PD: MIND AND MEMORY

CHANGES
Kathleen L. Poston, MD, MS
Department of Neurology & Neurological
Sciences and (by courtesy) Neurosurgery
Division of Movement Disorders
Oct 2, 2015

Stanford Movement Disorders

Center (SMDC): Who are we?

Helen BronteStewart, MD, MS

Neurology, Movement
disorders specialist

Kathleen Poston,
MD, MS
Neurology, Movement
disorders specialist

Veronica Santini,
MD

Laurice Yang, MD

Neurology, Movement
disorders specialist

Neurology, Movement
disorders specialist

James Tetrud,
MD
Neurology, Movement
disorders specialist

Jaimie Henderson, MD

Casey Halpern, MD

Sharon Sha, MD

Neurosurgery, DBS specialist

Neurosurgery, DBS specialist

Neurology, Dementia specialist

Melanie Lising,
MD
Neurology, Movement
disorders specialist

Initial description of
PD stated that the
senses and intellects
being uninjured
Now, PD specialists
independently assess
both Motor and
Non-motor
symptoms

Possible Motor and Non-motor

symptoms in PD
Motor Symptoms

Slow Movement
(Bradykinesia)
Tremor
Stiff muscles
(Rigidity)
Slow walking
Decreased facial
expression
Soft voice
Small or slow
Handwriting

Non-Motor
symptoms (early)

Non-Motor
symptoms (later)

Constipation
Loss of smell
Sleep disorders
(RBD)
Depression and
anxiety

Memory and
thinking changes
Urinary problems
Swallowing
problems

All of these can

occur BEFORE any
of the MOTOR
symptoms.

Typically start
AFTER the onset of
the MOTOR
symptoms.

PD: Mind and Memory Changes

What type of mind and memory changes
can be seen in a person with Parkinsons
disease?
What causes these memory changes?
What can be done to prevent or treat
these memory changes?

What type of mind and memory changes can be

seen in a person with Parkinsons disease?

Cognitive
Domains

Executive
function

Attention and
Working
Memory

Language

Visuospatial
function

Memory

Memory
On your way out the door your spouse asks
you: Can you pick up some milk while you
are at the store?

Memory
20 minutes later at the store, do you:
A. Remember that you need to pick up milk
without any prompting?
B. Remember that you need to pick up milk only
when you get to the dairy section?
C. Remember that you need to pick up
something when you get to the dairy section,
but have a hard time remembering if it was
milk, or yogurt, or cheese?
D. Dont remember that you were asked to pick
up anything?

Memory
Encoding
Maintenance
Retrieval

Attention and Working Memory

Attention and Working Memory

A friend tells you a 10 digit phone

number you keep it in your mind for
about 30 seconds while you look for a
pen and paper to write it down

Executive Function

The cognitive processes that dictate

flexible and dynamic adjustment of
performance in response to a changing
environment.

Executive Function - examples

Planning/organizing
Complex or novel problem-solving
Shifting attention, keeping track of, or
alternating from 1 task to another
Not being susceptible to distractions
Generating fluent sequence of thought or
words
Learning the rules of a new task without
direction or explicit cueing

Visuospatial Function

Visuospatial Function

Problems with parking the car or clipping

corners when driving

Problems with directions somewhere

that is not familiar

Language
Word and sentence generation
Names of objects and people
Problems can be simple
Tip of the tongue
Problems can be more severe
You cant remember the
name of something you use
regularly.

What is dementia?
A person who can no longer do an
activity of daily living because of a
cognitive impairment has dementia.
Examples:
Can no longer pay the bills correctly
Gets lost when driving
Cannot shop for groceries

One study of 137 people with PD,

who were followed annually over 20
years from the time of diagnosis.

Dementia and hallucinations

were a key factor leading to
nursing home placement ...

PD: Mind and Memory Changes

What type of memory and thinking
changes can be seen in persons with
Parkinsons disease?
What causes these memory changes?
What can be done to prevent or treat
these memory changes?

Can Parkinsons disease alone cause

memory problems?
Yes, but we dont understand why some
people get more severe memory
problems and others do not.
Sometimes other factors can contribute,
like small strokes.
It is possible for some patients with
Parkinsons disease to also get
Alzheimers disease.

PD: Mind and Memory Changes

What type of memory and thinking
changes can be seen in persons with
Parkinsons disease?
What causes these memory changes?
What can be done to prevent or treat
these memory changes?

