Re: Is it PD?

[Robert Fink <rafink@xxxxxxxxxxxxx>]

You wrote:

>
>Hi everyone:
>
>I've been lurking on this list for months, and it's now time to
introduce
>myself and possibly pose a few questions. Before that, however, I would
>like to compliment all of you who contribute to this list; PD patients,
>family, caregivers, doctors, researchers, et al., who have so much
>compassion, information, and time to offer for the benefit of the rest
of
>us. Long live the net when used for purposes such as this.
>
>Now for specifics: My dad's wife, Janet, age 68, was diagnosed with
>Parkinson's in August of '93. The prognosis was that she had a *mild*
case,
>and was prescribed low doses of sinamet, which gave her some relief
from
>the usual symptoms. Within a year however, Janet started having what I
>would call anxiety or panic attacks, pervasive and dibilitating. These
>attacks increased in frequency over the last 12 months. The neurolgist
>treating her insists they were unrelated to either the medication or
the
>parkinson's itself, which, according to further testing, had stabilized
and
>not progressed beyond a mild state.
>    Within the last 6 months, however, Janet's mental and emotional
state
>has steadilly decreased. She suffered from occasional loss of memory,
>couldn't recognize her surroundings or friends or family, still had
anxiety
>episodes, even  wandered away from home a few times, much to the dismay
of
>my Dad, who is the primary caregiver, and her doctors. As her situation
has
>deteriorated, we suspected that she was suffering from depression, and
she
>started seeing a psychiatrist last month, who, I believe, prescribed
>various anti-depressants or mood elevators, though I'm not sure
>specifically which ones. Recently, all of this behavior has escalated
and
>she has become paranoid, and with the psychiatrist's approval, Dad had
to
>put her in the hospital for testing and observation. *Those* doctors
are
>now starting to whisper about dementia.
>    What is happening to Janet and what can we do to help her? Does
anyone
>out there recognize this steady, downward, emotional spiral she seems
to be
>afflicted with? We were hoping initially she was suffering side effects
>from her medication, but that doesn't seem to be the case, as sinamet
has
>been withdrawn and no difference has been detected. Then we were hoping
it
>was *just* depression, which could be treated with medications and/or
>therapy, but she seems to be slipping away from us so quickly there may
not
>be time for that. Now we are hearing about dementia, and the treating
>physicians at the hospital want to start administering anti-psychotics.
Her
>long time neurologist, the psyciatrist, and hospital staff offer
>conflicting information as to waht they think the problem is, and seem
to
>have trouble communicating with each other (and us). Deep down, I think
my
>family is starting to wonder if these people *really* know how to treat
>Janet, and if so, which one diagnosis to trust?
>     So, a few questions that my father asked me to post:
>1. What constitutes the dividing /defining line between depression and
>dementia   in a PD patient?
>2. How does, or should, the drug treatment differ for the two
conditions?
>3. Can extreme depression in PD mimic dementia?
>4. If so, for how long?
>
>Thanks to all of you. I'll forward all replies and comments to my
father.
>Steve
>
>-----------------------------------------------------------------------
-----
>Steve A. Dunleavy (dunleavy@xxxxxxxxxx)
>-----------------------------------------------------------------------
-----
>
>
Steve:  I have some concern that Janet may have something other than PD.
Did she have a complete neurological workuop, this including a CT or MRI
scan?  There are other conditions (brain tumor, hydrocephalus, vascular
disease) that can mimic PD and which have their own treatments.  As to
the medications, they can produce side-effects as mentioned by you
above.  Please keep us posted.

Best,

Bob

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Robert A. Fink, M. D., F.A.C.S.   Phone: 510-849-2555
Neurological Surgery              FAX:  510-849-2557
2500 Milvia Street  Suite 222
Berkeley, California 94704-2636
USA

E-Mail:  rafink@xxxxxxxxxxxxx
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America Online:  BobFink          "Ex Tristitia Virtus"

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