He sits straight in the chair, his hands clasped in front of himself, his elbows resting on the chair’s armrests. The wife confides that she’s quite alarmed by the change in her spouse over the last two and a half months. They are an attractive couple, tall and handsome with dark hair. To look at the spouse there appears to be nothing wrong. Only when the physician asks the patient to perform a set of three discrete movements with his hand, does it become apparent he is unable to learn three simple gestures. His hands shake, his arms quiver. His face focuses and watches his hand and it’s obvious he is attempting to learn the sequence, but has a lot of trouble.
The patient is not yet sixty and was diagnosed with PD in the last three years. The difficulty he has learning is profound and not typical of the standard patient with the illness. Though cognitive function is affected in Parkinson’s disease, it is more likely to occur later, after ten years, or more. The process is gradual and begins with general slowing of thought. Patients with PD retain the ability to learn, though it may take them longer.
The pramipexole the patient takes contributes to his muddied mind. The dosage is escalating and with it the patient is more paranoid, more anxious, more forgetful and more preoccupied with sex. The spouse relates her husband may set a glass of water down and then not find it. He is unable to fix simple things like the towel flapper and doesn’t attempt to fix the computer any more. He got in the car and drove through his neighborhood lost.
The physician would like the patient to undergo neuropsychological testing. The pattern of his cognitive deficits may point to whether the patient suffers from Lewy Body Disease, Alzheimer’s or other dementia. He recommends the patient begin taking Namenda, Exelon or Aricept to slow the process of mental decline. Seroquel he recommends for sleeping, with instructions that the patient up the dose until he arrives at a dose that will allow him to sleep 6 hours without interruption.
The cost of Seroquel has been prohibitive. The patient is completely disabled and the spouse works to pay the bills. Three more medications are not what she hoped for. The doctor gives her several sheets of paper, commenting they may qualify to receive drugs free. The wife thinks not, her salary is not paltry but goes completely to pay their financial obligations.