What can be done to prevent or

treat these memory changes?

Know what the problem is

Exercise
Dopamine
Treat other conditions
Medications
Cognitive tests
The future

Know what the problem is.

Neuropsychological testing is used to
understand how a person is doing in each
cognitive domain.
Understanding the problem is the first
step in adapting to it.
Change over time is more helpful than
performance at one time point.

What can be done to prevent or

treat these memory changes?

Know what the problem is

Exercise
Dopamine
Treat other conditions
Medications
Cognitive tests
The future

Exercise

Exercise really? For Memory?

Exercise really? For Memory?

YES!
In animal studies of
Alzheimers disease and
Parkinsons disease mice
who are physically active have
less pathology in the brain
then those who are sedentary.

Exercise what kind?

The best exercise is not exactly known

Exercise bike

Tai Chi good for balance

Most important
something that is safe and
something that you enjoy

What can be done to prevent or

treat these memory changes?

Know what the problem is

Exercise
Dopamine
Medications
Treat other conditions
Cognitive tests
The future

Dopamine
It is unclear if dopamine replacement
medications (dopamine agonists or
levodopa) help with cognitive changes.
In patients who have hallucinations, all
dopamine replacement medications can
make the hallucinations worse.

What can be done to prevent or

treat these memory changes?

Know what the problem is

Exercise
Dopamine
Treat other conditions
Medications
Cognitive tests
The future

Treat other conditions that make

memory worse.
Depression and Anxiety
Medications (sedatives and pain killers)
Sleeping problems
General illness (like a urinary tract
infection)

What can be done to prevent or

treat these memory changes?

Know what the problem is

Exercise
Dopamine
Treat other conditions
Medications
Cognitive tests
The future

Medications
Drugs originally developed for Alzheimers
disease have been approved in Parkinsons
disease
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon) pill or patch
Drugs for Alzheimers disease that have
NOT been approved in Parkinsons disease
Memantine (Namenda)

Medications

Donepezil (Aricept), Galantamine

(Razadyne), Rivastigmine (Exelon)
Side effects: increased tremor (slight),
stomach upset or diarrhea.
Only slight improvement seen
Might help with hallucinations

What can be done to prevent or

treat these memory changes?

Know what the problem is

Exercise
Dopamine
Treat other conditions
Medications
Cognitive tests
The future

Cognitive tests

Already have an account? Login

Improve your brain health and performance

Build your Personalized Training Program
Enhance memory and attention
Web-based personalized training program
Track changes in brain performance

Get Started Now

Multiple studies have shown mixed results

regarding these brain training programs.

What can be done to prevent or

treat these memory changes?

Know what the problem is

Exercise
Dopamine
Treat other conditions
Medications
Cognitive tests
The future

The Future

Consider participating in research studies

focused on understanding the mind and memory
changes that can happen as part of normal aging
and in people with Parkinsons disease

DID YOU KNOW

30% of all clinical trials fail to recruit a single person
85% of clinical trials face delays due to limited
participation
Fewer than 10% of Parkinson's patients ever take part in
trials, despite overwhelming interest in working with
scientists to help speed treatment breakthroughs

Research opportunities at Stanford

The Stanford Alzheimers disease Research
Center (ADRC)
NIH/NIA funded 5 year study to understand mind
and memory problems in Parkinsons disease and
Alzheimers disease
We are currently recruiting people with
Parkinsons disease who do not have memory
problems and who have mild to moderate
memory problems.
We are also recruiting non-Parkinsons disease
participants.
3 research visits per year for 5 years.

Research opportunities at Stanford

Brain Imaging in Parkinsons disease
NIH funded Study to understand the
connection between memory and balance
problems.
We are currently recruiting people with
Parkinsons disease who have fairly good
memory and thinking for their age.
We are also recruiting non-Parkinsons disease
participants.
Total commitment: 3 days

Research opportunities Elsewhere

Check out the Michael J Fox foundation
FoxTrialFinder!
FoxTrialFinder.michaeljfox.org
Local, national, and international studies
Tell your friends! (they can participate as
non-PD participants in studies near where
they live).

MJFF: Partners in Parkinsons

May 14th, 2016. Oakland, CA

Moderator: Dave Iverson

Featured talks at prior PIP events:
Seeing a movement disorders specialist:
What to Know, Ask, and Expect
Parkinsons research: The Road Ahead
Keeping your Balance: Caring for Mind
and Body with Parkinsons
Resource Fair
www.partnersinparkinsons.org

The World Parkinsons Congress!

