Dopamine: For More than Mobility

About half of those dealing with LBD also have Parkinson's disease (PD). Anyone dealing with PD soon learns about the need for adequate dopamine.

Dopamine has several functions in the brain, including:

• Facilitating mobility. This is the function that PlwPD are most aware of. Without adequate dopamine, symptoms such as slowness of movement, tremor and stiffness occur.
• Reward-based behavior. Anything we consider a treat will increase the secretion of dopamine which facilitates positive emotions. Certain drugs also cause an increase of dopamine, which can make them addictive.
• Executive functions. In the cortex of the brain, dopamine and acetylcholine play a delicate balancing act that is seldom a problem until cognition becomes an issue.
• Pain management. In multiple areas of the brain, dopamine acts to decrease pain. Too little dopamine results in more pain, as in restless leg syndrome and an increases susceptibility to pain for PlwPD.

Drug issues. The body protects the brain with a barrier that prevents most substances from passing from the general blood stream into the brain. This is called the blood brain barrier (BBB). Dopamine by itself cannot cross the BBB and so doctors have to find ways around it.

• Levadopa is a precursor of dopamine that can cross the BBB. Once it is inside the brain, it transforms into dopamine. While levadopa works well for mobility, its effect on mood is limited. Thus, depression is a common PD symptom not treated well with levadopa.
• Cognition. When PD advances to PDD, with decreased acetylcholine levels, levadopa further interferes with the acetylcholine-dopamine balance and increases already present cognitive issues like hallucinations and slow thinking.
• Dopamine agonists are drugs that mimic the action of dopamine and can cross the BBB. These drugs appear to have a better effect and may improve depression. However, when dementia is already present, they can increase cognitive dysfunction and compulsive behaviors.

Outside the brain, dopamine has many other functions. It regulates:

• In the cardiovascular system and kidneys, dopamine acts to increase sodium and water retention, increase heart rate and constrict your blood vessels. Inadequate dopamine can cause low blood pressure and sluggish circulation.
• In the pancreas, dopamine's job is to regulate insulin production. Too much insulin triggers the release of dopamine, which may also may find its way into the brain where it functions as a reward. Eating high carbohydrate "comfort food" is an example of eating to produce higher levels of dopamine.
• In the immune system, dopamine retards lymphocyte activity, acting as a brake for when the immune system gets out of control and attacks healthy cells. Inadequate dopamine would result in increased levels of diseases such as arthritis.
• In the GI tract, dopamine again acts as a brake, reducing gastrointestinal motility and protecting intestinal lining. Too much dopamine can cause constipation. Too little might cause diarrhea and sores on the gut lining.

And so the bottom line is that when a person has PD or PDD, any of these other issues may come into play.  (Reference) (Reference)

We love and welcome comments but we will not print any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures.

* Acronyms:
LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD, PD, LBD, PDD, etc: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

The 2017 Arizona Alzheimer's Consortium Conference

Yesterday we attended the annual Arizona Alzheimer's Consortium Conference. We started out on a rather negative note. We left in plenty of time to enjoy the advertised pre-session Continental breakfast. But, long story short, we went to the wrong place MILES away from the right one! By the time we finally arrived, the speaker had already started. At our age, such incidents always end with us asking ourselves, "Is this a sign of impending dementia?"

But on to serious stuff. This is a conference directed at scientists, which we definitely are not. It is also strongly focused on Alzheimers rather than LBD. Nevertheless, we always come away from this conference in a hopeful frame of mind. This wonderful group of nine Arizona institutions collaborate to do research that a single one would find difficult if not impossible, reaching out to other institutions in the country and the world as well. Every year, they have a special focus for their conference. Several years ago, it was actually Lewy body dementia and other less common dementias. Another year, it was caregivers. This year it was students. Most of the presenters this year were students and they were great.

