[coachmomlu]

My neuro appt was changed to tomorrow, so I can also ask the dr, but respect your opinions as well. do any of the meds prescribed for PD help with executive function? Right now, this and focus seem to be my greatest difficulty. You should see some of my spelling in this text before correcting it!

[Conductor71]

Originally Posted by coachmomlu

My neuro appt was changed to tomorrow, so I can also ask the dr, but respect your opinions as well. do any of the meds prescribed for PD help with executive function? Right now, this and focus seem to be my greatest difficulty. You should see some of my spelling in this text before correcting it!

Fairly recently, it has become in vogue for neuros to prescribe cholinesterase inhibitors used routinely for Alzheimer's to treat cognitive impairment for PD. However, you should ask your neuro many questions before doing so because they directly counteract the effect of any other PD drugs we may take and further screw with what little neurotransmitters we have left. We have dissected this in another recent long thread, but this is the gist of it all:

-PD results in loss of dopamine and a subsequent increase in acetylcholine; the latter is what causes our motor symptoms: bradykinesia, tremor, and rigidity.

-Taking a cholinesterase inhibitor actually raises our levels of acetylcholine when we already have too much. Common sense would tell us that this will exacerbate our Parkinson's symptoms. Sure enough, there are studies to substantiate this:

From PubMed:

Cholinesterase inhibitors: tremor and exacerbation of Parkinson's disease.

[No authors listed] Prescrire Intl

(1) Three cholinesterase inhibitors are marketed in France for the treatment of Alzheimer's disease: donepezil, galantamine and rivastigmine. Tremor and dystonia are known adverse effects of cholinesterase inhibitors. (2) In patients with Parkinson's disease who have cognitive disorders, or in patients with Lewy body dementia, exacerbations of parkinsonism and tremor have been observed during treatment with cholinesterase inhibitors at normal doses. The disorders were reversible on withdrawal of the cholinesterase inhibitor. (3) Withdrawal of cholinesterase inhibitors should be considered if gait disorders, falls or parkinsonism occur or worsen during treatment.


-To further confound our treatment, neuros do this when we are already taking anticholinergics like Amantadine to lower the acetylcholine levels. Why would they give us another drug that then increases it? Doesn't this seem counterintuitive?

-Finally, from the DSM IV:

e. Mild cognitive impairment

The term "mild cognitive impairment" describes a heterogeneous group of individuals, with some patients in the earliest stages of Alzheimer's disease and others suffering from other conditions. There are no FDA-approved medications for the treatment of mild cognitive impairment at this time. Clinical trials of cholinesterase inhibitors for mild cognitive impairment have enrolled a narrower and better defined population of patients with mild cognitive impairment than most clinicians actually treat in practice, but even with these well-defined patients the evidence from clinical trials supporting use of cholinesterase inhibitors is weak (172, 173). Given the inconclusive data, the potential safety concerns that exist with this class of medications in this patient population, and the lack of FDA approval for this indication (reviewed in Sections V.B.1.a.4 and II.C.5.a.1.a), no specific recommendation can be made in favor of routine use of cholinesterase inhibitors in patients with mild cognitive impairment at this time. Nonetheless, individual patients may benefit from their use.


That being said, it sucks to see a change in our executive function. Levodopa therapy should help, but maybe seek some natural brain boosters like "Brain Gym" (search the forum archives here), neuro-friendly foods like blueberries, Omega 3'a, Gingko, crossword puzzles, learning something new, in other words keeping your brain nimble by learning and other aids may help. In PD, we tend to suffer from short term and procedural memory deficits- maybe looking into exercises to help make the most of what we have is the best we can do right now? Not recommending anything one way or another, but it is important to be aware of all these things; pharmaceutical companies do not in the end care about much beyond their bottom line, so we have to look out for ourselves and one another.

Laura

P.S. You may want to edit your title to reflect you are looking into memory or cognitive meds, you may get a lot more input.

[coachmomlu]

Originally Posted by Conductor71

Fairly recently, it has become in vogue for neuros to prescribe cholinesterase inhibitors used routinely for Alzheimer's to treat cognitive impairment for PD. However, you should ask your neuro many questions before doing so because they directly counteract the effect of any other PD drugs we may take and further screw with what little neurotransmitters we have left. We have dissected this in another recent long thread, but this is the gist of it all:

-PD results in loss of dopamine and a subsequent increase in acetylcholine; the latter is what causes our motor symptoms: bradykinesia, tremor, and rigidity.

-Taking a cholinesterase inhibitor actually raises our levels of acetylcholine when we already have too much. Common sense would tell us that this will exacerbate our Parkinson's symptoms. Sure enough, there are studies to substantiate this:

From PubMed:

Cholinesterase inhibitors: tremor and exacerbation of Parkinson's disease.

[No authors listed] Prescrire Intl

(1) Three cholinesterase inhibitors are marketed in France for the treatment of Alzheimer's disease: donepezil, galantamine and rivastigmine. Tremor and dystonia are known adverse effects of cholinesterase inhibitors. (2) In patients with Parkinson's disease who have cognitive disorders, or in patients with Lewy body dementia, exacerbations of parkinsonism and tremor have been observed during treatment with cholinesterase inhibitors at normal doses. The disorders were reversible on withdrawal of the cholinesterase inhibitor. (3) Withdrawal of cholinesterase inhibitors should be considered if gait disorders, falls or parkinsonism occur or worsen during treatment.


