control movement. H e has found that music might help people with cognitive impairment, including Alzheimer’s and Parkinson’s disease, a study suggests.

Music therapy can help Parkinson's patients walk and people with Alzheimer’s remember, with song lyrics surfacing in the brain even among people who have lost the ability to recognize their own relatives.

Russo is hoping to develop a clearer picture of how music can rehabilitate damaged circuitry and hopes to apply that research to conditions ranging from autism to stroke.

CBC's Kim Brunhuber reports on how music therapy might grow as the population ages at www.cbc.ca/news/credit.html

Prevention

Experts don't yet understand how to prevent Parkinson's disease. In some instances, there seems to be a genetic predisposition to develop Parkinson’s disease, but this isn’t always the case. Research is underway to find new ways to treat and prevent the disease. Research has also shown that a better diet and Coenzyme 10 may slow the progression of early Parkinson. Continued treatment and support networks work towards preventative measures and treatments for those with Parkinson’s disease.

[pic]

Finding help

There are several helpful online resources and support for those struggling with Parkinson disease and their family members for more information about treatments, or need to find support; they can contact the www.parkinson.bc.ca, www.medicinenet.com, or other very helpful online sites.

Programming for Quality of Life

Research is finally showing new facts that music therapy can help alleviate the symptoms of both Parkinson’s, and Alzheimer’s as I have also witnessed myself in this line of work several times. This will definitely implicate my programming towards an even more musical direction in programming including more singing, or live music, dance exercise, and some other activities that I already use with the residents I work with. All of this and more will only add to the activities and the quality of life for those participating in them. As research on this subject advances to better the lives of those involved so to will the programming in activities help those involved have a better quality of life.

-----------------------
The Individual with Parkinson disease and their family

Neurologist,
GP
Nurse

Physiotherapist
Occupational Therapist
Speech Language Therapist

Pharmacist
Councilor
Social Worker

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