Of course, much of what we heard went over our heads. But we did learn that there are some amazing minds out there working on learning how to identify Alzheimer's early on. That's exciting because what they learn about AD will be translated to others like LBD very quickly. Here are some highlights of the conference:

Precursors: Several presenters talked about trying to discover what the precursors of Alzheimers. They weren't looking at external things like toxins, but on changes in the molecules themselves and what they do to other proteins that turns them into the plaques and tangles of AD. What seems to drive the changes? How common are they? Which changed molecules are present in people known to be at risk for AD and which ones aren't? And so on. The idea is that if they can discover these precursors, then they can find a way to stop them. Further, r researchers can use the methods they develop to look for precursors of LBD and PD and other neurogenic diseases in the same way.

Drugs. Most of us are aware of the damage anticholinergics can cause for anyone with LBD or even at risk for LBD. There's also a lot of the research that shows that the elderly who use these drugs are at greater risk than those who don't. A young researcher (a high school student!!) reported on his findings that middle aged people (40-50 year-olds) who used anticholinergics are at low risk for dementia. This was a primary finding and needs a lot more research, but quite interesting! Another researcher reported on findings that antidepressants like Prozac are fairly safe to use with dementia and in fact, may retard the development of AD.

Clinical trials. One of the roadblocks to research is the need for participants. Naturally they need people with the disease but they need healthy folks too, for their controls. We'd recommend that everyone who can should sign up for the Alzheimer's Prevention Registry. We also learned about the GeneMatch program that they have to help researchers working at the gene level. If you are 55-75 years old, live in the US and don't have a diagnosis of cognitive impairment, you are eligible to sign up for this too.

Caregiver care. Finally, we talked to a group called H.O.P.E. for building Health, Optimism, Purpose and Endurance in family caregivers and people with dementia. We were so pleased to see such a caregiver-oriented program represented at this conference. Their focus for the conference was anticipatory grief...which anyone dealing with LBD knows about...or should. They recommended the book, Loving Someone Who Has Dementia by Pauline Boss. "It's the book every dementia caregiver needs to have. It helps you deal constructively with that ambiguous loss that happens as your loved one gradually disappears in mind but is still there in body." Yes! We agree. It's a book you need in your library.

Oh, and we did get something to eat besides the muffins that we stealthy nibbled on while listening to the first speaker. They had a great lunch buffet with lots of healthy food and some decadent little desserts. Interestingly enough, they also had sodas. Have you heard about the latest research that people who have just one carbonated diet soda a day are three (3!!) times more at risk for dementia? And there's more research showing that drinking sugary sodas is linked to dementia too. Scary, huh? (More about this later.)

We love and welcome comments but we will not print any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures.

* Acronyms:
LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD, PD, LBD, PDD, etc: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Helpful Sites for Care Partners

We recently received two lists of links of for care partners that we believe are worth passing on. The first is from Natalie Kelly, who represents a group of educators and librarians called Forever Curious. The commentary is mine:

Transportation Resources for Older Adults
A very thorough brochure from always helpful Eldercare.gov that lists many suggestions for tranportation once a person can no longer drive. It also lists some agencies to contact for more suggestions in your area.

Selling a Home with Modifications for Older Adults
This valuable group of articles offered by Home City Real Estate are about so much more than selling a handicap-modified home. Anyone with a loved one whose daily living skills are challenged living at home needs to read this. It covers the types of modifications a person can do to make living easier, how these modifications will affect resale value in different areas of the country and how to do these modifications to avoid damaging resale value.

Fall Prevention
A brochure from the National Council on Aging that offers lists of programs to prevent falls by area and several lists on tips for preventing falls. The information is good but the links require patience--they are slow to load.

Assistive Technology Buying Guide
This extensive list of articles was compiled by RetailMeNot for their online shopping advisor, The Real Deal. They accurately advertize it as "Everything you need to know for buying assistive technology smartly." The articles cover everything from what is Assistive Technology and the equipment involved to where to find the best deals, and even how to get at least part of the cost covered. A great read before you buy any of this kind of equipment.

Special Needs Seniors: Planning for the Future of this Vulnerable Population
Retiring Wise is a blog by OneReverseMortgage of Quicken Loans. This particular blog entry discusses financial, medical, communication, and other concerns that seniors face as they age, with an extensive list of links to national, state and private agencies that offer assistance. This article also addresses the advantages of planning ahead, with information about Special Needs Trust, Long Term Care Insurance, and other things to consider early on. A must read, the earlier in the dementia journey the better.

