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Suggest Treatment For Dizziness When Diagnosed With Parkinson's Disease And Dementia
Question: Hi, I have been diagnosed with parkinsons disease and dementia 3yrs ago and would like to be a human triallist. Could anyone tell me if there is one going in New Zealand or not, or do I just accept what I have got and just fade away. I find myself getting very dizzy when I go walking and nearly falling over, but have not as yet.
Brief Answer:
Have you seen a neurologist
Detailed Answer:
Good evening sir. Thank you for your question. My question to you is whether or not you've seen a neurologist and on what basis the dementia was diagnosed because on the surface of what you're writing- I don't detect much confusion or disorientation.
Of course, the clinical data may be more subtle and the history may be suggestive. On the other hand being on medication itself can cause reduction in memory and cognitive function interpreted as a dementing feature of illness when in actuality it's only a side effect of medicine. Also, at your age It is generally considered standard of care to add additional medications to something such as Sinemet as opposed to simply increasing dosings or frequencies of 1 medication so that clinical effect is achieved.
Also, are you performing any type of EXERCISE THERAPY for your tremors or other parkinsonisms? Are you performing cognitive skills types of exercises either on the computer or in books you can purchase at a bookstore to help you with things such as memory, sequencing, and logical thinking?
You don't necessarily need experimental protocols and drugs to feel better and function at a higher level. What you need is a physician or team of health care professionals that can optimize your treatments given the clinical stage you're at. As far as exercises are concerned there is a very good program of full body involvement and exercise type of regimens that are specifically designed for Parkinsons' patients. The program is called DELAY THE DISEASE. There is an online ability for you to review this program and potentially purchase items from the program if you're interested. I would highly doubt that there are any therapists in New Zealand that have been trained and certified in this program but you could certainly suggest it and they could go about the certification process by hooking up with the online materials and the organization in order to figure out how to become certified.
I would ask the doctor to check on your orthostatic pressures and to perform a modified AMINOFF maneuver to see where your autonomic system is since autonomic dysfunction can be a consideration in someone with parkinsonisms (diagnosed as PARKINSON'S DISEASE) but then, becoming unresponsive to the drug of choice (Sinemet).
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 69 minutes of time to read, research, and respond.
Have you seen a neurologist
Detailed Answer:
Good evening sir. Thank you for your question. My question to you is whether or not you've seen a neurologist and on what basis the dementia was diagnosed because on the surface of what you're writing- I don't detect much confusion or disorientation.
Of course, the clinical data may be more subtle and the history may be suggestive. On the other hand being on medication itself can cause reduction in memory and cognitive function interpreted as a dementing feature of illness when in actuality it's only a side effect of medicine. Also, at your age It is generally considered standard of care to add additional medications to something such as Sinemet as opposed to simply increasing dosings or frequencies of 1 medication so that clinical effect is achieved.
Also, are you performing any type of EXERCISE THERAPY for your tremors or other parkinsonisms? Are you performing cognitive skills types of exercises either on the computer or in books you can purchase at a bookstore to help you with things such as memory, sequencing, and logical thinking?
You don't necessarily need experimental protocols and drugs to feel better and function at a higher level. What you need is a physician or team of health care professionals that can optimize your treatments given the clinical stage you're at. As far as exercises are concerned there is a very good program of full body involvement and exercise type of regimens that are specifically designed for Parkinsons' patients. The program is called DELAY THE DISEASE. There is an online ability for you to review this program and potentially purchase items from the program if you're interested. I would highly doubt that there are any therapists in New Zealand that have been trained and certified in this program but you could certainly suggest it and they could go about the certification process by hooking up with the online materials and the organization in order to figure out how to become certified.
I would ask the doctor to check on your orthostatic pressures and to perform a modified AMINOFF maneuver to see where your autonomic system is since autonomic dysfunction can be a consideration in someone with parkinsonisms (diagnosed as PARKINSON'S DISEASE) but then, becoming unresponsive to the drug of choice (Sinemet).
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 69 minutes of time to read, research, and respond.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have been to a neurologist who told me it was definitively not alzheimers but a parkinsons type of dementia.She gave Exelon patches and amantadine and does not seem to do a thing for me. She now thinks I may have P.S.P as the patches and Amantadine don't seem to be working for me. I have an extremely bad lower back and my eyesight is failing me badly in last.5-6weeks
Brief Answer:
Thank you for your clarifications
Detailed Answer:
We now know that what we once referred to as a PARKINSON'S TYPE of dementia is in fact, more likely than not Alzheimer's dementia. We no longer refer to dementia in the presence of PD as its own dementia. Having said that it would appear that your doctor doesn't believe you have PD as you had first mentioned. The working diagnosis has now changed to PSP (progressive supranuclear palsy). I don't know whether this is related to your perception that your eyesight is failing but in PSP..one of the abnormalities that is quite common is a patient's loss of ability to move the eyes in a vertical direction and in particular DOWNWARD rapidly. If the eyes are moved slowly in a vertical plane they tend to move much better than when the eyes are commanded to go quickly from top to bottom.
