- I AM A PORTRAIT ARTIST, AND I WAS
AN ILLUSTRATOR AT BOEING FOR ABOUT 17, 18 YEARS.
I HAD ABOUT 20 CUSTOMERS INSIDE BOEING A WEEK,
AND THESE ALL WERE PROJECTS AND GROUPS OF PEOPLE WHO
FORMED TEAMS AND ACCOMPLISHED THESE PROJECTS.
AND YOU HAD TO HAVE A GOOD MEMORY.
SO I HAD A GOOD MEMORY.
I DEVELOPED IT OVER THE YEARS AND UNDER A LOT OF STRESS.
AND NOW I COULDN'T GO BACK TO ANY OF THOSE JOBS,
IN MY OPINION, BECAUSE OF THE MEMORY.
- COGNITION AFFECTS EVERYTHING THAT WE DO.
IT MAKES UP WHO WE ARE.
SO WHEN YOU HAVE A CHANGE IN YOUR COGNITION, A LOT
OF TIMES, IT'S A VERY PERSONAL CHANGE, AND IT AFFECTS PEOPLE
QUITE DEEPLY.
- MOST PEOPLE THINK ABOUT THE RESTING TREMOR, THE STOOPED
POSTURE, THE SLOW GAIT FOR PARKINSON'S DISEASE.
AS WE'VE BEEN STUDYING PARKINSON'S DISEASE OVER TIME,
WE'RE RECOGNIZING THAT OTHER WHAT WE CALL NONMOTOR SYMPTOMS
CAN KICK IN, AND ONE OF THE MAJOR ONES HAS
BEEN COGNITIVE IMPAIRMENT OR SORT OF MEMORY PROBLEMS.
- WE USED TO THINK THAT IT WAS ONLY A MOTOR DISORDER AND THAT
THERE WEREN'T ANY COGNITIVE CHANGES WHEN IT FIRST
WAS DISCOVERED.
HOWEVER, THE MAJORITY OF PATIENTS DO SHOW AT LEAST SOME
MILD COGNITIVE CHANGES.
- FORGETTING THE SUBJECT OF WHAT I'M TALKING ABOUT.
MY VOCABULARY IS GONE TO HELL.
JUST CONCENTRATION, LACK OF.
- DOCTORS LIKE TO USE THE TERM "DEMENTIA," WHICH IS A VERY
SCARY TERM, AND DEMENTIA REALLY MEANS THAT YOU'VE LOST
SOME THINKING SKILLS FROM A PREVIOUS HIGHER LEVEL AND THAT
THAT LOSS HAS BEEN SUFFICIENTLY SEVERE THAT IT
IMPAIRS YOUR ABILITY TO TAKE CARE OF SOME KIND OF
DAY-TO-DAY ACTIVITY.
- ABOUT 60% OF THE PATIENTS WE NOW KNOW HAVE COGNITIVE
CHANGES IN PARKINSON'S DISEASE, AND ABOUT 30%
ACTUALLY MEET CRITERION FOR PARKINSON'S DISEASE DEMENTIA.
- WHAT MOST PEOPLE THINK ABOUT WHEN THEY THINK ABOUT DEMENTIA,
THEY THINK OF ALZHEIMER'S DISEASE, AND ALZHEIMER'S
DISEASE, IN CONTRAST, IS A DISORDER OF WHAT WE CALL
SHORT-TERM MEMORY.
PEOPLE HAVE TROUBLE HOLDING ONTO NEW INFORMATION.
SO YOU CAN HAVE A CONVERSATION WITH THEM, AND THEN YOU COME
BACK AN HOUR LATER AND THEY DON'T REMEMBER ANYTHING
ABOUT THE CONVERSATION.
FOR PARKINSON PATIENTS, THAT'S USUALLY NOT AS
MUCH OF A PROBLEM.
WHAT THEY HAVE PROBLEMS WITH IS ACTUALLY WHAT I LIKE TO
CALL THE "IN THE NOW" MEMORY-- WHY YOU'RE IN A DISCUSSION.
THEY'RE HAVING TROUBLE SORT OF KEEPING UP.
AND SO YOU'LL OFTEN FIND, FOR EXAMPLE, WHEN WE TEST
PEOPLE, THAT AS THEY TRY TO HOLD ONTO INFORMATION,
THE PARKINSON PATIENTS STRUGGLE.
