1. Paul Short, Ph.D. The Parkinson’s Coach www.theparkinsonscoach.com NEUROPSYCHOLOGY OF PARKINSON’S COMMUNICATION PROBLEMS

2. WHAT IS PARKINSON’S DISEASE?

3. PARKINSON’S DISEASE (PD) A Movement Disorder Marked by varying combinations of Tremor Bradykinesia Muscle Rigidity Postural Instability

4. PARKINSON’S DISEASE (PD) Centered in upper midbrain in the Substantia Nigra

5. PARKINSON’S DISEASE (PD) Substantia Nigra experiences loss of neurons producing the neurotransmitter dopamine

6. PARKINSON’S DISEASE (PD) Centered in the upper brain stem in the Substantia Nigra

7. LIVING IN THE WORLD OF PARKINSON’S

8. TREATMENT OF PARKINSON’S DISEASE Exercise Diet & Nutrition Stress Management Education Social Support

9. EARLY STAGE PARKINSON’S TREATMENTS Amantadine Side Effects/Complications

10. DOPAMINE AUGMENTATION Dopamine Agonists Mirapex Requip Side Effects/Complications Sudden sleep (Mirapex) Potential for inccrease compulsivity

11. 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

12. DOPAMINE REPLACEMENT Complications/problems Protein can interfere with absorbtion Sensitivity can cause dyskinesias and dystonias over time.

13. 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

14. DEEP BRAIN STIMULATION Advantages Constant stimulation much like steady dopamine treatment Manages medication-induce dyskinesias Programming can be done far into the disease process

15. 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

16. 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

17. 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)

18. 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

19. 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

20. 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

21. 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

22. DIMINISHED COMMUNICATION IN PARKINSON’S DISEASE

23. EXPRESSIVE COMMUNICATION DEFICITS WITH PARKINSON’S DISEASE Diminished prosody Hypophonia Reduced social contact

24. 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

25. 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

26. 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)

27. RECEPTIVE COMMUNICATION DEFICITS IN PD EXECUTIVE DYSFUNCTION Executive function deficits impacting communication Impaired Verbal Fluency Difficulties with organization and execution Anhedonia Metacogntion

28. RECEPTIVE COMMUNICATION DEFICITS IN PD DEMENTIA Many of the communication problems of dementia reflect more severe executive dysfunciton