November 7, 2014

For Parkinsonians Like Me, Gait Problems May Presage Cognition Decline

I think it might be time to change the blog's title to "Aging and Parkinson’s and Dementia and Me."

Last week, a new study concluded that people with Parkinson's (PWPs) who also have neurogenic orthostatic hypotension (NOH) carry increased dementia risk. NOH is my latest and most troubling affliction.

Earlier this week, I discovered that people who feel lots stress and anxiety (“neurotics”) during midlife are at higher risk for developing late-life Alzheimer’s. I’m pretty sure my midlife situation fits the description – I was dealing with alcoholism, concealed sexual identity, the early death of a spouse, and all the typical family issues. I wrote about that study in this blog post.

As if that weren’t enough, a new study finds that PWPs whose symptoms principally involve gait issues – not tremor -- may be more susceptible to developing cognition issues. According to the study’s conclusion, “progressive gait problems may be associated with progressive cognitive decline in people with Parkinson’s disease.” My main Parkinson’s-related problem is gait and its associate balance.

Are Study Results Reaching Critical Mass?
These three studies – coupled with my own feelings and observations – make me think my odds for developing dementia are increasing.

When I’ve mentioned these thought to friends and family, they understandably try to reassure me, to downplay my observations. I know they mean well, and may even believe what they say.

When it comes to acknowledging problems, I’ve shown world-class denial skills all my life. But now, in light of what I feel and learn, I must face the fact that developing Alzheimer’s -- or some other dementia -- is a real possibility for me.

Not to sound ghoulish, but I’ve been reading up on assisted suicide options in Switzerland. My dad was born in Zurich. Looks like I might die there, he said half jokingly.

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The full text of the gait-tremor-cognition study is available via the link above. Here are the study’s conclusions:

Parkinson’s is a neurological disease with characteristic features of tremor, rigidity and slow movements, as well as a variety of other classic symptoms, including Parkinson’s dementia.

This case-control study demonstrates how measures of both gait (walking) and cognition are, as would be expected, poorer in people newly diagnosed with Parkinson’s disease compared with healthy controls.

The study also demonstrates that in Parkinson’s disease, people with a predominant postural instability and gait disorder (PIGD) unsurprisingly have poorer measures of gait than people with predominant tremor disorder (TD).

Though there was little difference in cognitive measures between people with PIGD and TD, in those with PIGD there was a correlation between measures of their gait and cognitive function.

This suggests that progressive gait problems may be associated with progressive cognitive decline in people with Parkinson’s disease, though the specific biological mechanisms behind this link were not investigated by this study. The researchers now plan to investigate this link further.

The researchers also acknowledge several limitations with their study, including the relatively small sample size – involving only around 50 people with each subtype of Parkinson’s. This means these are small numbers on which to base firm conclusions about the differences between the two subtypes.

There are also other measures the study may not have been able to take into account, including the influence of medication (some had started Levodopa, some not) and depression.

Overall, this study helps doctors to further understand how gait may be associated with cognition in people with Parkinson’s, and that predominant gait problems may also be an indicator of more cognitive problems.

While there are no current preventative or treatment implications of these findings in terms of Parkinson’s, early recognition of people who may be at risk of dementia is likely to be beneficial.


Loene said...

Hi John,

I think you are an outlier in all ways, and I will be surprised if you develop cognitive issues at an equivalent age to anyone else with PD.

Don't do as Robin Williams did, conclude how awful life will be at some future date and then arrange never to get there. Who knows what fun awaits along the way?

Warm regards -- and keep on writing! -- Loene --

Anonymous said...

Hi John,
You recently wrote a blog about peoples’ choices regarding choosing suicide. You also gave a list of experiences you would have missed out on in the past few years had you chosen to take that path.
My perspective is regarding your past few years also - but what we, as your readers, would have missed out on had you checked out. Since I was diagnosed with Parkinson’s in 2008 you have been the most regular source of encouragement. The first time I logged onto our regional PD support page in Ontario, Canada and read what was coming in my future I burst into tears and shut it down. As a single parent with 4 kids, (2 teenagers in high school, one young adult in university and another on disability), and a vindictive ex, it just felt like the last straw. I can’t recall when I came across your blog, but you have been instrumental in keeping me going.
• Openly shared your life journey
• Educated us regarding medications, complications, PD implications
• Shared your discoveries, families, trips
• Shared how you keep modifying your life, home, organization tips etc
• Weren’t afraid to admit if something was incorrect
• Humbly admit your foibles, are able to laugh at yourself
• Keenly search out new research
• Have made it feel like you’re travelling together with us
• Haven’t been afraid to deal with topics that others would avoid

My bet is that there are many more readers out there who would add far more reasons for why you are appreciated -why we’re glad you’re still here😊 If your future blogs have spelling mistakes or are repeat postings, or need to be shorter / less frequent, that’s ok. It’s worth the wait. Thanks for being there!♥