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Tuesday, August 4, 2015
Depression or Parkinson`s
My father had been helping me take care of my children up until about 4 years ago. About 4 months after he moved out and into a place of his own he started having memory loss and stiffness. He was diagnoses with Parkinson`s Disease due to the stiffness but none of the drugs that he has been given do anything for him. As a matter of fact he has been taken off most of the Parkinson`s medication and is less stiff now then he was when he was taking Sinemet and Stalevo. He takes two doses of Stalevo 50 a day and he moves well before he takes his meds in the morning and after he takes them he can barely move and just stares off into space. Can you help me understand the lack of movement after the meds are given.
There several disorders that have similar features as idiopathic Parkinson's Disease (PD) and fall in a broader category of disorders we term Parkinsonian Syndromes. These syndromes commonly share the 4 cardinal parkinsonism symptoms of:
- slowness of movements
- postural instability
- and tremor.
With regards to mentation, it is fairly common for people with PD to have cognitive slowing. Basically, this refers to people needing more time to process information and respond. In addition, people with PD have difficulty multitasking, and also trouble processing more than one thing at a time. As PD patients get older they may also develop cognitive impairment. There are many medications that can worsen cognition and potentially induce confusion, delusions or hallucinations. This can also occur with some of the medications used to treat PD symptoms and need to be monitored by the physician prescribing the medication.
Aside from PD, there are atypical Parkinsonian syndromes that include progressive supranuclear palsy, corticobasalganglionic degeneration, and multiple system atrophy. These diseases often are associated with cognitive issues early in the disease. Because of the disease process with these syndromes, it is not uncommon to see worsening cognition with various types of medications, including those used to treat PD. The worsening cognition can sometimes be more debilitating than the motor symptoms of the disease. In addition to monitoring for changes in cognition, patients should also monitor their blood pressure since this can also be affected. A patient experiencing any trouble with any certain Parkinson's medication needs to discuss possibly lowering the dose or stopping the medication with their doctor.
There are no specific diagnostic studies to diagnose PD at this time, and we rely on clinical history and examination to make a diagnosis. PD typically responds to dopamine replacement, as do atypical Parkinsonian syndromes to a lesser extent. With all patients, it can sometimes be a fine balance treating the motor symptoms of disease with medications without worsening cognition.
Punit Agrawal, DO
Assistant Professor of Neurology
College of Medicine
The Ohio State University