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* 1. Have you ever had difficulty controlling impulses since being diagnosed with Parkinson’s disease?

About 14 percent of people being treated for Parkinson’s experience obsessive and impulsive behaviors. These symptoms may begin after starting treatment with dopamine agonist medications, such as Requip (ropinirole), Apokyn (apomorphine), and Mirapex (pramipexole dihydrochloride). Impulsive behaviors are especially common in people who are taking both a dopamine agonist and levodopa/carbidopa.

Decreasing or removing treatment with the dopamine agonist and switching to levodopa extended-release medication often helps to alleviate these symptoms. Support groups for impulsive behaviors such as gambling may also help.

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* 2. Do you ever feel so anxious that you have an outburst or a panic attack?

Feelings of anxiety contribute to the irritability and outbursts that can occur with PD. Between 20 percent and 50 percent of people with Parkinson’s disease develop issues with anxiety.

Anxiety issues tend to begin early in disease progression and may worsen over time. Scientists aren’t sure whether panic and irritability are caused directly by Parkinson’s disease or by co-occurring mood disorders like depression and anxiety disorder.

For some people, anti-anxiety medication like benzodiazepines can help with these symptoms, as can cognitive behavioral therapy. Other possible ways to manage anxiety include mindfulness, avoiding anxiety triggers, and doing activities you enjoy.

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* 3. Have you lost interest in things you used to enjoy? Do you no longer react to things that previously would have made you angry, sad, or happy?

About 40 percent of people living with Parkinson’s disease will experience apathy at some point. People experiencing feelings of apathy lose interest in things they previously enjoyed and may have blunted reactions to what would otherwise be moments of joy, sadness, or anger. Experiencing apathy can be distressing for the person living with Parkinson’s and their loved ones.

Some people with Parkinson’s begin losing interest in activities early in progression before they are initially diagnosed with the disease. The root cause of apathy in Parkinson’s is unclear. Apathy is a common symptom of depression, and 35 percent of people with Parkinson’s experience depression or depression-like symptoms. However, many people with Parkinson’s who don’t have depression do experience apathy, so there isn’t a clear cause-and-effect relationship. Apathy may be due to changes in reward centers in the brain.

One small study showed that treatment with the dopamine agonist piribedil may help apathy. If a person is experiencing other depressive symptoms, treating their depression with psychotherapy and medication may help.

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* 4. Do you often have problems paying attention, planning, remembering, or feeling motivated to do your daily activities?

People living with Parkinson’s disease may experience cognitive issues with planning, attention, and motivation. In some cases, those with PD may also have problems remembering things.

Up to 19 percent of people living with Parkinson’s already had mild cognitive impairment at the time of diagnosis. However, it can take as long as 20 years for this impairment to advance to dementia. Between 18 percent and 41 percent of people with Parkinson’s develop dementia or some form of cognitive decline.

The root cause of impaired cognition in Parkinson’s is unclear. It may be caused by the neurology of the disease. Scientists have found that sleep issues are common in Parkinson’s and are associated with cognitive decline.

Your doctor may recommend regular neuropsychiatric evaluations to see if cognitive symptoms are worsening.

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* 5. Have you ever talked to your health care provider about any behavioral changes that concern you?

Your health care team can help you best understand what may be causing your behavioral changes and work with you to find solutions. Some of these may include adding to, changing, or adjusting your medications, while others could involve talking to a therapist or making changes to your lifestyle.
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