BUT IF YOU EVENTUALLY GET IT IN THERE, YOU CAN GET THEM TO
PAY ATTENTION TO IT AND KEEP WITH IT, THEY HOLD ONTO
INFORMATION MUCH BETTER THAN PEOPLE
WITH ALZHEIMER'S DISEASE.
- I DON'T LOSE THE INFORMATION; IT'S JUST FILED
AWAY IN MY BRAIN AND SOMETIMES IT DOESN'T POP UP
SUBCONSCIOUSLY.
I HAVE TO CONSCIOUSLY SEARCH IT OUT,
AND SOMETIMES IT TAKES A LONG TIME, BUT IT COMES.
- NEUROPSYCHOLOGICAL EVALUATION ALLOWS US TO
PROVIDE AN ACCURATE DIAGNOSIS SO THAT THE TREATMENT CAN BE
TAILORED TO THE PATIENT.
- WE HAVE A TEST OF VOCABULARY WHICH IS A GOOD TEST
OF A PERSON'S BACKGROUND EDUCATION.
SO TRY TO GET A SENSE OF HOW COGNITIVELY INTACT WERE THEY.
- IT'S REALLY NOT A PERFORMANCE ON ONE PARTICULAR
TEST THAT'S GOING TO TELL ME WHAT IS GOING
ON WITH THE PATIENT.
IT'S REALLY THEIR PERFORMANCE ACROSS ALL
THE DIFFERENT TESTS.
- THE SECTIONS I DO BEST IN, I'M NOT VERY GOOD AT ANY
OF THEM, BUT AS ANYTHING TO DO WITH GRAPHICS, LIKE DRAWING
SQUARES IN PERSPECTIVE AND TRIANGLES AND CIRCLES
AND VARIATIONS OF THEM, I HAVE NO PROBLEM WITH.
- WE HAVE HIM TRY TO REMEMBER A LIST OF WORDS, AND WE GO
OVER IT 3 TIMES, AND HE WAS VERY SLOW TO PICK
THOSE WORDS UP.
- THEY LIST 5 OR 6 ANIMALS, AND THEN THEY GO
AND TALK ABOUT OTHER PROBLEMS, AND THEN THEY COME BACK
AND SAY, "WHAT ANIMALS WERE THEY?"
SO SOMETIMES I REMEMBER THEM, SOMETIMES I DON'T.
- BUT THEN WHEN WE PRESENTED HIM WITH A LIST OF A BUNCH
OF DIFFERENT WORDS, HE WAS VERY EASILY ABLE TO PICK OUT EVERY
SINGLE WORD THAT WE'D GIVEN HIM BEFORE, A LIST
OF 12 WORDS.
SO HE'S SORT OF, AGAIN, THAT VERY PARKINSON'S-LIKE
TROUBLE GETTING THAT INFORMATION IN, MAYBE A LITTLE
TROUBLE RETRIEVING IT SPONTANEOUSLY,
BUT THE INFORMATION IS IN THERE, UNLIKE ALZHEIMER'S,
WHERE THE INFORMATION NEVER GETS IN.
- SO I HAVE GOOD AND BAD RESULTS DEPENDING ON THE TEST
BUT REAL PROBLEMS IN THE MEMORY DEPARTMENT.
- USUALLY THE COGNITIVE DECLINE OCCURS LATER
ON IN THE DISEASE PROCESS.
SO IT MIGHT BE 5, 10 YEARS INTO A DIAGNOSIS
OF PARKINSON'S DISEASE BEFORE THEY WOULD POTENTIALLY START
NOTICING MORE SEVERE CHANGES IN THEIR COGNITION.
- I'VE HAD PATIENTS WITH WHAT WE MIGHT CALL MILD COGNITIVE
IMPAIRMENT, WHERE THEY HAVE SUBTLE CHANGES, BUT IT REALLY
DOESN'T IMPAIR THEIR ABILITY TO DO THEIR DAY-TO-DAY
ACTIVITIES, AND THAT CAN LAST EVEN 10, 15
YEARS BEFORE THEY MOVE ON TO WHAT WE CALL DEMENTIA,
WHERE IT IS INTERFERING WITH YOUR ACTIVITIES
OF DAILY LIVING.
