> Thank you for the welcome to the Parkinson List.  My father was diagnos=
ed
> with Parkinson's approx. 7 years ago.  He has very rapidly gone down hi=
ll
> and is now in a nursing home.  I thought that I might perhaps learn
> something new about Parkinson's as well as learn if his mental confusio=
n,
> halucinations, etc. are common.  No where in books can I find anything
> that addresses what this disease has done to his mind.  He is 69 years
> old and had always been super active (hunting, etc.).  My family feels
> that he must also have an underlying condition -- that Parkinson's alon=
e=20
> could not (or should not) have affected his mind.

Lin, has anyone tested your father for clinical depression?  Not the kind
where unhelpful outsiders say, "Just pull yourself together!", but the
medical condition.=20

To quote (in brief - the whole thing is in itself depressing) from Dr. Ne=
al
Slatkin, neurologist, parkinsonologist and director of the Parkinson Cent=
er
at the City of Hope Medical Center in Duarte, California -=20

"Depression is the most common neuro-psychiatric disturbance among PD
patients. It is more common than psychosis, confusion and dementia. The
prevalence in PD, which is about 40%, is higher than for any other chroni=
c
illness that is matched for similar degree of functional impairment. Of
those with depression, about 50% are having a major depression."

"There are two different types of depression: Endogenous which is
biological such as neuro-chemical, and exogenous which is situational
coming from the environment (that is, the personal circumstances of the
individual PWP - Jim). Normally a depression is composed of some
combination of both endogenous and exogenous causes.=20

Studies have been done on the neurochemical component of depression. It h=
as
been found that the neuro-chemicals of serotonin and norepinephrine are
involved in depression. Everyone knows that there is a deficiency of
dopamine in PD. It turns out that norepinephrine is manufactured from
dopamine."

"DEPRESSION -->> MOTOR IMPAIRMENTS -->> DEPRESSION=20
Most people can understand that motor impairments can cause depression. I=
t
is more difficult to understand that depression can cause motor
impairments. We have no difficulty believing that the mind can heal the
body. It is more difficult to grasp that the mind can cause physical
impairments."

"SYMPTOMS OF DEPRESSION=20
=95Sadness =95Depressed mood (especially in the morning) =95Hopelessness,
helplessness and self-blame =95Loss of interest and pleasure in activitie=
s
=95Loss of energy - fatigue - leading to inactivity =95Decreased concentr=
ation
- indecisiveness which has led some doctors to diagnosis dementia
incorrectly =95Sleep disturbance =95Preoccupation with negative thoughts =
-
seeing the world through maroon colored glasses rather than rose colored.
=95Poor appetite and weight loss =95Thoughts of death and suicide and in =
some
cases actually doing it."

"CLINICAL FEATURES OF DEPRESSION
=95Sad faces =95Fatigability =95Sleep disturbance =95Speech: slow, ... , =
=95Stooped
posture =95Constipation =95Diurnal variation =95Low mood =95Motivation lo=
ss
=95Hopelessness =95Loss of interest =95Feel inadequate =95Suicidal wishes
=95Indecisiveness =95Conscious guilt =95Loss of appetite =95Cry in interv=
iew."

I am not saying that this is what is affecting your father's condition, b=
ut
I am sure you can see why, especially in a previously fit and self-relian=
t
person, some degree of exogenous depression (what most people would term
'ordinary' depression, caused by the mind reacting to circumstances) is
usually present in *all* PWP's.

Speaking for myself, I was a fit, physically and socially active person
(member of 15 committees at once - perhaps I should have had my head read
at the time), and the depredations PD made on me in the early years (I wa=
s
diagnosed 12 years ago, and probably had it for about 2-3 years before
that) caused, eventually, severe depression requiring medical interventio=
n.
I'm alright now  :-)

Add to this the fact that some of the medications we take are psychotropi=
c
(can affect the brain and behaviour), and can therefore cause endogenous
(chemically-induced) depression, and one can see why such a state can lea=
d
to a deterioration in health.

Now for the good news!  Mood state can be improved by exercise, increased
activity, antidepressants and counselling. The physical state can be
improved with Parkinson's medications, carefully combined and balanced to
the individual PWP's current needs.  This is a gradual process, and needs
observation and adjustment over time.

Again, in my own case, I went from a sombre, despairing individual,
seriously contemplating suicide, to a brand new profession in a field I
love, and am currently teaching in this field as well.

We here in Orange are using the Beck Depression Inventory, an
internationally recognised scale, as one of the research tools for the
Central West Parkinson's Disease Research Group.  As the results come in,
they are progressively added to a secure database on which the interviewe=
es
remain anonymous to all except the chief researcher.  Results to date
confirm Dr.Slatkin and other researchers around the world, in the view th=
at
depression in PD is a little recognised, but seriously debilitating aspec=
t
of PD.

I know that even considering the possibility is, in itself, depressing to
family and friends of the PWP, but it *is* essential.  The reward of seei=
ng
the health, outlook, and future prospects of the PWP improve is well wort=
h
the effort.

> I don't know if I have anything to offer the members of the list.  Woul=
d
> welcome your thoughts.

You *do* have something to offer; the continuing affirmation to other
users, that, despite the news media's version of the state of the world
today, there are still considerate, caring people like yourself out there=
,
concerned about the welfare of others.

Jim