Download Neuropsychology of Parkinson`s Communication Problems

NEUROPSYCHOLOGY OF PARKINSON’S
COMMUNICATION PROBLEMS
Paul Short, Ph.D.
The Parkinson’s Coach
www.theparkinsonscoach.com
WHAT IS PARKINSON’S
DISEASE?
PARKINSON’S DISEASE (PD)
• A Movement Disorder Marked by varying
combinations of
• Tremor
• Bradykinesia
• Muscle Rigidity
• Postural Instability
PARKINSON’S DISEASE (PD)
• Centered in upper midbrain in the
Substantia Nigra
PARKINSON’S DISEASE (PD)
• Substantia Nigra experiences loss of
neurons producing the neurotransmitter
dopamine
PARKINSON’S DISEASE (PD)
• Centered in the upper brain stem in the
Substantia Nigra
LIVING IN THE WORLD
OF PARKINSON’S
TREATMENT OF PARKINSON’S
DISEASE
• Exercise
• Diet & Nutrition
• Stress Management
• Education
• Social Support
EARLY STAGE PARKINSON’S
TREATMENTS
• Amantadine
• Side Effects/Complications
DOPAMINE AUGMENTATION
• Dopamine Agonists
• Mirapex
• Requip
• Side Effects/Complications
• Sudden sleep (Mirapex)
• Potential for inccrease compulsivity
DOPAMINE REPLACEMENT
• Levodopa
• Dopamine will not cross blood-brain barrier
• Precursor for dopamine can be transmitted to
CNS
• Can cause nausea so combined with
carbadopa
• Carbadopa/Levodopa is the primary treatment
for advanced PD
DOPAMINE REPLACEMENT
• Complications/problems
• Protein can interfere with absorbtion
• Sensitivity can cause dyskinesias and
dystonias over time.
DEEP BRAIN STIMULATION
• Surgery implants leads into mid-brain
structures
• usually the subthalamic nucleus or globus
pallidus
• Patient awake during surgery
• Treatment must be done by a skilled
programmer
DEEP BRAIN STIMULATION
• Advantages
• Constant stimulation much like steady
dopamine treatment
• Manages medication-induce dyskinesias
• Programming can be done far into the
disease process
DEEP BRAIN STIMULATION
• Disadvantages/complications
• Can affect memory and verbal fluency
• Generally not recommended for patients with
dementia
• Best programming sometimes causes
dysarthria
• Cannot have MRIs
PARKINSONISM- THE “PARKINSON’S PLUS”
SYNDROMES
• Parkinson’s like movement disorder with other
medical concerns
• Typically more severe than PD
• Sometimes not as responsive to regular PD
treatments
• Death often occurs several years after
diagnosis
PARKINSONISM- THE “PARKINSON’S PLUS”
SYNDROMES
• Progressive Supranuclear Palsy (PSP)
• Bradykinesia and rigidity without tremor
• Postural instability with falling early in disease course
• Gaze palsy
• Dysphonia, dysphagia, dysarthria, chewing problems
• Cognitive problems
• Slowed thought process, forgetfulness
• Executive dysfunction such as perseveration
• Personality changes (apathy, irritability)
PARKINSONISM- THE “PARKINSON’S PLUS”
SYNDROMES
• Multiple Systems Atrophy (MSA)
• Tremor, Rigidity, Loss of Muscle Coordination
• Autonomic dysfunction such as fainting, loss of bladder control,
temperature regulation, and blood pressure
• Speech problems such as vocal cord paralysis
• Dysphonia, dysphagia, dysarthria, chewing problems
• Less Cognitive involvement than PD and PD+
• Attentional problems and slowed thinking
• Executive dysfunction such as set-shifting
• Some verbal fluency concerns
PARKINSONISM- THE “PARKINSON’S PLUS”
SYNDROMES
• Corticobasal Degeneration (CBD)
• Akinesia, Rigidity, Balance Problems, Apraxia, Myoclonus
• Problems with Speech Fluency and Dysphagia
• Cognitive Changes (Variable)
• Sustained Attentional problems
• Phonological deficits and progressive non-fluent aphasia
• Dementia in Later Stages
PARKINSONISM- THE “PARKINSON’S PLUS”
SYNDROMES
• Parkinson’s Disease Dementia (PDD) & Dementia with Lewy
Bodies (DLB)
• Both involve Lewy Bodies
• PDD is a progression from PD but in DLB motor symptoms
tend to occur only a year or two before cognitive dysfunction
• More common in older onset patients with rigidity, gait, and
postural disorders.
• Rarer in tremor-dominant onset
PARKINSONISM- THE “PARKINSON’S PLUS”
SYNDROMES
• Parkinson’s Disease Dementia (PDD) & Dementia with Lewy Bodies
(DLB)
• REM sleep behavior disorder very common
• Recurrent Visual Hallucinations
• Fluctuating cognition, primarily variable attention and focus
• Perception problems primarily visuospatial
• Memory Problems
• Executive dysfunction
• Problems with semantic fluency
• Abstract reasoning and cognitive flexibility
DIMINISHED
COMMUNICATION IN
PARKINSON’S DISEASE
EXPRESSIVE COMMUNICATION DEFICITS WITH
PARKINSON’S DISEASE
• Diminished prosody
• Hypophonia
• Reduced social contact
RECEPTIVE COMMUNICATION DEFICITS IN PD
DIMINISHED EMOTION DECODING
• Diminished emotion decoding
• Many individuals with PD have difficulty:
• Interpreting emotions implied by facial expression.
• Interpreting emotions implied by vocal intonation and
prosody
• Alexithymia- tendency not to think about emotion
RECEPTIVE COMMUNICATION DEFICITS IN PD
• Diminished emotion decoding
• Many individuals with PD have difficulty:
• Interpreting emotions implied by facial expression.
• Interpreting emotions implied by vocal intonation and
prosody
RECEPTIVE COMMUNICATION DEFICITS IN PD
DIMINISHED EMOTION DECODING
• Diminished emotion decoding
• Many individuals with PD have difficulty:
• Interpreting emotions implied by facial expression.
• Interpreting emotions implied by vocal intonation and
prosody
• Being attuned to emotional signals in general
(alexithymia)
RECEPTIVE COMMUNICATION DEFICITS IN PD
EXECUTIVE DYSFUNCTION
• Executive function deficits impacting communication
• Impaired Verbal Fluency
• Difficulties with organization and execution
• Anhedonia
• Metacogntion
RECEPTIVE COMMUNICATION DEFICITS IN PD
DEMENTIA
• Many of the communication problems of dementia reflect more
severe executive dysfunciton