December 2023

Facing Dementia in Parkinson’s Disease

“Peter, did you want the burner on?” Pam wanted to know. Crap! I’d forgotten all about the burner I had left on—a bad move unless you want to burn your house down. The questions flood forth. Do you want to burn the house down?  Can you be trusted to cook anymore on the electric range? Is this the onset of Parkinson’s dementia, or just garden variety absentmindedness? What can I do about it?

Dementia is a less-discussed complication of Parkinson’s Disease. This is hard to understand, given that a majority of people with Parkinson’s Disease will be facing dementia after living 10 years with PD.

According to the Johns Hopkins medical Website, “Parkinson’s Disease dementia can cause problems with:
Speaking and communicating with others
Problem solving
Understanding abstract concepts
Paying attention
Changes in memory, concentration and judgment.

It goes on to say “If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.”

The Alzheimer’s Association notes the following features of PD dementia:

Trouble interpreting visual information.
Muffled speech.
Visual hallucinations.
Delusions, especially paranoid ideas.
Depression, irritability, and anxiety.
Sleep disturbances, including excessive daytime drowsiness and rapid eye movement
(REM) sleep disorder. 

One large study found that about three-quarters of people who live with Parkinson’s for more than 10 years will develop dementia. Before they develop dementia, they experience milder cognitive changes called mild cognitive impairment (MCI). Among individuals with normal cognition at Parkinson’s diagnosis, about 30% will develop MCI after five years. However, cognitive changes and when they occur vary from person to person.

Well, this is not encouraging. What, if anything, can we do about this wretched state of affairs?

Surprise! There is hope to be found in exercise! According to the Practical Neurology Website, “Around a third of dementia cases are attributable to modifiable risk factors such as physical inactivity, smoking and hypertension.” The site goes on to observe, “Exercise has emerged as a key intervention for influencing cognition positively, including reducing the risk of age-related cognitive decline and dementia.”

There are other risk factors for dementia that are also under your control.  According to the Alzheimer’s Society, a roundup of test results for dementia interventions found, “Of the five behaviors that were assessed (regular exercise, not smoking, moderate alcohol intake, healthy body weight and healthy diet), exercise had the greatest effect in terms of reducing dementia risk. Overall, people who followed four or five of the above behaviors were up to 60 percent less likely to develop dementia. Further, they found “a month or more of regular aerobic exercise resulted in improvements in memory, attention and processing speed.”

Given what we have learned about the benefits of exercise on motor symptoms of Parkinson’s, it’s not too surprising that it might be beneficial for non-motor symptoms as well. But this is not a well-explored idea in PD medicine and begs for further study.

What if exercise doesn’t work, what then?

One thing we can do is seize the present. Because the future is not guaranteed, we must make the most of the good time we have. Spend it with friends and those you love. You will make memories for others, even if you cannot remember those moments forever yourself.

by Peter Dunlap-Shohl
NW Parkinson’s Blogger

“It is the work of the creative to be a prosthetic imagination for the distracted and the dull”
– Maxwell Hubert Maxwell, playwright, butterfly collector, amateur surgeon and snob.