September 20-23, 2016. Portland, Oregon

MISSION: To provide an international forum to learn

about the latest scientific discoveries, medical
practices, caregiver initiatives and advocacy work
related to Parkinson's disease. By bringing physicians,
scientists, nurses, rehabilitation specialists, caregivers
and people with Parkinson's disease together, each
Congress allows for a worldwide dialogue to help
expedite the discovery of a cure and best treatment
practices for this devastating disease.

www.wpc2016.org

The New Stanford Neuroscience

Health Center Opening Jan 2016!
This stand-alone Neuroscience Center will
integrate neurology and neurosurgery,
along with specialized support services, in
a single location, creating a superior onestop destination experience for patients.
Next to the Hoover Pavilion on Quarry Rd
(with its own parking garage!)
Tai Chi and Dance for Parkinsons classes
are open now! See flyer for details.

In conclusion

The mind and memory changes that can

happen in Parkinsons disease are different
from those in other disorders
Understanding if you have mind and memory
changes can help you to better adapt.
Exercise, treating other things like depression,
and some medications might help your mind
and memory changes.
Consider getting involved with research FoxTrialFinder.michaeljfox.org

Thank you

For an appointment call:

(650) 723-6469
300 Pasteur Drive, Stanford, CA

Stanford University
Comprehensive Movement Disorders Center
Neurology:
Helen Bronte-Stewart, MD, MSE
Kathleen Poston, MD, MS
Veronica Santini, MD
James Tetrud, MD
Laurice Yang, MD
Melanie Lising, MD
Sharron Sha, MD

Neurosurgery:
Jaimie Henderson, MD
Casey Halprin, MD

Balance Center and Motor Laboratory:

Leanel Liwanag

(behavioral neurology)

Nursing:
Victoria Tanoury RN, Lauren
Stroshane RN, Irina Krugomova PA

Neuropsychology:
Simon Tan, PhD
Penelope Zeifert, PhD
Gayle Deutsch, PhD

Poston Research Team:

Taylor Hendershott, Jee Kim, Kai
Zhang, Matt Ua Cruadhlaoich, Clara
Warden

The Stanford Movement Disorders Center

300 Pasteur Drive, Room A301 Stanford, CA 94305 Tel: 650.723.6469 Fax: 650.320.9443 neurology.stanford.edu/md

STATE-OF-THE-ART CLINICAL CARE

The Stanford Movement Disorders Center offers a comprehensive range of

medical and surgical treatments for adults and children with any type of
movement disorder, including but not limited to Parkinsons Disease,
Essential Tremor, Dystonia, Huntingtons disease, Chorea, Blepharospasm,
Tics, Tardive Dyskinesia, Multiple System Atrophy, Progressive
Supranuclear Palsy, Corticobasal Syndrome, Dementia with Lewy Bodies,
and other Parkinsonian syndromes.

FACULTY & STAFF

Neurologists
Helen Bronte-Stewart, MD, MSE, Director
Kathleen Poston, MD, MS
Veronica Santini, MD
James Tetrud, MD
Laurice Yang, MD
Melanie Lising, MD
Safwan Jaradeh, MD, Autonomic Neurology
Sharron Sha, MD, Cognitive Neurology
Katherine Mackenzie, MD, Pediatric Neurology

JANUARY 2016 The grand opening of the Stanford Neuroscience Health

Center! This stand-alone Neuroscience Center will integrate neurology and
neurosurgery, along with specialized support services, in a single location,
creating a superior one-stop destination experience for patients.
MEDICAL SERVICES
Patients with blepharospasm, hemifacial spasm, dystonia, tremor and/or
spasticity may also benefit from botulinum toxin therapy, which is offered
through our chemodenervation clinic.
The Stanford Human Motor Control and Balance Laboratory directed by Dr.
Helen Bronte-Stewart utilizes computerized measurements of movement to
help diagnose movement disorders and to customize therapy such as DBS.

Neurosurgeons
Jaimie M. Henderson, MD
Director of Functional Stereotactic Surgery
Casey Halpern, MD

The Huntingtons Disease and Ataxia Clinic offers an integrated, holistic

approach to care. We provide consultations and treatment for people with no
symptoms, those at risk for developing these conditions, couples who could
pass the genes to their children, all the way through advanced stage disease.

