MENTAL SYMPTOMS                                            16

MENTAL SYMPTOMS:       It is becoming clear that PD affects many
parts of the brain other than centers of motor control. Specific
aspects such as memory, sleep disturbance, hallucinations and
psychoses have been thoroughly studied, but since PD is age-
related, it's hard to know whether such symptoms are due to
the disease or merely to normal aging deterioration.

ATTENTION DEFICIT:       Many patients (and caregivers) report
difficulty concentrating on a mental task. To be sure it's a
cognitive effect, one must rule out such causes as reading and
eye problems. Tests do confirm that PWP are less able than
normal controls to handle multiple simultaneous tasks.

MEMORY:          It was recently discovered that there are at
least two distinct kinds of memory, which occupy different
locations in the brain. That supports the idea that loss of
one or another comes from localized degeneration that is
typical of PD. Long-term memory of facts, such as dates, places,
and events, seems to be spared in PD, but other kinds are not.

Short-Term Memory:       In my own lexicon, there is a sort of
scratch-pad memory, which we depend on after deciding to go to
the next room for some article, or for avoiding some obstacle
that appears in view while walking. PWP seem more likely than
usual to forget the object of a very short errand, or to bump
into something which they had seen was in the way.

Habit And Rote Learning:       Everyone has to learn how to
deal with stochastic situations without memorizing specific
facts; for instance how to navigate on foot through a crowd,
how to play a game of chance, habits of hygiene, and so forth.
In a fascinating study, PWP were found deficient in ability to
learn what amounted to new habits. Some PWP, and a group of
people with confirmed amnesia, were given a short training
course in a simple guessing game of chance, where the sequence
of clues gave not the precise outcome but only a statistical
hint. The amnesiacs forgot taking the training but did learn
to play as well as normal subjects. The PWP recalled taking
the training but they didn't learn from it how to play.

Pattern Recognition:           Learning a set of numbers or
other parameters is different from learning a pattern, such
as a face. In one study, PWP were not only less able to
assume specified emotional expressions, but also less able
to recognize such expressions on the faces of others.

MENTAL SYMPTOMS (cont.)                                    17

SLEEP DISTURBANCE

Interruption:        Sleep of PWP may be interrupted in many
ways. Some of the drugs commonly taken, such as Sinemet, cause
insomnia because of their stimulating effect. Also, the dosage
schedule may require waking up two or three times each night. Because of
the brief "lift" from dopaminergic drugs, patients
may report that they stay up for a half hour or so after a dose,
to read or otherwise occupy themselves before returning to bed.
If the dopaminergic regimen is frugal, the sleeper may be
awakened by painful dystonia, usually in the leg or foot, as
a reminder that the time for the next dose has arrived.

Vivid Dreams:       Neither PD itself nor its drugs seem to
interfere with the soundness of sleep, as shown by frequent
reports of vivid dreams, often with a complex plot. The
dreams may result from some psychological state, but I
suspect that medication drugs are the root.

Violence:          Researchers have collected many reports
that PWP punch, kick, or shove their bed partners while in
deep sleep. It may come from the medications, as do the
dreams.

HALLUCINATIONS:         These are a mild form of delusions,
reminding that some PD drugs may cause genuine psychosis in
certain patients. It is also noted that dementia of many
forms may occur in advanced stages of PD, particularly in
elderly patients who are more susceptible.

Visual:           Visual hallucinations are a common side
effect of some PD medications, and can be troublesome
enough to force discontinuance of a drug. The effect seems
to vary widely, with patients having different susceptibility
to different drugs. Therefore the recourse is to try various
drugs until one having similar therapeutic benefit is found to
be tolerable.

Auditory:        Not all hallucinations are visual; auditory
hallucinations are often reported, but seldom by patients
who don't also have visual hallucinations. At one time during
the course of my own loss of smell sensitivity, I had
olfactory hallucinations- unfamiliar odors that I could not
identify and no one else could detect.

MENTAL SYMPTOMS (cont.)                                    18

DEPRESSION:        When a patient has PD, there is no
guarantee of immunity from any other neurological dysfunction.
Depression is very often diagnosed along with PD, and when
found is considered to place the subject in a different
category, for such purposes as a research program. I
perceive two basic kinds of depression: so-called clinical
depression, which is even more common in absence of PD, and
the short-term mood swings that are exclusively related to PD.

Clinical Depression:   This illness is beyond the scope of
the present discussion, except to say that it is now treatable
very effectively in many cases by drugs alone. Unfortunately
for PWP who also suffer clinical depression, some of those
drugs have serious, potentially fatal, interaction with
certain drugs used to treat PD. Clinical depression may be
distinguished from the mood swings of PD by its very long
development time, and of course by its lack of response to
drugs used for PD. Mood swings, in contrast, are brief and
sudden, and response to the usual antidepressant drugs may
be disappointing.

Mood Swings:       The reason why cocaine, nicotine, and
chocolate evoke psychological dependence is that they all
contain elements that bind to dopamine receptors related
to the sensation of pleasure. No surprise then, that
dopamine itself has a similar effect. I'm not clear how
the effect can be virtually instantaneous, since dopamine by
mouth has to go a long way to enter the brain, but it's
true. PWP in the fluctuation stage very often feel depressed
as their levodopa dose nears exhaustion, and get a quick
lift immediately on taking the next dose. This is so common
that the onset of gloomy thoughts may serve as an indicator
of the best dosage interval. It seems that many patients
and doctors don't recognize the difference between this
short-lived depression and true "clinical" depression, and
therefore choose antidepressants such as Prozac or Zoloft,
which may not be really needed. In contrast to clinical
depression, the mood swings from fluctuating dopamine supply
are not nearly so severe, and are quick to come and go. The
depression may arrive within seconds, like a big wave on the
seashore, and recede within a few more seconds, after taking
the next scheduled dopamine-enhancing medication.

BRADYPHRENIA (Slow Or Impaired Reasoning):        Another
phenomenon that has generated much research and debate, on
whether it is a true symptom of PD, or (since most PWP are
middle-aged or older) merely the result of "normal" aging.
Scientific opinion presently is about evenly divided. It's
easy to test thinking speed, the hard part is to prove where
any such effect originates.

(This completes the file)
Cheers,
JOe
--
J. R. Bruman   (818) 789-3694
3527 Cody Road
Sherman Oaks, CA 91403-5013