Download Remaining Social while living with Parkinson`s Disease

Travis H. Turner, Ph.D.
Neuropsychologist
Ralph H Johnson VAMC, Charleston SC
Depts. of Psychiatry & Neurosciences, MUSC
What do these animals have in
common?
Overview
 Rationale
 Challenges particular to Parkinson’s
disease
 Tricks of the trade
The speaker, Travis H. Turner, has no disclosures
Social activity increases with age in
older adults
Cornwell, Laumann, Schumm 2008
Social activity is critical for
maintaining cognitive functioning.
 Bassuk, Glass, & Berkman 1999 Study - QUALITY
 n=2812 Adults 65+ followed over 12 years (‘82-’94)
 Cognitive decline 2x at 3, 6, and 9 year follow-ups in socially
isolated older adults
 MacArthur Studies of Successful Aging - QUANTITY
 n=4030 high functioning adults 70-79 years of age (’88-’96)
 Quality of social support predicted better cognitive functioning
 Baltimore Memory Study – ENVIRONMENT = GENETICS
 1140 adults 50-70 years of age
 Poor social environment as predictive of cognitive deficits as key
genetic marker for Dementia (APOE-4), and combination
Social activity is critical for motor
functioning.
Buchman, Boyle, …Bennett 2010
Not lonely (10th percentile)
Lonely (90th percentile)
“One must imagine Sisyphus happy.” – Albert Camus
Challenges of socializing with
Parkinson’s disease – the obvious
 Mobility
 Tremor
 Speech
 Expressing emotion
 Medication schedule
 Alcohol
 Fatigue
 Mental clarity
Challenges of socializing with
Parkinson’s disease – Apathy?
Apathy – lack of interest, enthusiasm, or concern
Anhedonia – diminished ability to experience pleasure
 Dopamine is key neurotransmitter for binding activity or
behavior to experience of pleasure and prediction of
pleasure
 Dopamine levels are disturbed in motor and reward
pathways in PD
 PD patients with depression show less response to Ritalin
(dopamine reuptake inhibitor) than PD patients w/out
depression and patients with depression (Cantello et al., 1989)
 Mirapex (dopamine agonist) reduces anhedonia in PD patients
with and without depression(Lemke et al. 2005)
 “Going through the motions”
Challenges of socializing with
Parkinson’s disease – Anxiety
 Anxiety disorders present in about 25% of PD patients
 Social anxiety
 Concern regarding presentation of motor symptoms in public
 Altered autonomic reactivity can precipitate panic attacks
 Performance pressures exacerbate motor symptoms
 Physiological mechanisms:
 Sleep disturbance
 Frustration
 Reduced dopamine
 Disturbed noradrenaline and serotonin functioning
Hearing Loss (presbycusis)
 Auditory sensitivity declines from age 30 onward
 Rate of decline 2x faster in men, especially for sounds
frequencies 1000-17,000Hz (human speech)
 Recent studies suggest greater hearing loss associated with
Parkinson’s disease
 Worse with medication? (Pisani et al. 2015, PMID: 26071125)
 Related to α-synuclein? (Vitale et al., 2012, PMID: 23032708)
 Result
 Feeling “out of the loop”
 Increased rates of depression (Davis et al., 2016, PMID: 26994265)
 Appearance of problems with concentration and memory
Loneliness in PD Caregivers
(McRae, Fazio, Hartsock, Kelley, Urbanski, & Russel 2009)
 PD caregivers reported similar level of loneliness as
caregivers for adults with Alzheimer’s dementia
 Patient characteristics accounted for only 12% of variability
in caregiver loneliness
 Caregiver variables accounted for 46% of variability
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Lower education
Lower sense of self-efficacy
Poor physical health
Less social support
NOT attending PD support group
Patient
12%
42%
46%
Caregiver
Unknown
Quick Summary
 Social isolation is NOT part of the normal aging
process
 Social activity is critical for cognitive health
 Patients with Parkinson’s disease face significant
challenges in socializing due to motor and
neuropsychiatric complications
 Caregivers of patients with Parkinson’s disease are
susceptible to loneliness, but there are opportunities
for intervention
Timing is everything
 Optimal time of day for symptoms
 Time of day for location (less crowds)
 Medication window
 Length of activity
 ALLOW EXTRA TIME TO PREPARE!!!
Location, location, location
 Open space
 Quiet location
 Limited clutter
 Avoid stairs
 Limit drive time
 Parking
 Restaurants with finger foods
Activities
 Smaller groups (especially with hearing loss)
 Physical activity if possible
 Parkinson’s groups yes, but not exclusively
 Challenge perceived limitations
Setting Realistic Expectations
 With anhedonia, the emotional experience is
diminished, but value for others is huge
 Athletic performance is unlikely to be the same
 Sometimes it won’t be fun
 You may not experience any obvious benefits
 The desired result is socializing – not a tangible
product
Psychiatric complications are common in
Parkinson’s disease
 Psych symptoms often precede motor symptoms
 Depression – 1/3 of all PD patients with major
depressive disorder
 Affects desire to engage and ability to enjoy social
interactions and other activities
 Not just a reaction to disease and limitations
 Anxiety – 1/4 or more PD patients with
 Generalized Anxiety
 Panic Disorder
 Social Phobia
Medications (Veazy et al., 2005; MDS Task Force 2010)
 SSRIs
 Tricyclic Antidepressants (TCAs)
 Selegiline
 Buproprion (depression and fatigue)
 Benzodiazapines (for anxiety, but cognitive side effects)
 Seroquel (psychotic symptoms, agitation, & sleep)
 Modafinil (sleepiness and mood)
 Mirapex
 Omega-3 (EPA and DHA)*
Psychotherapy for Parkinson’s Disease
(Yang, Sajatovic, & Walter 2012).
• Review of 8 studies examining effectiveness of
psychosocial interventions for PD.
• 5 of 8 studies were based on Cognitive
Behavioral Therapy (CBT).
•
8-12 weeks of treatment
•
All studies using CBT showed significant
improvement in mood symptoms
•
Extent of improvement (i.e., amount of change
and percentage of responders) consistent with
benefits seen from pharmacological intervention
Conclusions
 Social activity is critical for healthy cognitive, motor,
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and emotional functioning
Parkinson’s disease can present significant challenges
for remaining socially active
With some planning, social activity can be facilitated
Mood and anxiety problems are extremely common in
Parkinson’s disease and can interfere with socializing;
HOWEVER, symptoms are very treatable
Medications and psychotherapy can help with mood /
anxiety, as well as improve experience of socializing
Thank You!