Mental Health & Parkinson's: Breaking the Stigma
I thought that I would write about this crucial issue which is often overlooked or swept under the rug for fear of the stigma of being labeled mentally 'diseased'.
No one knows more about this topic than I; having dealt with numerous patients over the years as well as treating both my grandparents, one of whom had vascular dementia and the other psychosis due to Parkinson's disease (PD) and a brain tumor.
Dementia in Parkinson's disease
As a PD patient, the stakes of possibly developing psychotic symptoms are high since it is believed that up to 80% of those of us with PD for more than 20 years will eventually develop dementia.1
As a high functioning professional with in-depth knowledge of brain function, the notion of losing mental control for me can be paralyzing. This is especially true if I were to give in to the idea that there is no recourse or prevention even as my brain has continued to atrophy over the last decade.
Yet, my personal experience has dictated otherwise. The brain is an enigma not fully deciphered. It possesses a great unimaginable capability of regeneration, restructuring, and a great deal of redundancy. All of which we are just beginning to discover.
I have suffered psychosis due to Parkinson’s having experienced, visual, tactile, olfactory, and gustatory hallucinations at one time or another. But my brain is as sharp as ever - a bit slower but no less capable.
Addressing psychotic symptoms
Your healthcare team and family cannot help and find a solution if you hide the problem or are too scared to talk about it. Sure, seeing things when you are fully aware they are not real CAN be a frightening experience.
Once I had hallucinations with Requip. I thought, "Oh my, I am on a one-way track for getting dementia." But, then again this had happened with Vicodin post-surgery 15 years earlier. My cognitive functioning had not changed in that time. So we must keep our wits about us. Make note of the situation and discuss with your physician - often these symptoms are medicine-induced.
Although, if you have hallucinations early on in the disease or with every dopamine agonist and anticholinergics, then there is a likelihood that we are not dealing with typical Parkinson’s. Psychosis is common in PD and most times aside from discussing with your doctor there is no need to treat unless frightening; once underlying problems like thyroid disease, structural abnormalities, infections, or seizures have been excluded.
Types of delusions
Two types of delusion are often common with PD, persecutory and jealous nature. These are much more serious because they can cause problems like anxiety and depression for the patient. They can also cause a rift in the relationship with a spouse or caregiver.
I have suffered delusion secondary to amantadine in the form of unfounded jealousy. When someone has this problem, talking to a physician ASAP is important.
Once other causes are eliminated, then treatment can be started. This is the one indicator of underlying dementia if no known cause can be found as a trigger.
Mental health counseling and treatment
Along with medication for psychosis, patients and caregivers should undergo mental health counseling. Patients should also have a neuropsych evaluation and consider starting treatment for dementia.
Although, no cure is known and the only FDA approved medicine for PD dementia is Exelon, in my experience starting any of them early can significantly delay disability and the progression of cognitive symptoms.
Remember, it is only your future happiness and well-being you are putting at risk by not admitting there is a problem or asking for help. If a neurologist can admit when her brain seems a bit out of whack and still maintain her legitimacy and well-being – so can you.
Do you live with any sleep disorders (eg. insomnia, RLS, sleep apnea) in addition to PD?