Legal Guide for Newly Disabled Seniors
This article by Just Great Lawyers discusses the issues that every person with a disability and their care partner faces, including dealing with the change to being disabled, applying for services, protecting one's legal, financial and medical rights and more, with links galore for each subject. Every dementia care partner should read this no matter where they are on their journey.

Brain Support Network Blog
The second list comes from Robin Riddle and the Brain Support Network. I've written about their work in helping people donate brains, but now they have a blog that offers lots of information for care partners. Check it out. If you'd like to have the blogs emailed regularly to you, join their email list for LBD and general caregiving. Here is a list of some of the recent blogs:
* "Living Guilt Free" - notes from a one-hour talk
* "Respite Care: Finding and Choosing Respite Services"
* "Grieving Before a Death: Understanding Anticipatory Grief"
* "How do we cope with anger as a caregiver"?
* "13 Secrets That Make Caregiving Easier"
* Urinary problems in Parkinson's - webinar notes
* Complementary and alternative medicine in Parkinson's - webinar notes
* "Beyond Alzheimer's Disease" (including LBD) - webinar notes
* Overview of LBD symptoms and treatment - webinar notes
* Johns Hopkins Overview of Dementia with Lewy Bodies
* Five E’s of empowered living with chronic illness

Happy reading!

We love and welcome comments but we will not print any that advertise a product or a commercial website. This is especially true for testimonials about miraculous Parkinson's cures.

* Acronyms:
LBD: Lewy body dementia
PD: Parkinson's disease
PlwD: person living with dementia
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
PlwD, PD, LBD, PDD, etc: person/people living with dementia
PlwPD, LBD, PDD, etc.: person/people living with PD, LBD, PDD, etc.
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

The Value of Exercise

We've all heard and read about how exercise is so important as we age, and how it continues to be important for anyone dealing with dementia, both the PlwD and the care partner. Exercise increases blood flow...and oxygen...to the brain, increasing general functioning. But there is so much more!

Exercise is a great stress reliever. It immediately increases the levels of serotonin, noradrenalin, dopamine and endorphins.

• Serotonin is a feel good chemical that fights depression, common with most dementias, most chronic diseases--and most caregivers.
• Noradrenalin improves awareness and increases the ability to focus. Apathy, inattention and a short attention span are common dementia symptoms, all involving awareness and focusing.
• Dopamine facilitates small motor function and decreases depression. Dopamine is one of the chemicals targeted by Lewy bodies, making depression a chronic LBD symptom. (And of course, dopamine also facilitates small motor function, decreasing the tremors, slowness of movement and stiffness of PD.)
• Endorphins are natural pain relievers. Dementia is mostly a disease of the elderly, who have other illnesses such as arthritis. However, traditional pain relievers are often not recommended due to gastric discomfort or drug sensitivities. And there's more yet! 

Exercise increases cognitive function. It immediately increases the level of Brain Derived Neurotrophic Factor (BDMF), a growth factor chemical that facilitates new brain cells and maintains long term growth.

• BDMF increases a person's ability to maintain focus, or to switch their attention to something else. Most PlwD have a very short attention span unless they obsess, in which case, they can't stop easily.
• BDMF may also increase a person's ability to access abstract thinking, allowing them to move out of the here and now and to imagine new situations, and to be more creative. (This hasn't yet been tested on people.)

Finally, research has shown over and over that regular exercise decreases the risk of cognitive dysfunction in the future. That is, it won't stop the dementia that's present, but it may prevent dementia from showing up in the future...and it may slow down any that's present. It doesn't really matter what kind you do. Just exercise. Do whatever type you enjoy most. Do it with the PlwD. Do it with family. Do it with friends. Do it by yourself. Just do it!

Thanks to Wendy Suzki for this information.

* Acronyms:
BDMF: Brain Derived Neurotrophic Factor
LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.