-To further confound our treatment, neuros do this when we are already taking anticholinergics like Amantadine to lower the acetylcholine levels. Why would they give us another drug that then increases it? Doesn't this seem counterintuitive?

-Finally, from the DSM IV:

e. Mild cognitive impairment

The term "mild cognitive impairment" describes a heterogeneous group of individuals, with some patients in the earliest stages of Alzheimer's disease and others suffering from other conditions. There are no FDA-approved medications for the treatment of mild cognitive impairment at this time. Clinical trials of cholinesterase inhibitors for mild cognitive impairment have enrolled a narrower and better defined population of patients with mild cognitive impairment than most clinicians actually treat in practice, but even with these well-defined patients the evidence from clinical trials supporting use of cholinesterase inhibitors is weak (172, 173). Given the inconclusive data, the potential safety concerns that exist with this class of medications in this patient population, and the lack of FDA approval for this indication (reviewed in Sections V.B.1.a.4 and II.C.5.a.1.a), no specific recommendation can be made in favor of routine use of cholinesterase inhibitors in patients with mild cognitive impairment at this time. Nonetheless, individual patients may benefit from their use.


That being said, it sucks to see a change in our executive function. Levodopa therapy should help, but maybe seek some natural brain boosters like "Brain Gym" (search the forum archives here), neuro-friendly foods like blueberries, Omega 3'a, Gingko, crossword puzzles, learning something new, in other words keeping your brain nimble by learning and other aids may help. In PD, we tend to suffer from short term and procedural memory deficits- maybe looking into exercises to help make the most of what we have is the best we can do right now? Not recommending anything one way or another, but it is important to be aware of all these things; pharmaceutical companies do not in the end care about much beyond their bottom line, so we have to look out for ourselves and one another.

Laura

P.S. You may want to edit your title to reflect you are looking into memory or cognitive meds, you may get a lot more input.

Thank you, Laura. He's not ready to say PD. He has prescribed Mirapex for restless leg syndrome. When i asked about the cognitive issues, he brushed it aside and said not to worry about that right now. Seems he's more concerned with the twitching and I'm more concerned with the thinking!

thanks for the title tip, I'll try to change that.

[Sasha]

Thought this might be of some interest, even though the number is very small (from pubmed):

Brain Cogn. 2009 Mar;69(2):435-41. Epub 2008 Nov 8.
Benefits of physical exercise on executive functions in older people with Parkinson's disease.

Tanaka K, Quadros AC Jr, Santos RF, Stella F, Gobbi LT, Gobbi S.

UNESP, São Paulo State University at Rio Claro, SP, Brazil. katinhalua@yahoo.com.br

The benefits of physical exercise on cognitive functioning have been reported in the literature, but the potential benefits to slow the eventual decline in executive functioning (EF) caused by neurodegeneration from Parkinson's Disease (PD) have rarely been studied. Thus the objective of this study was to analyze the effects of a multimodal physical exercise program on EF in older people with Parkinson's disease. The EF of the older people was evaluated by neuropsychological testing, and for confounding variables such as attention, depressive symptoms and anxiety, before and after intervention. The 20 participants were assigned into Control (CG) and Trained (TG) Groups. The TG participated in generalized physical training for 6 months. The ANOVA showed a significant interaction (p<.05) that indicated a beneficial contribution of training on EF. No significant interactions were found in the results for confounding variables between groups and pre- and post-intervention, which supports the beneficial findings of physical exercise training on EF.

[coachmomlu]

Originally Posted by Sasha

Thought this might be of some interest, even though the number is very small (from pubmed):

Brain Cogn. 2009 Mar;69(2):435-41. Epub 2008 Nov 8.
Benefits of physical exercise on executive functions in older people with Parkinson's disease.

Tanaka K, Quadros AC Jr, Santos RF, Stella F, Gobbi LT, Gobbi S.

UNESP, São Paulo State University at Rio Claro, SP, Brazil. katinhalua@yahoo.com.br

The benefits of physical exercise on cognitive functioning have been reported in the literature, but the potential benefits to slow the eventual decline in executive functioning (EF) caused by neurodegeneration from Parkinson's Disease (PD) have rarely been studied. Thus the objective of this study was to analyze the effects of a multimodal physical exercise program on EF in older people with Parkinson's disease. The EF of the older people was evaluated by neuropsychological testing, and for confounding variables such as attention, depressive symptoms and anxiety, before and after intervention. The 20 participants were assigned into Control (CG) and Trained (TG) Groups. The TG participated in generalized physical training for 6 months. The ANOVA showed a significant interaction (p<.05) that indicated a beneficial contribution of training on EF. No significant interactions were found in the results for confounding variables between groups and pre- and post-intervention, which supports the beneficial findings of physical exercise training on EF.

Sasha, thanks for that information. I haven't been exercizing, but am adding yoga this week. If for nothing else that to help limber up a bit!