Paul Short, Ph.D.

The Parkinson’s Coach

www.theparkinsonscoach.com

NEUROPSYCHOLOGY OF PARKINSON’S COMMUNICATION PROBLEMS

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