Parkinson’s Disease — Psychological Analysis and Management
Parkinson’s Disease (PD) — Parkinson’s Disease (PD) is essentially regarded as a motor–neuro-degenerative disorder involving symptoms such as tremors, rigidity, bradykinesia (i.e. slowness of movement), balance, posture problems, micrographia (small handwriting). Festinating gait and hypophonic speech. However, recent evidence suggests that there is more than motor symptoms when it comes to Parkinson’s Disease. It also involves many non-motor symptoms like decline in cognition and a range of psychological disorders comorbidity. In simple word, this condition occurs due to changes in neurotransmitters in brain. Parkinson’s Disease (PD) is the second most common chronic neuro-degenerative disorder in older people of more than 60 years of age.
Who first coined the term Parkinson’s Disease?
The term Parkinson’s Disease was first coined by William Sanders and the idea then picked by a French neurologist Jean-Martin Charcot. However, this term is very first attributed to James Parkinson who was a famous English surgeon, social and political activist, geologist, paleontologist, described its symptoms thoroughly using the term “paralysis agitans” in his famous essay Shaking Palsy in 1817.
Prevalence of Parkinson’s Disease (PD)
Studies suggest that prevalence rate of Parkinson’s Disease in China, Japan and African countries is lower than that of Western countries. However, there is no epidemiological data on prevalence of PD from India. Few door-to-door surveys propose that there is less prevalence rate of PD in India than that of Western countries. These studies also suggest that risk of PD is higher among Parsi population, and also higher in males, and in people with family history of PD, and in those with clinically diagnose depression patients.
Psychological perspective on Parkinson’s Disease
However, the definition of Parkinson’s Disease focuses on motor symptoms of the condition but it is just the first peel of onion. There are many other serious non-motor symptoms including behavior aspect of this disease. It involves decline in cognition and psychological deterioration like psychosis, apathy, hallucinations, depression and impulse control; failure of autonomic systems such as cardiovascular, gastrointestinal, urinary, sexual dysfunction and homeostasis; sleep disturbances; and pain syndrome. In fact, it is said that advanced form of PD accumulates more non-motor aspect of symptoms than that of motor symptoms and are associated with poor quality of life and shortened life expectancy. People with poor quality of life with PD are more prone to psychological illnesses such as depression, anxiety, sleep difficulties and autoimmune dysfunction. In the advanced stages of disease, non-motor symptoms are major determinants of loss of independence, caregiver strain and nursing-home placements.
Mood problems in PD — Changes in mood in PD patients cause depression anxiety and even psychosis. Research proposes that people with PD can benefit from exercise as it elevates mood as well as it helps with motor related problems.
Cognitive aspect of PD — Cognitive changes can range from mild to severe in PD. Most severe form can be dementia. There are six areas that can be affected in terms of cognition:
i. Executive functioning- Patients feel difficulty completing tasks involving problem solving, different tasks at the same time, monitoring other for work/progress, planning, organization and controlling inappropriate actions and inappropriate speech.
ii. Attention- Patients feel difficulty in focusing on a certain task or have difficulty dividing attention between two different tasks, attention span decreases when there is auditory or visual distraction in the background.
iii. Speed- Patients may have slowed thinking. They find it difficult to pick a proper word for describing certain thing or solving a certain problem.
iv. Memory- Patients need to listen or watch certain thing from time to time in order to memorize it.
v. Language- Patients feel difficulty in saying a word for certain thing. Their speech becomes degenerative as the diseases progresses over time.
vi. Visual-Spatial Skills- Patients find it difficult to perceive visual information and judge distance, which increases the risk of falling again and again.
How can a Psychologist help people with Parkinson’s Disease?
There are many ways neuropsychologists and psychologists help people with Parkinson’s Disease and their caregivers.
1. Psychologists can treat psychological aspects of PD such as treating depression and anxiety in addition to teaching skills to improve quality of life by helping them with sleep difficulties and treating motor related problems through exercise.
2. Neuro-psychologists can evaluate changes in mood and cognition and make accordingly a management plan in order to maximize patient’s strengths.
3. Psychologists can help patients with adjustment issues; helping them to adjust to the new changes occurring in their day to day life.
Additionally, exercise has shown significant positive outcome in overall health of patients with PD. Sleeping adequately and eating a balanced healthy diet can also improve the condition. Making time for yourself like listening to your favorite music, try reading a book and complementary therapies such as aromatherapy, meditation and massage also improves overall health.
Parkinson’s Disease Patients and the Mental Health of the Caregiver(s)
A very substantial yet overlooked aspect of neuropsychological problems is that not only the patient suffers but their caregiver also has to bear the burden of the comorbidities. Family members, spouses, grown children and friends become the caregiver in such conditions. They automatically assume the role of caregiver. Caregiver’s attention and support becomes very useful in managing neuropsychological symptoms of patients. In this way, the caregiver’s quality of life also affects. Therefore, the best management plan should not only include managing symptoms of patients but also the support and care for “care-givers”. Providing support to the person with PD can involve an overwhelming burden, and may create family dysfunction causing toppling lives. The mental health and coping abilities of caregivers seriously affect their life as well as lives of patients with PD. Care of the caregiver is also the aspect of patient care which is highly neglected.
Studies suggest that patients with PD who are also suffering from depression, anxiety and psychosis alongwith movement problems can cause an increased burden of care for caregivers. This can also affect the coping skills of the caregivers. Apathy which is a psychiatric problem in PD causes frustration, stress and conflict between patients and caregivers. Apathy, indifference to certain situation and marked diminished interests are highly misinterpreted by family members and caregivers.
Patients in PD having sleep problems also suffer from frequent awakening in the middle of the night can markedly disturb the sleep of the caregiver. Therefore, caregiver suffers from sleep deprivation is unlikely to function the next day.
The fear of leaving patient alone just for few hours, or the patient’s fear of being left alone can occupied the caregiver twenty-four hour-seven days a week. The decrease in social life of patient severely impacts the quality of life of caregiver. Caregivers commonly experience anger, denial, guilt, resentment, irritability, agitation, anxiety, depression fatigue, exhaustion, a sense of being overwhelmed and sleep disturbances. Patients may sense that they are being ignored, neglected or verbally, physically or emotionally abused. Therefore, it is important not only for the patient but the care giver to speak with a psychologist in order to vent out their emotions and feeling without the feeling of being judged or embarrassment.
