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Recognizing and Managing the Emotional Aspects of Parkinson’s
Pamela R. Palmentera, LCSW Coordinator & Clinical Social Worker
Sensory information from the one hemisphere crosses over to the other side of the brain through fiber bundles (bridges)
Left Hemisphere Controls muscles on right side of the body Dominant Functions
•Language •Math •Logic
Linear, details oriented Sequential or list oriented Symbolic processing oriented Logical decision making Verbal processing oriented Reality-oriented
Right Hemisphere Controls muscles on left side of the body Dominant Functions
•Visual Information •Spatial Awareness •Emotional Expression •Intuition
Holistic, big-picture oriented Random processing oriented Intuitive decision making Non-verbal processing oriented Fantasy-oriented
Cognition refers to our brain processes:
• we discover and understand the world around us
• how we apply that knowledge from day to day
• these include: making sense of perceptions; storing and retrieving memories; learning things; forming concepts; solving problems; planning activities; language; achieving insights;
and abstract thinking
James Parkinson who first described the disease stated that the “intellect is preserved” (Parkinson, 1817)
20 to 30% of PD patients are estimated to have cognitive
deficits (Mayeux & Stern, 1983). Cognitive deficits ≠ dementia 20-30% of people with PD develop dementia
• More likely when PD is long-standing • Or when onset of PD occurs after age 70
Attention dysfunction is prominent among the cognitive impairments (multi-tasking)
Executive functioning: planning, organizing, self regulation, mental flexibility, follow through
Memory recall impairments: phone #’s, medication, leaving stove on, etc.
Simple Attention Spared Executive Functioning Impaired* Psychomotor Speed Slowed Language Spared** Memory Impaired free recall Visuospatial Impaired *impacts emotional expression & behavior **impacted by expressive communication issues
Table by Michael Mercury, PhD, Cadence Health
Many people report: Feeling distracted Disorganized Difficulty planning or carrying through on tasks Hard to focus especially in situations that divide
attention (group conversations) Overwhelmed by choices Difficulty with verbal recall and visual memory Harder to learn something new Impaired visual-spatial ability
Allocate more time when learning something new
Use a variety of learning techniques • (listening, writing it down & visual cues)
Visualization & visual cues (photos with phone contacts)
Write and follow step-by-step directions for complex tasks
Arrange steps of a task
• minimize switching from task to task • focus on one step at a time • Minimize noise, distractions and stress!
Focus on what works well (strengths) ! Accommodations at home and at work (e.g. ADA)
Support Groups
• community, reliable information, real world tips
Technology • Built in reminders (pill boxes, calendars, apps, etc.)
Consistent schedule Safety
• Grab bars, medical alert bracelets, personal response system
Adaptive devices • Clothing, home and work environment
Apathy and Depression Mood Disorders
• Depression: a serious medical condition in which a person feels very sad, hopeless, and unimportant and often is unable to live in a normal way. (greater than two weeks, daily occurrence) o Myths about depression
• Apathy: lack of feeling or emotion : IMPASSIVENESS o Apathy is the lack of motivation, interest and emotion. The patient
expresses indifference and has no goals for the future
Mood and Motivation are primary factors for quality of life
Increase in mood disturbance = decrease in motivation
Reported in 12-16 % of patients Loss of Interest
• Associated with cognitive difficulties • Distinct from depression, but has some overlap
Loss of Motivation • Lack of initiation of goal oriented behaviors • Decrease in purposeful behaviors (“freezing”)
Intervention: Behavior Activation • Plan and create steps to realize a plan or goal • Use natural motivators • Active living
o Discover what's really most important to you in your life o Design a plan to achieve those things o Eliminate/decrease any obstacles or blocks that stand in your way
Between 20% to 50% % of people with Parkinson’s experience mild or moderate depressive symptoms
Depression precedes motor symptoms in approximately 30% of cases
PD depression typically differs from depression in the general population – there are less expressed feelings of sadness, little tearfulness or guilt, and a low suicide rate
There is treatment for depression
Parkinson’s patients who were depressed had more trouble with daily activities, and were more likely to begin medication for motor symptoms sooner than those without depressive symptoms
Depression decreased their quality of life and made their motor symptoms worse—but treating the depression, rather than the motor symptoms, improved both quality of life and movement
Ongoing sad, anxious, or empty feelings Feeling hopeless Feeling guilty, worthless, or helpless Feeling irritable or restless Loss of interest in activities or hobbies Fatigue Difficulty concentrating, remembering details, or
making decisions Sleeping too little or sleeping too much Overeating or loss of appetite Thoughts of death and suicide or suicide attempts Ongoing aches and pains, headaches, cramps, or
digestive problems that do not ease with treatment
Most common psychiatric condition in PD
Reactive: to diagnosis, and to living with chronic
disease.
• Immediate concerns o job, social situations, daily activities
• Fear about future unknowns Endogenous (Internal): a biochemical consequence of
having PD.
• Associated with motor impairment and fluctuations
Identify reversible/treatable causes
Minimize effects of cognitive deficits
Maximize person’s strengths
Minimize and manage deficits with structure and tools Promote wellness and brain health
• Physical Exercise • Social Interaction – Staying Connected • Intellectual Stimulation • Sleep
Abnormal blood work (TSH, Vitamin B12, Vitamin D, etc)
Medications (polypharmacy) Physical (pain, infection, Diabetes, etc.) Sensory Deprivation: Hearing and Vision Loss Sleep problems (e.g. sleep apnea) Habits (drug and alcohol consumption) Wellness (dehydration, constipation) Systems (family, work, finances, etc.)
Pharmacological (SSRI) serotonin-specific reuptake inhibitor[1] (SSRIs) are a class of compounds typically used as antidepressants in the
treatment of depression, anxiety disorders, and some personality disorders.
CBT • Cognitive therapies result in changes in the brain (20+ studies) • Brain is dynamic and changes to current experiences and
behavior
CBT + SSRI best combination Newton's First Law of Motion states that a body at rest
will remain at rest unless an outside force acts on it.
A mind at rest will remain at rest!
Treatment and Interventions Develop new strategies for coping
• Mindfulness therapy (focus on the here and now) • Develop and use your coping “tool kit”
You are the agent of change CBT (mind over mood)
Correct Cognitive Distortions
• Don’t believe everything you think • All or Nothing attitude (black vs. white thinking) • Negative Thinking • Mental filtering (focusing on one single detail) • Magnification and Minimizing • Emotional Reasoning • Rigid Rules • Fortune Telling
Facing life with chronic disease involves surviving
• coping, unrelenting perseverance, adapting
thriving: savoring life even in the face of suffering, creating something new
The Beethoven Factor, by Paul Pearsall PhD
AND
A common symptom of depression is social
isolation
Benefits • Simply being around other people and moving
around has positive effects on mood • interactions with another person can help ease
depression symptoms
Requisites • Get out of your comfort zone • Action over Mood o don’t wait till you feel like it
Non-verbal communication
“When the eyes say one thing, and the tongue another, a practiced man relies on the language of the first.”
–Ralph Waldo Emerson
• Use words to express emotions (e.g. “I’m happy that…”) • Use non-verbal cues like nodding • Culture sensitivity re: maintain eye contact and touching
Timing is everything (when meds are working)
Speak loudly (LSVT)
Tips • Create a daily schedule o If an activity is planned, you are more likely to
participate • Join a support group • Volunteer o Helping others kindles happiness o Strengthens ties to your community
• Identify social goals o E.g. activity with a friend once a week, join a book club
or an exercise class, go to a lecture • Maintain communication o Phone calls, letters, e-mails and texts
