Ask an Expert: Dr. Naaz Parmar Discusses Dementia in People with Parkinson’s Disease

Dr. Naaz Parmar, MD, is a geriatrician at Vancouver General Hospital, where she specializes in dementia, mobility, falls prevention, and polypharmacy. She is also a Clinical Assistant Professor at the University of British Columbia (UBC), and an attending for the UBC Geriatric Medicine Longitudinal Fellows Clinic. Her commitment to improving access to geriatric care across the province led Dr. Parmar to founding the Pacific Geriatricians Group, which provides comprehensive care and assessment for patients across BC both virtually and in-person at their Vancouver clinic.

What is the difference between Parkinson’s disease dementia and other types of dementia, like Alzheimer’s?

Parkinson’s disease dementia (PDD) differs from Alzheimer’s disease (AD) in the changes that occur at the level of the brain cells. Parkinson’s dementia is associated with changes called Lewy bodies or Pick bodies, whereas Alzheimer’s results from tau protein plaques. PDD is caused by the same changes in the brain that cause motor symptoms (namely the decrease in dopamine), and as such, the memory changes in PDD follow a timeline associated with the motor changes in Parkinson’s. Usually, PDD presents with changes in walking (gait) and fine motor tasks first. Over several years, memory changes then begin, usually affecting language (naming of people or objects) and executive function (being able to do complex or multi-step tasks). Alzheimer ’s presents with short-term memory problems first, and changes in mobility happen in later stages of the disease.

What are some warning signs of cognitive decline and dementia?

One early warning sign is losing track of time; for example, this may mean missing an important appointment or forgetting to pay bills on time, when this was not an issue previously. Other common changes include repeating questions or telling the same story over and over again, thinking that these things haven’t been said before. Losing an ability that you had before, such as using the remote to turn on the TV correctly or operating the microwave correctly, are other examples.

What should people with Parkinson’s and their caregivers do if they notice signs of cognitive decline? What is the process for getting diagnosed with dementia?

If you have concerns about memory change, even if you are not sure if they are minor or something else, it’s important to bring them up with your doctor. Early assessment means we can rule out other causes, such as depression or medical issues (like low Vitamin B12) quickly, before they cause long-term damage. Early treatment for dementia is also important to slow progression of the disease.

When discussing memory changes with your doctor, they will begin with some questions about your memory changes, and may do a short memory test. Your family doctor can then refer you on to a specialist for formal diagnosis and follow-up. This may be a specialist in Geriatric Medicine (Geriatrician) or a Geriatric Psychiatrist. In BC, there are specialists in these fields across many communities, and if there are none in your area, memory assessment can also easily be done via telephone or video conference through organizations like the Pacific Geriatricians Group.

What are some ways that people with Parkinson’s can maintain and improve their cognitive health, and avoid cognitive decline? How can their caregivers support them?

The most important and effective way to minimize or avoid memory changes is to stay active. Both physical and mental activity help to protect the brain. Cardiovascular activity, such as walking, swimming, or stationary bikes, is an excellent form of exercise to prevent heart disease and promote brain health. A target of 150 minutes of cardiovascular activity a week is suggested. It is important to note that you do not have to be doing vigorous exercise — just doing extra physical movement outside of your regular routine is enough to be helpful. I should also point out that daily chores, like walking up and down the stairs with the laundry, or yard work, do not count as exercise. Exercise has to be extra movement.

Staying mentally stimulated with hobbies or daily tasks is also important. Even if you are having early trouble with your memory, try to keep track of your own calendar or shopping list. The old cliché, “if you don’t use it, you lose it,” is true for memory as well. Reading, followed by discussing what you’ve read, is a great way to challenge your memory. Hobbies that can help with memory include card games, crosswords, artwork, crafting, singing, knitting, sewing, and other activities that require a great focus of attention. It’s not helpful to force yourself to start new things, however, as this can cause additional stress. If you previously enjoyed a hobby, make it a priority now, but don’t try to pick up new ones that could cause anxiety.

What treatments and therapies are available to people with dementia?

Dementia currently does not have any cure, but we do have strategies to slow the progression. The foundation of treatment is what we call non-pharmacological, or lifestyle changes. This would be the same as the preventative measures of regular cardiovascular activity and mentally-stimulating activities. Optimizing other risk factors such as cholesterol, blood sugars, and blood pressure are a focus as well.

There are medications specifically targeted for dementia called cholinesterase inhibitors. The first line of these in BC is donepezil. The role of these medications is to slow the progression of the symptoms of dementia. This helps people maintain their independence for longer, and stay in their own home for, hopefully, the rest of their life. The decision to start these medications is based upon the results of memory testing and other medical issues that a person may have, and your specialist can discuss whether they are an appropriate option for you.

Dementia is highly stigmatized. What is your message to those who may be frightened or worried about experiencing cognitive changes?

Dementia does have a heavy cloud around it in popular culture, and in our society in general. The true meaning of the word, however, is simply memory change. Dementia does not necessarily mean that a person will lose who they are, change in personality, or become completely dependent on others. It does not mean that a person is destined for a nursing home either.

Similarly to how diabetes and heart disease had very negative connotations in the past, but are now managed as common diseases with good outcomes, dementia is also changing. We now have better understanding of dementia, and can work towards slowing its progress. We have better ways to provide dignified care for those with memory changes, and much research is being done on potential cures. Over 11% of Canadians are currently living with dementia, and that number is increasing with our aging population. We understand it better than in years past, and as such, the prognosis of dementia is not a dire one any longer. There is much we can do, and there are many supports available, so it is important to seek out assessment and treatment from your doctor if you have any concerns.

This content was published in the Summer 2021 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.