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Non-motor Complications of Parkinson’s Disease and Management Valerie R. Suski, DO University of Pittsburgh Department of Neurology Pittsburgh Institute.

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Presentation on theme: "Non-motor Complications of Parkinson’s Disease and Management Valerie R. Suski, DO University of Pittsburgh Department of Neurology Pittsburgh Institute."— Presentation transcript:

1 Non-motor Complications of Parkinson’s Disease and Management Valerie R. Suski, DO University of Pittsburgh Department of Neurology Pittsburgh Institute for Neurodegenerative Diseases UPMC Comprehensive Movement Disorders Clinic

2 Importance Affects quality of life, hospitalization rates, and relationships. Correlate with advanced age, duration and severity of the disease Under-reported

3 Insomnia –Sleep fragmentation/Frequent and early arousals –Causes: slowed movements during the night Changes in sleep/wake cycle Difficulties turning in bed or adjusting blankets Pain, cramps, nocturnal and early morning dystonia frequent need to pass urine –Treatment Melatonin, sleeping pills Long acting Parkinson’s meds Bladder medications Changing timing of the medications

4 Restless Leg Syndrome –12-20% more prevalent –may be common in off-state in patients with motor fluctuations –Made worse with medications: tricyclic antidepressants, selective serotonin reuptake inhibitors, lithium, caffeine, neuroleptics, H2 blockers Diseases/conditions: Kidney disease (particularly end-stage), iron deficiency, neuropathy –Check serum iron, ferritin, magnesium, B12, folate levels –Treatment: Parkinson’s meds, antiseizure meds, tranquilizer, opiods, supplementation (if deficient)

5 Excessive Daytime Sleepiness up to 50% caused by Medications Sleep Apnea Sleep Attacks – decrease dopamine agonist Poor sleep hygiene

6 REM Sleep Behavioral Disorder –Preclinical symptom –dream-enacting behaviors laughing, talking, shouting, kicking, fighting invisible enemies –Precipitated or worsened by antidepressants –Treatment Medications Safeguard bedroom, twin beds

7 Hallucinations –Up to 40% –risk for nursing home placement –What makes you prone to have these? infection, medications Sudden withdrawal of PD meds Chronic memory problems Deteriorating vision (macular degeneration, cataracts)

8 Managing Altered Mental States Reduce/eliminate meds: –Anticholinergics– Sedatives –Amantadine – Muscle relaxants –Sleeping pills – Bladder medication Reduce dosage of PD meds Initiate anti-psychotic therapy

9 FATIGUE Can be associated with –Disease progression –Low blood pressure –Depression –Excessive daytime sleepiness, sleep disturbances Treatment –Sleep hygiene –Antidepressants –Medications –Increase water intake, BP management

10 Depression –10-45% –Preclinical symptom Primary disorder Secondary disorder –Treatment medications psychotherapy Stress release Combination of therapy

11 Anxiety –Preclinical symptom –panic attacks, phobias, or generalized anxiety disorder –Treatment Primary anxiety disorder: benzodiazepines “Secondary anxiety disorder:” Associated with “off-periods” or low-levodopa levels: adjust levodopa dosing

12 Memory Loss Up to 40% progressive clinically characterized Treatment Cholinesterase Inhibitors – may worsen tremors

13 Orthostatic Hypotension Light-headedness, dizziness, fatigue, shoulder or neck pain; blood pressure drops when standing Treatment –Frequent orthostatic measurements –Taper anti-hypertensives, non-PD drugs –Increase water/salt intake –Compression stockings –Medication

14 Constipation Causes Slowing down of the GI tract decreased fluid intake -2  urinary frequency or incontinence (?) Decreased activity Side effect from PD medication –Anticholinergics –Dopaminergic therapy Treatment Stool softeners, increase water intake, dietary bulk, exercise, laxative, lactulose, in some case enemas

15 Nausea Cause/Treatment Levodopa-related: take with meals, add carbidopa, Add antinausea meds delayed GI transit time: more frequent and smaller meals

16 Bladder Urinary Incontinence Urinary frequency Urinary hesitancy Treatment –Urology consult –Urodynamic study

17 Sexual Dysfunction Reduced drive/Abnormally increased drive –Testosterone implicated Men: attaining and maintaining erections or ejaculation Women: difficulty with orgasm Treatment Medical screening: depression, anxiety Endocrine evaluation: prolactin, testosterone, lutenizing hormone, thyroid screen Urologic evaluation medication

18 Sweating –Cause: Usually levodopa related, and may be seen at: – peak level »Reduce levodopa –trough levels »add dopamine agonist, COMT inhibitor or levodopa

19 Drooling Causes Reduced swallowing Stooped posturing Treatment Drying side effects from medications Glycopyrrolate Botulinum toxin injections Atropine ophthalmic solution mouth rinse Scopolamine patch

20 Pain –motor fluctuations, early morning dystonia, Musculoskeletal –Adjust dopamine therapy Smell –Preclinical symptom –Eventually affects up to 90%

21 Compulsions Side effect of Dopamine Agonists –Excessive eating –Pathological gambling

22 Take Home Points Parkinson’s management is individualized You are not alone Importance of Non-Motor Complications Importance of Water Medication/Symptoms Lists Importance of Timing Symptoms

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24 MEDICATION SIDE EFFECTS

25 Carbidopa/Levodopa Nausea Confusion/Hallucinations Dyskinesias Orthostatic hypotension

26 Dopamine Agonists Side Effects Excessive daytime sleepiness Sleep attacks Swelling in the legs Hallucinations/confusion Compulsions Orthostatic hypotension

27 Amanatadine Rash Urinary Retention Dry Mouth Constipation Confusion Blurred Vision

28 Selegeline/Rasagaline Nausea Dry mouth Constipation Confusion/hallucinations Insomnia

29 COMT inhibitors Hallucinations Diarrhea hypotension urine discoloration With tolcapone, liver toxicity

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