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Here is my personal view of apparent personality disorders in PD, from my 25 years of having PD, and 10 years of intensive research. I am not a doctor of medicine and anything I say here is my personal opinion only. 1. I prefer to use the term "parkinsonism" to avoid needless petty argument as to whether or not a particular group of symptoms is "true IPD" (idiopathic Parkinson's Disease). If it looks like a duck, walks like a duck and quacks like a duck, it probably is a duck, though not necessarily an Anas platyrhynchos. Strange when you think about it, since "idiopathic" means "arising from an unknown cause". However, PD is quicker, so lets stick to that. 2. If you look up the drugs used to treat PD and/or its side-effects, you will find they many of them are "psychotropic" (affecting the mind or mood or other mental processes). For example selegeline metabolises in the body to meth-amphetamine, hard to explain if you get pulled over for a traffic bust! 3. One of the most often quoted side-effects is "depression" (chemically induced in this case, although it often rides on top of depression arising out of the circumstances of the PWP and family). 4. Most PWPs have the so called Parkinson's "facies" (a facial appearance typical of a particular disorder). A psychologist or psychiatrist might say they have a "flat aspect", often attributing it to depression, whereas it is brought about by lack of muscle tone as a direct consequence of PD. 5. Most PWPs have, at one time or another (often on and off throughout the day), "anarthria", a partial or total loss of articulate speech, directly arising from loss of muscle tone in the organs of speech. Paradoxically, the PWP often thinks they are speaking in a reasonable tone and volume. 6. The above two symptoms can give rise to a feeling that the PWP is "disinterested" or "uncaring" about family or personal matters, whereas they themselves may think they are acting perfectly normally. Children especially are prone to believe that "Gran doesn't love us anymore." 7. Again checking the manufacturer's own data, a combination of symptoms from medication may give the appearance of dementia, or even Alzheimer's Disease. If this is suspected, a doctor may recommend a "drug holiday" where, under strict professional supervision, the PWP is taken off all medication, and they are re-instituted one at a time in small increasing doses. This is known as drug "titration". This process can be very dangerous if mishandled, and should only be undertaken by a doctor skilled in the process. 8. The difference between dementia or Alzheimer's from natural causes, and that chemical induced, is that the former is irreversible, where, with care and skill, the later usually disappears when the causative agent is removed. 9. Common or garden variety constipation can be very detrimental in PD, rendering some medication partially or totally ineffective. For example l-dopa, the principal ingredient of dopamine-replacement medication, has a half-life of 30-45 mins. It is induced into the blood stream by absorbtion from the small intestine, so any delay amounting to more than about 22 mins between swallowing and absorption may render that dose useless. Without going into too much detail, PD affects "motility" (movement of food through the digestive system), the muscle tone of the rectum walls, the anorectal flap, and the anal sphincter. If constipation persists, the PWP can become seriously undermedicated. 10. PWPs seem loath to drink sufficient fluids during the day. Chronic dehydration can have deleterious effects on the chemical processes within the brain. 11. PWPs can descend into a mental "fugue", a dream-like state of altered consciousness that may last for hours or even days unless the PWP is forced out of it. This might involve definite eye-contact and physical intervention. 12. Dopamine, the substance in short supply in PD, is a member of the "catecholamine" chain of neuro-transmitters which contains, among others, adrenaline, of which dopamine is a precursor, so any excessive stress can severly deplete the supply of dopamine. The details of these processes are too complex to go into here. So, all in all, the business of balancing the salutary effects of medication against the deleterious side-effects, coupled with the symptoms of the disease, is no easy process, and it is useful to have some knowledge of the complexities, whether medical practicioner or carer. Dr James F. Slattery PhD Soc Sc ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn