Parkinson’s Disease Dementia

held April 3, 2014

SERIES BACKGROUND

Arriving at an accurate diagnosis for both the presence of dementia and then the type of dementia takes time and requires clinicians to look at a variety of factors (Alzheimer’s Disease International, 2009). Recent research reflects a growing understanding of non-Alzheimer’s dementias. While Alzheimer’s disease continues to make up a majority of the dementia diagnoses, studies estimate the prevalence of vascular dementia to be 10-30%, making it the second most common dementia (WHO, 2012, Alzheimer’s Disease International, 2009; Stephan & Brayne, 2008; Alzheimer’s Society, 2007). Estimates for the prevalence of Lewy Body dementia tend to be harder to pinpoint, with some studies estimating prevalence at less than five percent and others estimating it at ten percent or even as high as vascular dementia (Stephan & Brayne, 2008, WHO, 2012, Alzheimer’s Disease International, 2009).

It is estimated that Parkinson’s disease dementia, a type of Lewy Body dementia, affects up to two percent of those over 65 and that of the nearly one million Americans with Parkinson’s, 50-80% will experience the dementia associated with it (Alzheimer’s Association, 2013). Additionally, there is increasing evidence to suggest that mixed dementia, a combination of two or more types of dementia, is more prevalent than previously thought and that it under diagnosed (Stephan and Brayne, dementia public policy; world report).

For these reasons it is important to provide sound, evidence-based training on the different types of dementias, including the origins, symptoms and best practice treatments. Therefore, this series, through virtual training and active learning, seeks to advance the training and workforce development goals of the Virginia Dementia State Plan.

The webinar series will include a pre-recorded 30-minute free lecture that briefly reviews types of dementia and three, live 60-minute free webinars on different types of dementia (Lewy body dementia, vascular and mixed dementias, and Parkinson’s disease dementia) and with a special emphasis on ethnic and racial minorities. This is the second live webinar in the series which discussed in-depth the issues surrounding Parkinson’s disease dementia.

WHAT WILL YOU LEARN (big picture)?

  1. Define Parkinson’s disease dementia
  2. Review characteristics of Parkinson’s disease dementia
  3. Differentiate Parkinson’s disease dementia from other causes of dementia
  4. Review management of Parkinson’s disease dementia

SESSION OBJECTIVES

  • The webinar will review the causes, signs and symptoms, disease trajectory, treatment options, and best practices for caring for the individual with Parkinson’s disease dementia as well as their caregivers.
  • The webinar will pay particular attention to ethnic and racial minorities as well as available supports for individuals.
  • The presenter will provide a case scenario to the webinar attendees and participants will be encourage to answer questions and provide suggestions for how to handle the case.
  • Flashcards will be available to allow participants to test their knowledge before and after the webinar.

PRESENTERS

BarrettM Matthew Barrett, MD, MS, joined the University of Virginia Department of Neurology in August 2012. He received his MD degree from UVA in 2005.

After neurology residency at UVA, he completed a three-year  clinical and research fellowship in Movement Disorders at Beth Israel Medical Center in New York City. During his fellowship, Dr. Barrett also received a Master’s of science in Clinical Research Methods from Albert Einstein College of Medicine.

He is a native of Midlothian, VA.

AngelaTaylorAngela Taylor is the Director of Programs for the Lewy Body Dementia Association.

In 2004, Angela joined LBDA as a member of LBDA’s Board of Directors when she was a caregiver for her father who had Lewy body dementia.

Angela now oversees all of LBDA’s programs and services, advocates to federal agencies on behalf of LBD families, and serves as the liaison to the Scientific Advisory Council.

MODERATOR

Ayn WellefordE. Ayn Welleford, PhDreceived her BA in Management/Psychology from Averett College, M.S. in Gerontology and PhD in Developmental Psychology from Virginia Commonwealth University. She has taught extensively in the areas of Lifespan Development, and Adult Development and Aging, Geropsychology, and Aging & Human Values.

As an educator, researcher, and previously as a practitioner she has worked with a broad spectrum of individuals across the caregiving and long term care continuum. As Associate Professor and Chair of VCU’s Department of Gerontology, she currently works to “Improve Elder Care through Education” through her Teaching, Scholarship, and Community Engagement.

