Are there stages in Parkinson's? And if so, is there such a thing as Psychotic dementia? -

Are there stages in Parkinson's? And if so, is there such a thing as Psychotic dementia?


My sister seems to think Mom is in the Psychotic dementia stage of Parkinson. Never heard of that type of dementia. Mom is more confused sometimes, but mostly OK and realizes where she is and who everyone is.

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Slightly over a century ago a prominent German neurologist, Fritz Heinrich Lewy, discovered in the autopsied brains of persons with Parkinson's Disease microscopic deposits of alpha-synuclein protein that are now referred to as Lewy Bodies. These deposits interfere with the normal working of the brain, and result in various debilitating symptoms which worsen over time. One set of symptoms are the physical ones we associate with Parkinson's. Another set of symptoms are cognitive and behavioral and are a kind of dementia.

When talking about "stages" it is interesting to note that the cognitive symptoms (dementia) can come first and be most prominent, or the physical symptoms can come first. One set of symptoms can follow the other very quickly, or there may be a large gap between the onset of the first set and the onset of the second set.

I have never heard the cognitive symptoms called Psychotic Dementia. If the Parkinson's symptoms came first (as is apparently the case with your mom) the disease is called Parkinson's Disease Dementia (PDD). If the cognitive symptoms come first (as was the case for my husband) the disease is called Dementia with Lewy Bodies.

Whichever comes first, the dementia is quite different from Alzheimer's, the dementia most people are familiar with. For example, my husband knew who everyone was until the day he died. Your mother is likely to, too. Losing recognition of people is not a typical symptom of the Lewy Body diseases. Hallucinations are common early on. Sleep problems, especially a sleep disorder called RBD which involves acting out dreams, are common. Significant fluctuations in cognitive ability from day to day (or hour to hour) are common.

What makes your sister think Mom is displaying dementia symptoms?

The website of the Lewy Body Dementia Association ( has a lot of information about this disease.
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My Dad was diagnosed with Parkinsons14 years ago and the progression is steady with the dementia. But some of it can be controlled with medications used to help alzheimers patients. Dad used to see a little girl on a bicycle that wanted him to come out and play with her. He was very adept at explaining why no one could see her except him. Once we started him on the Exelon patch, she went away and hasn't been seen since! Due to the cost of the Exelon patch, we changed him to Rivistigmime twice a day and the results are just as good. He still has confusion over whether he is still employed and still frequently wants to design a new "product" but I can usually talk him down from those fantasies with a little patience and affection. He was an electrical engineer and has 10 patents for inventions during his career so his delusions are quite detailed sometimes. Yesterday he wanted me to take him to the bank to deposit a check (that didn't exist) for a new invention (that didn't exist) and it was easier to play along and agree to fill out the deposit slip than it was to convince him of the truth. It doesn't hurt anything and it makes him happy to think he can still contribute to the household income. I blessed that he still knows who I am and can identify everyone in his world. Regular outdoor walks really help his cognition as well.
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Sometimes this occurs from over medication of Parkinson's drugs. Talk to her Doctor about lowering the dose. It's tricky getting the dose right, and not overlapping doses. This happened to my Dad when we upped the dose to give him more mobility, it caused full blown psychotic dementia. As soon as we lowered the dose he went back to normal.
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Psychotic dementia? Never heard of that one. She is probably referring to the hallucinations etc that are cause by Parkinson's and some medications. Parkinson;s Dementia is just that, parkinson's dementia. It may be later identified as Lewy Body dementia.
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If this is sudden, it could be a UTI (urinary tract infection). If it is onset after a medication change, call the MD right away. If it is something that appeared gradually, bear in mind she may have more than one malady. Having Parkinson's doesn't mead she does not have kidney failure or some other debilitating condition, and this is where you rely on the MD to know what to look for. Parkinson's may start with a tremor, but as the nerves break down, many more bad things can happen, including delusional states.
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apparently, patients with Parkinson's often have visual hallucinations or delusions of infidelity and the like. Google Parkinsons and psychosis. Have you spoken with her neurologist? If there is a change in mental status, it should be reported to the treating doctor.
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