PSYCHOSIS (HALLUCINATIONS AND DELUSIONS) IN PARKINSON'S DISEASE

HALLUCINATIONS IN PARKINSON’S DISEASE

Main symptoms of Parkinson’s disease

Parkinson’s disease (PD) is a slowly progressive degenerative disease of brain. The major symptoms are tremors (shivering), slowness of movements, stiffness and postural imbalance.  These symptoms lead to motor disability and interfere with walking, as well as with other activities of daily living.

Memory impairment in Parkinson’s disease

The mental functions are usually normal in patients with PD, however, 10% of patients can develop dementia (memory impairment along with other cognitive dysfunction), especially in later stages of illness.

What are hallucinations?

Other significant problem in people with PD in later stages is hallucination. Hallucination is often visual. In this condition, patient sees something, which is not there. For example, they may see snakes or lizards in their room (which are not there), and get disturbed with them. They may also see strangers in their house, which are supposedly there to spy on them or harm them. These hallucinations are very upsetting for the patient, making them anxious and depressed. Some patients also have sleep disturbance due to hallucinations.

What are the causes of hallucinations in patients with PD?

1.     Adverse effects of anti-parkinsonian medicines.

2.     Infections such as urinary tract infection or pneumonia,

3.     Side effects of other medications such as pain killers and sleeping pills,

4.     Parkinson’s disease mimic such as Diffuse Lewy body disease (DLBD). In DLBD, patients may have slowness and rigidity (just like PD). However, they have prominent hallucinations and dementia (unlike PD). Moreover, DLBD patients do not respond to levodopa treatment.

Other symptoms of psychosis in patients with PD

1.     Illusions,

2.     Delusions especially paranoid

3.     Confusion,

4.     Sleep disturbance

Delusion refers to a condition where a patient believes in something, even when there is an evidence of the contrary.

How common is psychosis in PD?

About one third of patients with PD suffer from psychosis. So, it is quite common.

How do we manage psychosis in patients with PD?

Management of psychosis can be done in a stepwise fashion as outlined below:

1.     Underlying alternate causes should be looked for and managed. This would include looking for infection and offending drugs.

2.     Comorbid psychiatric conditions, such as anxiety and depression, if present, should be treated.

3.     Minor symptoms such as vivid dreams or minor hallucinations (which are non-disturbing in nature) do not require any treatment.

4.     Anti-parkinsonian drugs should be reduced or stopped. First to eliminate are trihexiphenydyl, amantadine and selegeline/rasagiline. If psychotic symptoms persist, then, the next drugs to be reduced are dopamine agonists (ropinirole and pramipexole), entacapone and levodopa.

5.     In people with cognitive impairment, cholinesterase inhibitors such as rivastigmine or donepezil can be used.

6.     Anti-psychotic medication- quetiapine is the most commonly used.

7.     The first and only FDA approved drug for treating PD psychosis (hallucinations and delusions) is PIMAVANSERIN (Nuplazid). The dose is 34 mg capsules once daily.

DR SUDHIR KUMAR MD DM

Consultant Neurologist

Apollo Hospitals, Hyderabad

04023607777

drsudhirkumar@yahoo.com

https://www.facebook.com/bestneurologist/

"BRAIN" FOODS THAT HELP PREVENT NEUROLOGICAL DISEASES

"BRAIN" FOODS THAT HELP PREVENT NEUROLOGICAL DISEASES

Choice of foods is important, when it comes to prevention and treatment of certain neurological disorders. The article on this topic was published in November 2017 issue of B Positive magazine, a health and wellness magazine.

Dr Sudhir Kumar MD DM (Neurology)
Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777/60601066
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/

MEDICINES FOR TREATING ACIDITY COULD INCREASE THE RISK OF DEMENTIA

COMMONLY USED MEDICINES FOR ACIDITY INCREASE THE RISK OF DEMENTIA

Dementia is a condition, characterised by progressive loss of memory and other higher brain functions. It is a common cause of disability and dependence on others in older people. 

Alzheimer's disease and brain stroke are the two most common causes of dementia.

1. In a recent research, medicines commonly used for treating acidity, were found to increase the risk of developing dementia in older people.

2. The effect of medicines belonging to the group of proton pump inhibitors (PPIs) such as omeprazole (omez), pantoprazole (pantodac, pantocid), rabeprazole (razo) were studied.

3. The study population included about 74,000 people from Germany, aged 75 or more.

4. People on regular prescriptions of PPIs (anti-acidity medications) had a significantly higher risk of developing dementia.

5. The possible mechanism is an increase in beta-amyloid in brain (which are involved in causing Alzheimer's disease).

This study was published in JAMA Neurology (April 2016), and those interested in reading further details of the study can access it at the following link:

http://archneur.jamanetwork.com/article.aspx?articleid=2487379

DR SUDHIR KUMAR MD DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Hyderabad
Ph- 04023607777/60601066
Email: drsudhirkumar@yahoo.com

Frequent Coffee Breaks Keep You Healthy Too!

Coffee Breaks Make You Healthier

Coffee drinking is quite popular all across the world. There are many, who have coffee first thing in morning, referred to as bed coffee. Bed coffee is supposed to energize people and get them out of sleepiness. Many others take “coffee breaks” while at work, which relaxes them. Who would have forgotten the student days, when numerous coffee cups kept them awake until late nights just before examinations? Coffee drinking is supposed to increase alertness and concentration. The effects are mainly related to caffeine contained in the coffee.

