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Apathy impulsivity and motivation with parkinson's nwpf 2011
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Apathy impulsivity and motivation with parkinson's nwpf 2011

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Learn about Parkinson's associated symptoms of apathy, impulsivity an tips to overcome these problems and stay motivated for positve lifestyle change

Learn about Parkinson's associated symptoms of apathy, impulsivity an tips to overcome these problems and stay motivated for positve lifestyle change

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  • 1. Opposite Ends of the SpectrumApathy and ImpulsivityParkinson’s
    Monique Giroux, MD
    Movement Disorders Neurologist
    Integrative Medicine and Holistic Health
    Medical Director Northwest Parkinson’s Foundation
  • 2. Overview
    Understanding apathy and impulsivity
    Why focus on these symptoms
    Strategies
    Medical Checklist
    Personal Checklist
  • 3. Under-drive vs over-drive
    Initiation of action
    Goal or result driven action
    Impulsivity
    Apathy
  • 4. Apathy and ImpulsivityBiological Cause
    Brain Circuits mediate reward behavior -striatal limbic, anterior cingulate, mesolimbic and mesocortical brain areas
    Dopamine - major neurotransmitter in this circuitry- “Dopamine promotes what we think of as wanting.”
  • 5. Understanding Apathy and Impulsivity
    Apathy- Lack of Motivation - Assoc with
    Depression, Fatigue, Cognitive Changes
    Disease Changes
    Medications
    Dopaminergic
    Sedatives
    DBS - STN stimulation or medicine change
    Impulsivity
  • 6. Understanding Apathy
    Apathy
    “Lack of motivation”
    Components
    Behavioral - reduced initiative or drive
    Cognitive - reduced interest
    Emotional - “indifference”
  • 7. Pseudo- Apathy
    Facial Expression
    Slowed Cognition or Movement
    Poor Stamina
    Fear, Social Phobia and other Stressors
    Change in Performance
  • 8. Impulsivity Opposite End of the Spectrum
    Initiation of action
    Goal or results driving action
    Impulsivity
    Apathy
  • 9. Understanding Impulsivity
    “Decreased control or insight”
    Failure to resist an impulse not in one’s best interest
    Behavioral – repetitive act- i.e. gambling
    Cognitive – repetitive thoughts – i.e. rumination
    Emotional – i.e. emotional rewards or good feeling.
  • 10. Impulsivity Control
    Hypersexuality, Binge Eating, Impulsive Shopping, Pathologic Gambling, Hoarding, Punding
    Medication:
    13% people taking PD medications
    17% on dopaminergic agonists
    Ropinirole (Requip), Pramipexole (Mirapex)
    DBS
    Cognitive Challenges- Multi-tasking and Prioritizing
  • 11. Apathy and impulsivity impair ability to aCHIEVETakEback control Medical ChecklistPersonal Checklist
  • 12. Apathy Checklist- Mood
    Is depression present?- feelings of sadness, depressed mood
    Counseling, support, exercise, sleep, antidepressants
    Antidepressants- buproprion (Wellbutrin), venlafaxine (Effexor) boost norepinephrine or dopamine
    Is anxiety present?
    Counseling, stress management techniques
    Mindfulness therapies- deep breathing, meditation, guided imagery
    Antidepressants- SSRIs for anxiety with and without depression
  • 13. Apathy Checklist-Fatigue
    Are movement problems limiting?
    PT, OT
    Motor Fluctuations- Fatigue worse with wearing off
    Is Stamina a problem?
    Fitness, Exercise
    Medical Problems
    Cardiopulmonary, thyroid, etc.
    Testosterone deficiency
    Sleep
    Medications- Dopamine agonists
  • 14. Apathy Checklist- Cognitive
    Are cognitive problems present?
    Neuropsychological testing
    Medical- Vitamin B12, TSH, glucose control
    Medication- rivastigmine (Exelon)
    memory enhancing medicines that can improve apathy
    Cognitive Strategies- Prioritize and simplify to avoid multitasking
  • 15. Apathy Checklist- Disease
    Adaptation to Change
    Movement Efficiency- PT, OT
    Medicines- too much, too little
    DBS
  • 16. Impulsivity Checklist- Disease
    Review with your healthcare provider
    Review medicines- Dopamine Agonists?
    Cognitive Abilities- Avoid multitasking, Simplify
    DBS
  • 17. Apathy and Impulsivity“So What Now”
    First Step is Awareness
    Second Step is to treat underlying issues
    Third Step is to determine if its worth ‘fixing’
    Fourth Step is to set an action plan in place
    The Personal Checklist
  • 18. Personal Checklist
    Positive Commitment
    Know Yourself
    Success and Barriers
    Choose the right tasks/set the right environment
    Have Fun
    Get Support
    Use Resources
  • 19. Personal Checklist
    Positive Commitment
    Motivation = Value * Confidence
    Positive Change Talk
    Moving along in direction of change. Not giving something away but drawing something out of the person.
  • 20. Personal ChecklistKnow Yourself
    What you value
    What you like
    Diary
    Learn from the past
    Be patient, accept ups and downs
    Practice Positive Self- Talk
  • 21. Personal ChecklistSuccess and Barriers
    Success
    Barriers
    Interest
    Shared Interest/ Concern
    Support
    Positive body/disease change
    Stamina
    Fatigue
    Time
    Interest
    Pain
    Depression, Apathy
    Ability
  • 22. Personal ChecklistRight tasks/Right environment
    Start simple, start slow.
    Set realistic goals.
    Mix it up
    Habit first. Optimize second.
    Accessible
    Motivating environment
    Interest Inventory- Group, Indoors, Outdoors
  • 23. Personal ChecklistFind Support
    People, Internet, Gadgets
    Talk about it, Write it down, Rehearse it
    Diary
    Support, Buddy, Group
    Establish the Rules
    Engage your Medical team
    PT, Personal Trainer
  • 24. Personal checklistMake it rewarding
    Make it fun- Treadmill or dancing?
    What makes you happy- Movies, Laughter Yoga
    Surround yourself with the right situation or people to motivate change
    Reward yourself
    Be an agent for change:
    Motivate, inspire and encourage others
  • 25. Personal ChecklistResources
    Calendar- make a list, write it down and keep track
    Online exercise tracking system- NWPF virtual team Parkinson’s, www.nwpf.org/wellnesss
    Gadgets
    Pedometer, Smart Phones, Calorie counter
    CDs, self help tape
    Community Centers, Medical Facilities, Libraries, Churches, Coffee Shops
  • 26. Virtual Wellness Center
    www.nwpf.org/wellness
    Inspiration and Support
  • 27. Motivational Tools
    Virtual Wellness Center
    www.nwpf.org/wellness