Motivation is a fundamental concept in psychology, expressing the fact that human behavior basis is formed of a system comprising necessities, needs, interests, intentions, ideals, which support the realization of certain actions, facts, and attitudes . One of the symptoms encountered by Parkinson’s patients is motivational disorder.
Recent studies reveal that motivational problems are related to patients’ quality of life, and contribute to caregivers stress. Motivational disorders may relate to disease progression. Lack of motivation may be treatable, but unfortunately sometimes it is unrecognized and unreported.
In order to describe ways of enhancing motivation a Parkinson’s patient may need after finding out his/her diagnostic, motivation he/she may get from his family, friends, and caregivers; motivation he/she has to learn to have during the progress of the illness a brief review of this disease is needed.
Parkinson’s disease is a degenerative malady, frequently encountered on masculine population, its common rate of appearance being between 40-50 years old.
Treatment of Parkinson’s may be nonpharmacologic, pharmacologic, and surgical therapy.
Parkinson’s disease is caused by the destruction of neurons producing dopamine. The symptoms appear when the level of dopamine in the brain reduces with 20%. Trembling and hypertonicity represent the symptomatology of this disease, along with insomnia, depression and apathy caused by the chemical modifications occurred at brain level, speaking difficulties such as voice volume reduction and tonal variations (hypophonia), verbal expression difficulties (dysarthria), lump in the throat sensation, and swallow difficulties.
Depression is encountered in more than 50% of Parkinson’s disease cases. Depressive disorders seen in Parkinson’s disease can contribute to functional impairment. The depressive disorders last from weeks to years and might appear during various stages of illness.
Apathy is a specific condition of Parkinson’s patients, studies show that apathy may appear to Parkinson’s disease patients in a significant proportion which range between 17% to 70%. A significant number of Parkinson’s patients exhibit apathy without depression.
Although apathy may be a symptom of a depressed mood of any patient, thus it may be confused with depression, they are distinct because patients suffering from apathy without depression do not show the main symptoms of depression, such as sadness, and feelings of helplessness, or hopelessness .
Apathy is not laziness, fatigue, or stubbornness. Apathy is a lack of initiation of purposeful goal directed behaviour. The treatment may be pharmacologic and/or nonpharmacologic, consisting of dopamine medication and/or behavioral activation therapy.
There are difficulties in diagnosing depression, because is not easy to differ depression from Parkinson’s, and from apathy. Apathy encountered to Parkinson’s depressed patients differ from apathy seen to undepressed Parkinson’s patients, the latter being characterized by a total lack of motivation, without feelings of hopelessness .
It is important to know and understand the elements which contribute to depressive and apathetic state to improve patients quality of life and to help them manage a diagnosis of Parkinson’s disease.
Parkinson’s patients require specific attention from their families, they must not be considered a burden, they should be helped and understood because their disability is involuntary.
The reinforcement of Parkinsonian’s positive behavior is one of the modalities through which caregivers may combat Parkinsonians’ undesired negative behavior.
Importance of finding motivation in spite of Parkinson’s
Mens sana in corpore sano antique saying is found in nowadays social mentality since everybody is looking for a good healthcare condition. A normal psychological status is desired by any individual. Creativity, ambition, imagination, perseverance, motivation play an enormous role in daily life. Any reduction of energy and initiative may have bad consequences on personal life, career, and general sense of accomplishment.
For a complete understanding of amotivation/apathy to Parkinson’s patients it is necessary to know how to recognize and to cure it.
Motivation is an ever-present, important determinant of behavior and adaptation. In Parkinson’s disease motivation and emotion are interrelated. Patients loss of a part of their motor capacities, expressivity, and body language may affect their emotional state. Diminished goal-directed behavior ( lack of effort, initiative, and perseverance), diminished goal-directed cognition ( lack of interest in learning new things), diminished emotional contributors of goal-directed behavior (indifference, the absence of emotional intensity) are parts of apathy syndrome named and described by Silva and Martin.
Sockeel realized a well structured interview (Lille Apathy Rating Scale – LARS) comprising 33 yes/no questions having as objective the acquisition of self-reports from Parkinsonian’s patients, based on them a specialists may quantify and track the changes in the severity of apathy. The interview underlines nine areas of expertise few of them are reduction in daily activity, lack of initiative, interest, concern, and motivational loss.
From organic biochemical perspective motivation and emotion reside in Paleomammalian brain, more exactly in the amygdala which can filter environmental stimuli and influence goal-directed behavior. Dopamine is the main neurotransmitter of a goal-directed behavior.
From a psychological point of view apathy description may be provided by personality theorists. Studies showed the personality of a Parkinsonian may be serious, rigid, introverted and cautious.