Dr. Hilary Goetz, a neuropsychologist with Inova, visited with us via Zoom on October 7. As part of her work at Inova, she does cognitive testing for people with Parkinson’s prior to DBS surgery. The focus of her discussion was managing mental health in Parkinson’s, including stress, anxiety, and depression. Resource links were provided by Dr. Goetz.
Feelings of anxiety and stress can result from the neural-chemical changes caused by Parkinson’s or from the emotional adjustment of having Parkinson’s. Anxiety can exacerbate physical symptoms and physical symptoms can exacerbate anxiety, so it is important to incorporate therapy and medication, as well as lifestyle changes, to deal with these feelings.
“Finding things you enjoy doing can give a sense of power,” Dr. Goetz advised. Some activities and hobbies our members enjoy are riding a recumbent/tandem bike; doing graphic design; riding an exercise bike; helping neighborhood children adjust to technology of online schooling; reaching out and keeping in contact with close friends; working on family genealogy; collecting Disney cards online; photographing birds; and creative writing. Dr. Goetz emphasized socializing as a good way to manage stress and anxiety. These days, we can feel connected with online support and exercise groups. Hobbies are more fun when shared with others, especially people who are upbeat and interested in learning.
A mindful meditation practice is an excellent tool for dealing with stress and anxiety. Begin by closing your eyes. Take a deep breath through your nose, breathing into and expanding the lower belly, then exhale out your nose, moving air from the belly up. Observe your surroundings, feel your feet touch the floor, focus on the breath. These all help the body and mind recalibrate. They can also help with freezing in Parkinson’s.
Meditation is simply focusing on one thing: the breath, sound, a repeated word (mantra), or physical sensations and disregarding unrelated thoughts. Start with five minutes at a time, working up to fifteen. You can also do guided imagery meditations, which can be found on YouTube. The Parkinson’s Mindfulness Toolkit is an online resource of mindfulness and the benefits of meditation. The UCLA Mindful Awareness Research Center offers free guided meditations specifically designed for those experiencing health-related difficulties.
Green spaces are relaxing. Dr. Goetz advises going outside and enjoying nature. It helps your mood and offers an opportunity to practice Mindfulness by being aware of and observing your surroundings more clearly. Pay attention to how you’re really feeling. Laughter is also beneficial to lift your mood. YouTube offers many online comedies.
Apps such as Calm and Beat Panic are good for when you feel panicky. To deter that panicky feeling, focus your awareness on the senses and pay attention to one sensation at a time: color, smell, sound, or physical sensations. Try Mindful eating: take a full minute to eat a single raisin, savoring the smell, texture, and taste. Dr. Goetz noted that one silver lining to the pandemic is that people are slowing down and noticing things.
Talk therapy can also help with the management of anxiety and stress. There are many types of mental health therapy: focused, exploratory, coping skills. More information can be found here — It’s important to feel comfortable and trust your therapist, who is a part of your care team along with your neurologist, primary care provider, and physical and speech therapists.
If you are working and work is producing stress, it can be helpful to tell HR of your diagnosis. Reasonable ADA accommodations can be made to make work less stressful. A few members shared feelings of loss at having to stop working earlier than they’d planned due to Parkinson’s. “We define ourselves by our work,” Dr. Goetz said, “but remember we are multi-faceted. Besides work, we have our personal integrity, personal characteristics, and personal relationships that define us.”
In response to questions about cognitive testing, Dr. Goetz advises only if you or those close to you notice any decline in cognitive function (attention, memory, reasoning, and other thinking skills) or cognitive issues interfering with occupational, social, or everyday activities (managing meds or paying bills). Short cognitive screenings can be done for things like forgetting people’s names, forgetting conversations, or forgetting the names of objects. Lab work and MRI’s should also be done to rule out physical causes such as UTIs, seizures, or strokes. Neurologists routinely ask about cognitive changes or changes in behavior. If there are no concerns about cognitive function by you or those knowledgable about your functioning (friends, family, bosses, or physician), neuropsychological testing may be overkill. Dr. Goetz does recommend a routine annual screening for depression and a routine annual screening of global cognitive abilities using a cognitive screening measure like the MoCa. Anyone having DBS must have neuropsychological testing prior to surgery to establish a baseline. Testing is done by a neuropsychologist, such as herself.
Decreases in dopamine and serotonin can cause physical changes in the brain that result in anxiety and depression. Symptoms of depression include difficulty concentrating, irritability, lack of motivation, loss of interest in things, and increased fatigue. Counseling can dive into underlying causes of depression and anxiety. Covid-19 social distancing has also contributed to depression and anxiety in many people. Dr. Goetz suggests staying mentally stimulated through online activities. You can stream live concerts and comedy shows; visit zoos and aquariums, watch wildlife, go to museums, and take other arts and cultural virtual field trips.
In response to questions about improving executive brain function, Dr. Goetz advises focusing on one task at a time. Do each task in sequence rather than multi-tasking, switching back and forth between tasks. Focus on the big picture to leverage frontal lobe function. How would you summarize in one line a book or a movie? The mental challenge of focusing on the big picture rather than being overwhelmed by details helps you organize your thoughts. Also plan to do tasks that require the most energy and effort when you are most alert and mentally fresh. Set aside two 30-minute blocks of time each day for high energy, high priority tasks.
Dr. Goetz’s work for Inova is focused on neuropsychological testing, although she has practiced neuropsychology in the past. Inova Health System has outpatient therapy services and psychiatric medication management for neurological-related psychiatric issues various locations. New patients can contact central scheduling for Inova Behavioral Health at 703-289-7560. You can also search for therapists at Psychology Today.
A few other resources: Mood: A Mind Guide to Parkinson’s Disease; Visualization/Guided Imagery