Opposite Ends of the SpectrumApathy and ImpulsivityParkinson’s<br />Monique Giroux, MD<br />Movement Disorders Neurologist...
Overview<br />Understanding apathy and impulsivity<br />Why focus on these symptoms<br />Strategies 	<br />Medical Checkli...
Under-drive vs over-drive<br />Initiation of action<br />Goal or result driven action<br />Impulsivity<br />Apathy<br />
Apathy and ImpulsivityBiological Cause<br />Brain Circuits mediate reward behavior -striatal limbic, anterior cingulate, m...
Understanding Apathy and Impulsivity<br />Apathy- Lack of Motivation - Assoc with<br />Depression, Fatigue, Cognitive Chan...
Understanding Apathy<br />Apathy<br />“Lack of motivation”<br />  Components<br />Behavioral - reduced initiative or drive...
Pseudo- Apathy <br />Facial Expression<br />Slowed Cognition or Movement<br />Poor Stamina<br />Fear, Social Phobia and ot...
Impulsivity Opposite End of the Spectrum<br />Initiation of action<br />Goal or results driving action<br />Impulsivity<br...
Understanding Impulsivity<br />“Decreased control or insight”<br />Failure to resist an impulse not in one’s best interest...
Impulsivity Control <br />Hypersexuality, Binge Eating, Impulsive Shopping, Pathologic Gambling, Hoarding, Punding<br />Me...
Apathy and impulsivity impair ability to aCHIEVETakEback control Medical ChecklistPersonal Checklist<br />
Apathy Checklist- Mood<br />Is depression present?- feelings of sadness, depressed mood<br />Counseling, support, exercise...
Apathy Checklist-Fatigue<br />Are movement problems limiting?<br />PT, OT<br />Motor Fluctuations- Fatigue worse with wear...
Apathy Checklist- Cognitive<br />Are cognitive problems present?<br />Neuropsychological testing<br />Medical- Vitamin B12...
Apathy Checklist- Disease<br />Adaptation to Change<br />Movement Efficiency- PT, OT<br />Medicines- too much, too little<...
Impulsivity Checklist- Disease<br />Review with your healthcare provider<br />Review medicines- Dopamine Agonists?<br />Co...
Apathy and Impulsivity“So What Now”<br />First Step is Awareness<br />Second Step is to treat underlying issues<br />Third...
Personal Checklist<br />Positive Commitment<br />Know Yourself<br />Success and Barriers<br />Choose the right tasks/set t...
Personal Checklist<br />Positive Commitment<br />Motivation = Value * Confidence  <br />Positive Change Talk<br />Moving a...
Personal ChecklistKnow Yourself<br />What you value<br />What you like<br />Diary<br />Learn from the past<br />Be patient...
Personal ChecklistSuccess and Barriers<br />Success<br />Barriers<br />Interest<br />Shared Interest/ Concern<br />Support...
Personal ChecklistRight tasks/Right environment<br />Start simple, start slow.  <br />Set realistic goals.<br />Mix it up<...
Personal ChecklistFind Support<br />People, Internet, Gadgets<br />Talk about it, Write it down, Rehearse it<br />Diary<br...
Personal checklistMake it rewarding<br />Make it fun- Treadmill or dancing?<br />What makes you happy- Movies, Laughter Yo...
Personal ChecklistResources<br />Calendar- make a list, write it down and keep track<br />Online exercise tracking system-...
Virtual Wellness Center<br />www.nwpf.org/wellness<br />Inspiration and Support<br />
Motivational Tools<br />Virtual Wellness Center<br />www.nwpf.org/wellness<br />
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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

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Apathy impulsivity and motivation with parkinson's nwpf 2011

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

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