As a result patients have a lot of trouble climbing up and ESPECIALLY DOWN steps since they tend to see double and are prone then, to falls as a result of what is called VERTICAL DIPLOPIA. Only 20-25% of PSP are responsive to any form of dopaminergic therapy which may be why your Sinemet is no longer working. Unfortunately, if the diagnosis is accurate then, there are no specific medications available to treat this disorder. The best we can do is to protect patients from falls by continually evaluating their gait and balance (usually not very good) and provide them the aids necessary to help such as canes, walkers, or wheelchairs. The doctor most qualified to VERIFY the diagnosis of PSP would likely be a neurologist who is a movement disorder specialist followed by a neuro-ophthalmologist who will verify the typical eye movement features which are virtually pathognomic (signature feature) of the entity.
There is a PSP society which you can write to and join. They are an excellent organization to receive information from and would be most knowledgeable regarding current treatment trials that are ongoing all over the globe. You very well may even have a support network for PSP in New Zealand. I will provide you their general information that I have here in the U.S. but as I said I think it's just a matter of your getting on the internet and doing a bit of investigation to find a local organization in your area.
Take a look at the following link to begin with which will give you an educational primer to begin with on PSP and from there you can start branching out to getting on mailing lists to receive information and from there get connected with a local group in your area.
http://www.psp.org/education/psp.html
At the following HOME PAGE of the PSP organization you will find them mentioning trials that are actively recruiting patients:
http://www.psp.org/
As I said earlier if you feel that your neurologist is not quite sure of what's going on (it's been 3 years at this point and things can still be changing) then, you may do well to ask for a referral to a neurologist who is a MOVEMENT DISORDER SPECIALIST. They are most knowledgeable in terms of treatment regimens that can be administered although one must be careful that the tendency to prescribe a lot of drugs of no value doesn't result in more harm than good (i.e. dizziness, vertigo, fatigue, lethargy, increased falls due to worsening balance function).
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 86 minutes of time to read, research, and respond.
Thank you for your clarifications
Detailed Answer:
We now know that what we once referred to as a PARKINSON'S TYPE of dementia is in fact, more likely than not Alzheimer's dementia. We no longer refer to dementia in the presence of PD as its own dementia. Having said that it would appear that your doctor doesn't believe you have PD as you had first mentioned. The working diagnosis has now changed to PSP (progressive supranuclear palsy). I don't know whether this is related to your perception that your eyesight is failing but in PSP..one of the abnormalities that is quite common is a patient's loss of ability to move the eyes in a vertical direction and in particular DOWNWARD rapidly. If the eyes are moved slowly in a vertical plane they tend to move much better than when the eyes are commanded to go quickly from top to bottom.
As a result patients have a lot of trouble climbing up and ESPECIALLY DOWN steps since they tend to see double and are prone then, to falls as a result of what is called VERTICAL DIPLOPIA. Only 20-25% of PSP are responsive to any form of dopaminergic therapy which may be why your Sinemet is no longer working. Unfortunately, if the diagnosis is accurate then, there are no specific medications available to treat this disorder. The best we can do is to protect patients from falls by continually evaluating their gait and balance (usually not very good) and provide them the aids necessary to help such as canes, walkers, or wheelchairs. The doctor most qualified to VERIFY the diagnosis of PSP would likely be a neurologist who is a movement disorder specialist followed by a neuro-ophthalmologist who will verify the typical eye movement features which are virtually pathognomic (signature feature) of the entity.
There is a PSP society which you can write to and join. They are an excellent organization to receive information from and would be most knowledgeable regarding current treatment trials that are ongoing all over the globe. You very well may even have a support network for PSP in New Zealand. I will provide you their general information that I have here in the U.S. but as I said I think it's just a matter of your getting on the internet and doing a bit of investigation to find a local organization in your area.
Take a look at the following link to begin with which will give you an educational primer to begin with on PSP and from there you can start branching out to getting on mailing lists to receive information and from there get connected with a local group in your area.
http://www.psp.org/education/psp.html
At the following HOME PAGE of the PSP organization you will find them mentioning trials that are actively recruiting patients:
http://www.psp.org/
As I said earlier if you feel that your neurologist is not quite sure of what's going on (it's been 3 years at this point and things can still be changing) then, you may do well to ask for a referral to a neurologist who is a MOVEMENT DISORDER SPECIALIST. They are most knowledgeable in terms of treatment regimens that can be administered although one must be careful that the tendency to prescribe a lot of drugs of no value doesn't result in more harm than good (i.e. dizziness, vertigo, fatigue, lethargy, increased falls due to worsening balance function).
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 86 minutes of time to read, research, and respond.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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