- WE HAVE A GROUP THAT GETS TOGETHER ON THURSDAY EVENINGS
AND HAVE GOTTEN TOGETHER FOR YEARS, AND ALL OF A SUDDEN,
I JUST FELT LIKE EVERYBODY'S SITTING AROUND WATCHING ME
SHAKE, AND I GO TO TELL A JOKE AND I FORGET THE PUNCHLINE,
OR MY TIMING'S OFF.
SO I'VE JUST KIND OF WITHDRAWN FROM THAT.
- A BEHAVIORAL SYMPTOM THAT OFTEN GOES WITH COGNITIVE
IMPAIRMENT IS SOMETHING WE CALL APATHY, SORT
OF A LACK OF DRIVE.
IT'S HARDER FOR PEOPLE TO GET UP AND GET GOING.
- I FIND THAT WITH PARKINSON'S, I HAVE GOOD DAYS AND BAD DAYS.
AND THE BAD DAYS ARE KIND OF INDECISIVE, SEVERE SHAKES,
LACK OF AMBITION.
AND OTHER DAYS, I FEEL GREAT AND ENERGIZED.
- STAYING PHYSICALLY AND MENTALLY ACTIVE, I THINK,
IS VERY IMPORTANT.
WE DO THINK PEOPLE GENERALLY DO BETTER.
AT THE WORST, BY BEING PHYSICALLY ACTIVE, YOU REDUCE
THE RISKS OF OTHER DISEASES THAT WE KNOW CAN AGGRAVATE YOUR
PARKINSON'S SYMPTOMS AND YOUR COGNITIVE IMPAIRMENT.
- IT'S IMPORTANT FOR US TO PROVIDE THE CAREGIVER
WITH INFORMATION AND THEN ALSO TEACH THEM DIFFERENT
STRATEGIES THAT THEY CAN USE TO HELP KEEP THE PATIENT
MORE INDEPENDENT.
SO BY USING COMPENSATORY STRATEGIES LIKE PILLBOXES THAT
HAVE TIMERS ON THEM, THAT THEY CAN LAY OUT ALL THE PILLS,
BUT THEN HAVE A TIMER GO OFF THAT WILL REMIND
THE PATIENT TO GO TAKE THEIR MEDICATIONS--THESE ARE JUST
EASY LITTLE STRATEGIES THAT THEY CAN DO THAT WILL REDUCE
THEIR CAREGIVING BURDEN AND HELP THE PATIENT REMAIN
INDEPENDENT FOR AS LONG AS THEY POSSIBLY CAN.
- THERE ARE SOME MEDICATIONS THAT CAN BE USED TO TREAT
THE COGNITIVE IMPAIRMENT OF PARKINSON'S DISEASE,
AND DEPENDING ON THE SEVERITY OF THE IMPAIRMENT, I MAY
DISCUSS THAT WITH THE PATIENT, WITH THE FAMILY, AND DECIDE IF
THEY'RE GOING TO UTILIZE THOSE MEDICATIONS.
- I WOULD GO TO MEDICATION IF I BECAME SEVERELY
INCAPACITATED, IF I COULDN'T KEEP UP WITH PEOPLE WALKING,
IF I COULDN'T ACCOMPLISH THINGS, LOST ALL AMBITION,
MEMORY STARTED TO GO.
AT SOME POINT, I'LL PROBABLY HAVE TO MAKE A DECISION WHEN
TO GO ON MEDICATION.
- WITH REGARDS TO COGNITIVE IMPAIRMENT AND PARKINSON'S
DISEASE, I USUALLY TELL PEOPLE IT'S KIND OF
A GOOD NEWS/BAD NEWS STORY,
AND THE BAD NEWS IS COGNITIVE IMPAIRMENT IS COMMON
IN PARKINSON'S DISEASE.
THE VAST MAJORITY OF PATIENTS WILL DEVELOP IT.
THE GOOD NEWS IS IT'S NOT ALZHEIMER'S DISEASE.
YOU MAINTAIN YOUR PERSONALITY.
THERE'S STILL LOTS OF THINGS THAT YOU CAN DO WHEN YOU HAVE
COGNITIVE IMPAIRMENT.
THERE ARE DRUGS THAT WE CAN USE TO HELP YOU OUT.
IN THE LONG RUN, YOU CAN STILL ENJOY YOUR LIFE.