Bio Medical Engineer

Thomas Prieto, PhD

SMDC patients have access to our network of services, including psychiatry,

neuropsychology, the Stanford Balance Center, speech, occupational,
vestibular and physical therapy, genetic counseling and social work services.
SURGICAL TREATMENTS

Neuropsychologists
Simon Tan, PhD
Gayle Deusch, PhD
Lab Technician
Leanel Liwanag
Physician Assistants
Russell
Mendonca
Lawrence Cloutier, PA-C

Deep Brain Stimulation (DBS) uses a surgically implanted neurostimulator to

provide electrical stimulation to targeted areas of the brain, similar to a cardiac
pacemaker. The goal is to reorganize the abnormal brain signals that cause
disabling motor symptoms, such as those in Parkinsons, ET, and Dystonia..
Genetic Counselor
Nurse Coordinators
Carly Siskind
The Stanford team has performed more than 600 DBS cases and uses the
Victoria Tanoury, RN
Social
Worker
frameless technique, pioneered by Dr. Jaimie Henderson with intraLauren Stroshane, MSN, RN, PHN
Amee
Jaiswal
operative electrophysiological mapping and imaging.
Selena Mendoza, BSN, RN
Sarah Kahn, MS, RN

Caregiver Support We utilize a state-of-the-art image registration system to analyze the DBS
Coordinator
lead location, which can assist in programming adjustments or revisions.
Robin Riddle

CLINICAL RESEARCH
Patients and family members (controls) also have the opportunity to participate in the many ongoing clinical research trials at the SMDC. These include:

Multi-modality functional brain imaging, including FDG PET, functional MRI, and ultrahigh-resolution structural MRI, to map the
abnormal neural circuitry underlying cognitive and motor symptoms of movement disorders. Investigator: Dr. Poston
Understanding cognitive impairment and dementia in Parkinsons disease. Investigators: Dr. Poston, Dr. Sha, and Dr. Santini
Brain Imaging to understand neural network connectivity in Parkinsons disease: Investigators: Dr. Bronte-Stewart and Dr. Poston
The neural signatures of tremor, bradykinesia and freezing behavior in Parkinsons disease. Investigator: Dr. Bronte-Stewart
Adaptive closed loop neuromodulation in Parkinsons disease (Michael J.Fox Foundation). Investigator: Dr. Bronte-Stewart
CLINICAL TRIALS
Unilateral thalamic focused Ultrasound for the treatment of Essential Tremor. Investigators: Dr. Santini and Dr. Henderson
A 12-week, Phase II clinical trial of AZD3241in subjects with Multiple System Atrophy. Investigators: Dr. Poston and Dr. Santini
PD clinical trials coming soon! Please see our website for updates: http://neurology.stanford.edu/md/clinicaltrials.html

The Stanford University Department of Neurology and Neurological

Sciences are looking for participants with a diagnosis of Alzheimers Disease,
Parkinsons Disease, Lewy Body Dementia or Mild Cognitive Impairment to participate
in a broad, multidisciplinary research study of memory and aging. The study involves
brain imaging (MRI), genetic testing, memory testing, questionnaires and the analysis
of proteins in the blood and spinal fluid. Our goal for this research is to develop
biological markers to aid in the better understanding, early detection, and treatment of
Alzheimers Disease, Parkinsons Disease and other dementias

All procedures will be performed at Stanford Health Care and Stanford

University
Participation will involve 2 to 3 days of participation. These
visits may be spread out over a range of 3 months.
Diagnosis of Alzheimers Disease, Parkinsons Disease, Lewy
Body Dementia and/or Mild Cognitive Impairment.
One to two MRI scans, a neurological exam, questionnaires, a
neuropsychological assessment (memory tests), a lumbar puncture (spinal fluid draw),
and a blood draw. We might ask you to participate in other tests and studies
Christina Wyss-Coray, RN, BSN, PHN
Email: ADRCStanford@stanford.edu
Telephone: (650) 721-2409
Principal Investigators: Victor Henderson MD, & Tony Wyss-Coray, PhD
Department of Neurology and Neurological Sciences, Stanford University School of
Medicine
For general information about participant rights, contact 1-866-680-2906.

