My dad is 83 and has had Parkinson’s disease for the last couple of years. My mom, who is 79, is his primary caregiver. Lately my dad appears to have more tremors and rigidity. He is less active, sits around a lot and is irritable with my mom. Every time I visit, I notice how depressed my dad is and that he seems uninterested in doing things. Is this normal in Parkinson’s? Anything I could be doing to help them? — J.C., Berkeley
Parkinson’s disease is the second-most-common neurodegenerative disorder in the United States, after Alzheimer’s disease. It affects from 1 million to 1.5 million people in the U.S. alone. Each year, approximately 60,000 Americans are diagnosed with Parkinson’s. The disease typically presents as a movement disorder, with patients having difficulties such as rigidity and tremors. Other symptoms include sleep disturbance, pain, urinary incontinence and changes in emotional well-being.
People with Parkinson’s disease are afflicted with depression more frequently than other older adults, at a rate of 30 to 40 percent as compared to 20 percent of older adults in the general population.
The high rate of depression among those with Parkinson’s is due to several factors. It is often a reaction to the stress of coping with the disease, but can also be due to neurochemical changes in the brain. Parkinson’s typically affects many areas of the brain that are important in controlling mood. Psychosocial factors such as coping style and amount of social support — which become important when faced with a chronic illness — are also predictors of depression.
Depressed older adults tend to self-isolate, be irritable and appear angry. Yet only a small percentage of Parkinson’s patients who are affected with depression receive treatment. Why?
One reason may be that a patient’s physical concerns overshadow psychological ones. Another possibility is that some symptoms of depression and Parkinson’s — such as decreased energy and disturbed sleep — tend to overlap, and neither the patient nor the doctor recognize that depression is involved. In addition, many older adults are reluctant to report symptoms of psychological anguish to their doctor. Studies have shown that depression, anxiety and fatigue are not identified in half of routine neurological consultations.
Depression in Parkinson’s is detrimental and can negatively affect long-term outcomes. It can exacerbate motor symptoms and interfere with daily activities. If your dad is depressed, then he may be focusing on what he can’t do, instead of what he can. This may make him less inclined to seek care.
A neurologist is probably the best person to speak to if you suspect that your dad is depressed. Depression in Parkinson’s can be treated, so you should not hesitate to seek this kind of help.
The first major clinical study testing common antidepressants among those with Parkinson’s, launched in 2012, found that some antidepressants ease symptoms of depression without aggravating the motor symptoms of the illness or interfering with medications for Parkinson’s.
Another good first step is to contact your dad’s primary care practitioner, who can make a referral to a psychiatrist, psychologist or clinical social worker to provide emotional support, relaxation training, problem solving and stress management. In addition, a clinical social worker or care manager can work with your mom in her caregiving role to provide further support.
One more tip: Incorporate dancing into your dad’s live. You could even help with this — when you visit your parents, put on some music and encourage your dad to dance with your mom. Studies have shown that dance improves balance and gait function and indirectly reduces falls in Parkinson’s patients. Dance can also help train the mind to initiate and complete patterns of movement, and of course it’s great for the kind of social interaction that someone with depression may be lacking.
Remember, too, that there are many good resources to tap into, such as the National Parkinson Foundation (www.parkinson.org) and the Michael J. Fox Foundation for Parkinson’s Research (www.michaeljfox.org). Also, there are Parkinson’s support groups throughout Northern California (www.parkinsons.stanford.edu/support_groups.html).
Most importantly, don’t underestimate the benefits of your love and support for your parents.
Rita Clancy, LCSW, is the director of adult services at Jewish Family & Children’s Services of the East Bay. Her columns appear regularly in j’s Seniors supplements. Have questions about your aging parents? Email email@example.com or call (510) 558-7800, ext. 257.