Outside of the classroom, Dr. Welleford provides community education and serves on several boards and committees. Dr. Welleford is former Chair of the Governor’s Commonwealth of Virginia Alzheimer’s and Related Disorders Commission, as well as a recipient of the AGHE Distinguished Teacher Award. In 2011, Dr. Welleford was honored by the Alzheimer’s Association at their annual Recognition Reception for her statewide advocacy.

Dr. Welleford is the author of numerous publications and presentations given at national, state and local conferences, community engagement and continuing education forums. In 2012, Dr. Welleford was appointed to the Advisory Board for VCU’s West Grace Village project. She is also the recipient of the 2012 Mary Creath Payne Leadership Award from Senior Connections, the Capital Area Agency on Aging.

THE WEBINAR

The webinar is a combination of video (showing slides) and audio (available through the computer’s speakers or a telephone dial-in).  PC and Mac platforms are available.  iPADs, iPhones and Android platforms are supported as well.  Instructions on accessing the event will be provided after the registration. The webinar was recorded and slides are posted below.  The recording is open to all and free for all.

Q&A

ADDITIONAL QUESTIONS POSED BUT UNANSWERED AT THE EVENT

We thank Dr. Barrett for the additional time taken to respond to these audience-posed questions.

Q: What are ways to deal with gait issues in PDD?

A: Some of the gait impairment in PDD will improve with levodopa. When imbalance, freezing, and falls are not responsive to levodopa or use of levodopa is limited secondary to pscyhosis or other side effects, then referral for physical therapy can be helpful. Use of a walker may be advised. Exercise to maintain strength and endurance is encouraged and can be directed by a physical therapist to ensure safety.

 

Q: What is the role of heredity in Parkinson’s Disease? Am I more likely to have Parkinson’s if a family member has it?

A: There is a small increased risk of Parkinson disease in those who have a family member with Parkinson disease. It should be noted, however, that the vast majority of patients (>90%) do not have a recognized genetic cause.

 

Q: What is the average age of developing dementia with PD? Do individuals with earlier onset disease develop dementia at that same rate?

A: Because PD patients have symptoms onset at different ages, it is less helpful to consider the average age of dementia in PD. We do know that being older and having longer disease duration are associated with dementia in PD. On average, individuals with earlier onset disease (before age 60) develop dementia later than those who are diagnosed with PD at older ages.

 

Q: Do hallucinations in PDD respond less well to psychotropic medications?

A: Placebo-controlled clinical trials with clozapine (an antipsychotic medication) have demonstrated improvement in hallucinations and psychosis. Improvement in hallucinations has also been reported with quetiapine. In many cases only small doses of either of these two medications are sufficient. I think it is fair to say that hallucinations in PDD respond at least as well to antipsychotic medications as hallucinations seen in other conditions.

 

Q: Please discuss sun-downing or evening hyperactivity in PDD. Please also discuss hypersexuality.

A: Evening hyperactivity or agitation are common in PDD and other dementias. Efforts to reduce stress or other factors that induce agitation in late afternoon and evening is important. These efforts can take multiple forms. Examples include maintaining a quiet, comfortable environment and adhering to a stable daily routine with minimal interruptions. There may be a role for cholinesterase inhibitors because they may reduce behavioral symptoms associated with dementia. Hypersexuality, as much as it is associated with agitation, may be addressed with some of the measures above. Unique to PD and its treatment, hypersexuality may be an impulse control disorder associated with use of dopamine agonists. If this is the case, reduction of dopamine agonists will improve this behavior.

 

Q: What is heterogeneity? A: Heterogeneity means that there is much variability among individuals vs all are the same.

The Other Dementias: Virtual Training and Active Learning on Non-Alzheimer’s Dementias series is made possible through a grant from the Virginia Center on Aging’s Geriatric Training and Education Initiative.

 

LEARN/TEST/PLAY

The window below will provide a variety of options for learning, testing oneself and playing (while learning!).  From the bottom right corner, you can select your options (for learning purposes, we suggest using only the Flashcards and the Test).  Note that a mobile version of this platform is available on Quizlet (for both, iOS as well as androids).

RECORDING

SLIDES

© 2014 by Matthew Barrett. All rights reserved

To download the slides, please click here.