The Stanford University Department of Neurology and Neurological

Sciences are looking for healthy volunteers to in a broad, multidisciplinary research
study of memory and aging. The study involves brain imaging (MRI), genetic testing,
memory testing, questionnaires and the analysis of proteins in the blood and spinal
fluid. Our goal for this research is to develop biological markers to aid in the better
understanding, early detection, and treatment of Alzheimers Disease, Parkinsons
Disease and other dementias.
All procedures will be performed at Stanford Health Care and Stanford
University.
Participation will involve 2 to 3 days of participation. These
visits may be spread out over a range of 3 months.
Healthy adults, ages 70 and up, with no history of memory loss,
movement problems or other neurological illness.
One to two MRI scans, a neurological exam, questionnaires, a
neuropsychological assessment (memory tests), a lumbar puncture (spinal fluid draw),
and a blood draw. We might ask you to participate in other tests and studies
Christina Wyss-Coray, RN, BSN, PHN
Email: ADRCStanford@stanford.edu
Telephone: (650) 721-2409
Principal Investigators: Victor Henderson MD, & Tony Wyss-Coray, PhD
Department of Neurology and Neurological Sciences, Stanford University School of
Medicine
For general information about participant rights, contact 1-866-680-2906.

Volunteeers Needed for HIV,

Parkinsons Disease and Aging Study
The Department of Neurology at Stanford is looking for people
between the ages of 45 and 75 who have Parkinsons disease, or
HIV, or can be healthy controls. The goal of this research is to
compare the neural networks among these groups.
HIV and control subjects participate in 1.5 days of testing.
Parkinsons disease subjects complete 2.5 days of testing ON
and OFF medication. All participants will be compensated for
their time and undergo an fMRI scan, cognitive and motor exam.

Interested?

For more information please call the Bronte-Stewart lab at

(650)855-4656.

The principal investigators for this study are Dr. Tilman Schulte and
Dr. Helen Bronte-Stewart
Participant information is kept srictly confidential, and participation is completely voluntary.
For general information about participant rights , contact 1-866-680-2906

PRESENTS:

TAI CHI AND QI GONG

Dance for
Parkinsons

*Mondays Wednesdays, and Fridays 4-5 PM

RSVP w/ Joe (Instructor) 650-494-7345, jbd@taichisage.com
Tai Chi is a recommended movement class for people with Parkinsons, their family, friends,
caregivers, and anyone wanting to improve their health & wellness. Tai chi improves postural
stability, other functional outcomes in patients with mild-to-moderate Parkinsons disease and
reduces the incidence of falls (according to The New England Journal of Medicine
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1107911)

QiGong: Improves digestive & immune

function, empowers psychological wellbeing, helps alleviate pain, and provides
a great foundation for TaiChi Chuan
practice.
TaiChi Chuan: Profoundly adaptable to
practitioners' level from easy to very
demanding, promotes associative
exercise, sharpens the mind, builds
bone strength and promotes joint
mobility/range of motion, develops
proprioceptive acuity and better
balance. People practice into their 70s,
their 80s, and even beyond the age of
100.

RSVP w/ Damara (Instructor) 831-251-5397

damaravita@yahoo.com
An inspired movement class for people with Parkinsons and their family,
friends, and caregivers
Classes are based on the innovative Dance for PD program designed by
the Mark Morris Dance Group and the Brooklyn Parkinson Group. Using
this method, professional dancers draw on their unique expertise to help
people with Parkinsons disease and their caregivers engage sight, sound,
touch, thought, and imagination to bring control to their movements.
Dancing in chairs, at a barre, or standing, experienced teaching artists will
lead participants in an enjoyable blend of modern dance, ballet, tap, jazz,
and social dancing. While strengthening, balancing, and moving in rhythm
to live music, people with PD also experience the power of dance and
music to sharpen attention, inspire, and empower.
http://danceforparkinsons.org/

http://www.taichisage.com/

*Please contact the instructor to verify class schedule and fees.

Go to our website for more info:

https://stanfordhealthcare.org/medical-clinics/movement-disorders-center/patient-classes.html

Classes are open to all (but specialized for the PD community) and are held at the:
Stanford Neuroscience Hoover Pavilion Room 208
211 Quarry Road, Palo Alto, CA
Hoover Pavilion Guest Services: 650-498-4938
Exercise Program Coordinator: Leanel, 650-724-2541, lliwanag@stanfordhealthcare.org