How Parkinson’s Can Affect Mental Health
Parkinson’s disease (PD) affects many aspects of well-being. For many people with PD, changes to their mental health are as concerning or more concerning than the changes to their physical abilities. To best maintain your well-being as you live with your PD, it is important to understand what these changes are and to recognize them when they occur. The good news is that there are treatments available that can help you cope with their effects. As with all aspects of PD, it is critical to talk with your health care team about any mental health changes you may be experiencing.
Cognitive Changes
Cognition refers to the entire range of skills that are part of thinking including analyzing, judging, imagining, planning and remembering. In PD, the cognitive skills that are most frequently affected are those involved in planning, multi-tasking, problem solving, paying attention and navigating space.
Mild cognitive impairment (MCI) occurs in about 25% of people with PD, and may begin quite early in the disease. The impairments of MCI are not enough to interfere significantly with activities of daily living. More significant cognitive impairment is termed dementia. Dementia is also common in PD, though exactly how common is still under investigation. Dementia does interfere with activities of daily living, and requires an increased level of care. When dementia begins within one year of motor symptoms, the diagnosis dementia with Lewy bodies (DLB) is used instead of Parkinson’s disease dementia (PDD). The brain changes that cause other forms of dementia, including Alzheimer’s disease and vascular dementia, may also occur in people with PD, and add to their cognitive issues.
Cognitive impairment and Parkinson’s
Depression
Depression is characterized by feelings of persistent sadness, loss of interest in things that were formerly pleasurable, feelings of helplessness or hopelessness, and changes in appetite and sleep. It can also present as cognitive problems, such as poor concentration, attention, learning, and memory. Depression affects up to 50% of people with PD, and may be present before diagnosis. “Reactive” depression, which develops in response to a serious condition such as PD, is common. But for many people with PD, their depression is thought to be an underlying part of their disease, just as much as tremor or slowed movements. Depression may be a challenge to diagnose in PD, since some other symptoms of PD, such as sleep changes, weight loss, or low energy, mimic changes seen in depression.
Depression & Parkinson’s disease
Anxiety
Anxiety is characterized by feelings of nervousness, worry, or impending doom, and may be accompanied by a racing heart, sweating, and difficulty breathing. Anxiety is common in PD, and often coexists with depression. Like depression, anxiety can manifest before diagnosis of PD. It can cause the person with PD to avoid social situations, increasing social isolation. Anxiety is often treated with the same medications, used to treat depression. In addition, other drugs called benzodiazepines (including diazepam and clonazepam) can be used to treat anxiety. Understanding the potential side effects before starting any medication is crucial. Like depression, anxiety may respond to cognitive behavioral therapy or participation in a support group.
The relationship between stress, anxiety and Parkinson’s disease
Apathy
One of the most challenging and puzzling non-motor symptoms of PD is apathy, which is defined as a feeling of indifference or a general lack of interest or motivation in activities. People with PD may feel that they have lost their “get up and go”, and can’t muster enthusiasm for anything – even things they once engaged in and enjoyed. Apathy can be a very frustrating non-motor symptom of PD not only for the person with PD but also for care partners, friends and family. Apathy can be accompanied by depression and/or cognitive decline (or occur independently), it can also mimic depression and cognitive decline. This can make apathy confusing to distinguish and identify. While there are no medications to treat apathy, there are management and coping strategies available to help.
Personality and Behavioral Changes
Parkinson’s disease can influence personality changes due to its impact on both neurological functions and the emotional stress of managing a chronic condition. These changes may include shifts in mood, motivation, and social behavior.
Behavioral changes can occur as a side effect of dopaminergic medications that are used to treat the motor symptoms of PD. A common symptom is the development of an impulse control disorder, or ICD. Behaviors commonly associated with ICDs include pathological gambling, excessive spending, hypersexuality, and over-eating.
Understanding and addressing these changes are crucial aspects of managing Parkinson’s holistically, emphasizing the importance of mental health support alongside physical treatment.
Personality changes in Parkinson’s
Psychosis
Psychosis is characterized by having thoughts or perceptions that don’t have a basis in reality. In PD, the most common symptoms of psychosis are visual hallucinations (seeing or sensing things that are not really there) and delusions (false beliefs). If psychosis begins suddenly, a health care professional will look for other illnesses that can trigger psychosis, such as a urinary tract infection.
Psychosis may occur as a result of the PD disease process itself, or as a side effect of dopaminergic drugs used to treat PD (for example, levodopa or dopamine agonists). Mild hallucinations may not be troublesome for those who understand they are not real, and may not need to be treated. More intense hallucinations, however, can cause anxiety and confusion and should be discussed with the healthcare team.
Understanding psychosis hallucinations and delusions
Addressing Mental Health Issues With Your Doctor
Deciding when to seek help for mental health concerns can be challenging, especially when balancing them with other daily struggles. If these concerns disrupt your usual functioning, it’s a clear sign to consult a healthcare professional. There are numerous options available, including counseling, lifestyle changes, adjusting Parkinson’s medications, or incorporating new treatments, offering effective ways to manage these issues without suffering in silence. Keep track of these concerns and changes so you can inform your doctor of what you’re experiencing, and how often. Seeking help can improve quality of life for you and your loved ones.
Spotlight on Parkinson’s Disease: Healthy Minds, Addressing Your Mental Health
Two renowned experts discuss how Parkinson’s disease can affect mental health, and the steps and strategies you can take to address and treat these issues in this Spotlight on Parkinson’s Disease webinar.
Tips to remember for your next medical visit
- Do not assume that there is nothing to be done. The mental health issue may not be solvable, but it could be made better by a lifestyle modification, medication adjustment, new medication or even a clinical trial.
- Don’t wait for your doctor to ask. Because there are so many different symptoms that can manifest in PD, your doctor may be focused elsewhere (e.g. on your tremor, your blood pressure, or your sleep). At any particular visit, your doctor may not bring up cognitive impairment, depression, anxiety, or psychosis. So bring it up yourself – don’t hesitate to address what’s important to you.
- Do not crowd the visit with a mention of every PD-related symptom that you have. If you want to discuss your mental health concerns, try to bring them up exclusively or with a limited number of other problems. Then your doctor will have more time to address them.
- Be specific. It is helpful to mention specific examples of how mental health issues are affecting your life or your loved one’s life. “Mark is seeing his dead uncle at the dinner table and it upsets him,” is more compelling than saying “Mark is having hallucinations.”
- Before the visit with your doctor, try to notice what makes the mental health issue better or worse. Think about the symptom as it relates to medication timing, sleep, and diet. This will be helpful for your doctor when trying to come up with a solution. For example, if depression seems to occur between doses of medication, then rearranging dosing or timing of medication may be helpful.
- Track your symptoms. APDA has developed a free Symptom Tracker App that you can download to your smartphone. It helps keep track of your symptoms and provides a report that you can share with your doctor. This can be useful when reporting on your symptoms since your last office visit.