Health-Related Benefits of Drinking Coffee

1. Lower risk of diabetes: In a Dutch study done on 40,000 people, it was found that drinking at least 3 cups of coffee or tea per day reduced the risk of developing diabetes by 42%. (Diabetologia 2009). The anti-diabetic effects are related to polyphenols found in coffee.

2. Lower risk of coronary heart disease: Moderate habitual coffee consumption (3-4 cups per day) lowers the risk of coronary heart disease, especially in women. (International Journal of Cardiology)

3. Coffee improves headaches and migraine, if taken alone or along with other painkillers.

4. Lower risk of brain stroke: Middle aged people in Japan, who drank 3 or more cups of coffee per day had lower rates of silent brain infarctions (strokes without symptoms, picked up on MRI scan of brain). Lesser brain infarctions would also lead to lesser incidence of dementia. (Journal of Stroke and Cerebrovascular Diseases, 2016)

3 or more cups of coffee intake per day reduced the risk of brain stroke (despite smoking tendency in coffee drinkers). A lower incidence of heart failure, diabetes and hypertension was also observed. (Nutritional Neuroscience, 2015)

5. Reduced risk of Alzheimer’s disease: Alzheimer’s disease is the commonest cause of dementia (memory loss and loss of other higher mental functions) in the world. Based on the meta-analysis of 11 research studies, it was found that higher coffee consumption reduced the risk of Alzheimer’s disease. (Nutrition, 2015)

6. Reduced risk of Parkinson’s disease: Parkinson’s disease is the commonest cause of movement disorder, characterized by tremors, rigidity and slowness of movements. Based on meta-analysis of 26 studies, increased caffeine/coffee consumption was associated with reduced risk of Parkinson’s disease. (Journal of Alzheimer’s Disease, 2010)

7. Reduced risk of multiple sclerosis: Researchers in USA and Sweden have found that drinking at least 900 ml (six cups) of coffee per day has protective effects against multiple sclerosis. Caffeine has neuroprotective properties and suppresses inflammation. (JNNP, 2016)

8. Reduced risk of depression and suicide: A meta-analysis of 11 studies showed a protective effect of coffee against depression. The relationship between coffee intake and depression was linear; for each cup/day increase in coffee intake, the risk of depression reduced by 8%. (Australia NZ Journal of Psychiatry 2016)

In addition, increased coffee consumption was also associated with reduction in incidence of completed suicides. (World Journal of Biol Psychiatry, 2014)

9. Reduced risk of cancer: Various studies have shown that regular coffee consumption is associated with lower risk of cancers. 5 or more cups per day reduced the risk of colorectal cancer (Oncotarget, 2016). Other studies have shown reduced risk of cancers of oral cavity, pancreas, urinary bladder, breast, uterus, and liver among regular coffee drinkers.

10. Lesser incidence of erectile dysfunction: Coffee can provide a boost to sexual health too. Men with coffee intakes of 2-3 cups of coffee/ day reported significantly lesser incidence of erectile dysfunction, as compared to those with no coffee intake or only 1 cup/day. (PLos One, 2015)

11. Lower death rates: Regular intake of coffee can increase longevity and prevent deaths too. Recent research has shown that people drinking 2-5 cups of coffee/day had significantly lower deaths from heart disease, chronic lung diseases, diabetes, pneumonia and influenza, and intentional self-harm. Coffee may reduce mortality risk by favorably affecting inflammation, lung function, insulin sensitivity, and depression. (American Journal of Epidemiology,

Possible Health Hazards of Coffee Drinking

1. Poor control of BP in patients with hypertension:  A recent study showed that older people with hypertension, who consumed 3 or more cups of coffee per day, had higher BP (systolic and diastolic). Coffee drinking, however, does not lead to an increased risk of developing hypertension (in people with normal BP).

2. Increased cholesterol levels: Drinking unfiltered or boiled coffee may cause an increase in the levels of LDL cholesterol and triglycerides.

3. Increased risk of coronary heart disease: Drinking 3 or more cups of Italian-style coffee (espresso or mocha) is associated with increased risk of coronary heart disease. (PLoS One, 2015). This effect was independent of cholesterol levels, as the cholesterol levels did not increase in this study.

4. Sleep problems: Caffeine is a brain stimulant and after consuming it, people feel alert. People sensitive to the stimulant effects of caffeine may not get proper sleep, if they drink coffee close to bedtime. Since, the effect of coffee may last for 5-6 hours, people sensitive to it should avoid coffee after 6 PM.

5. Not recommended for children: Coffee suppresses appetite, and may cause children to eat less. Also, after having coffee, children feel full, and avoid nutritious foods such as milk.

6. Pregnant and nursing women should have coffee in moderation: There is no restriction of coffee in pregnant or nursing mothers. However, they should restrict the coffee intake to 2-3 cups per day.

So, what is the final take home message?

1. Coffee is good for health, and can be safely consumed by adults.

2. For optimum benefits, it should be restricted to 2-5 cups per day.

3. The maximum safe limits for caffeine/coffee intake is 200 mg in one sitting (around 2½ cups of coffee) or 400 mg daily (around 5 cups of coffee). 

4. Coffee (without sugar and milk) has zero calories; and hence, people on strict diet too can freely have coffee.

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills, Hyderabad

Phone: 040-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online Consultation: http://bit.ly/Dr-Sudhir-kumar

An INTERVIEW focussing on COMMON NEUROLOGICAL PROBLEMS (with special focus on WOMEN)