The Effect of Parkinson’s Disease on Personality
Through APDA’s Ask the Doctor portal, we receive many questions on a vast array of topics. (Feel free to submit your own question at any time.) A frequent topic that readers ask us about is the effect of Parkinson’s disease (PD) on personality. Today, we will explore that difficult topic.
What is personality?
One useful definition is: the combination of characteristics or qualities that form an individual’s distinctive character.
Personality is a key component of our social and emotional selves, but it is not typically thought of as a component of our biological selves. However, it is important to remember that there is most certainly a neurologic basis of personality. Personality is, in its most reductive form, due to brain activity – neurons talking to each other in specific parts of the brain using specific brain chemicals.
What is a personality change?
A personality change is an alteration in a person’s defining nature – for better or for worse. An example could be becoming more or less selfish or more or less calm. Once again, we usually do not think of personality changes as changes in our brain biology. However, in some cases, changes in the brain, such as those that occur in PD, can result in personality changes.
It is especially important to note that sometimes a personality change can be very difficult to distinguish from a mental health concern such as anxiety or depression. Therefore, make sure to bring concerns of personality changes to the physician as there may be a medical response, such as medication or therapy, that can improve quality of life. It is also important to note that there could be other instigators of personality change such as general aging, life circumstances, or other factors; therefore, a noticeable change in personality does not necessarily indicate the person has PD.
Personality changes of Parkinson’s disease
When thinking about personality changes that relate to Parkinson’s, they fall into three main categories:
- Personality traits of people who subsequently receive a diagnosis of PD
- Side effects of PD medications that can affect personality
- Non-motor symptoms of PD that can affect personality
We will address each of these below. It is important to note that the person experiencing the personality change is typically not aware in which category their concern falls. It is also important to remember that every person with PD experiences the disease differently and therefore may or may not have to deal with personality changes.
A. The personality traits of people who develop Parkinson’s disease
It has been casually observed, almost since PD was first described in the medical literature, that many people with PD share particular personality traits such as being inflexible and cautious.
Researchers delved deeper into this phenomenon and formally investigated the personalities of people with PD. Using various personality assessments, studies have shown that people who develop PD tend to have more negative personalities. They also tend to be more introverted as well as risk averse. Some consider this personality profile to be a pre-motor feature of PD, much like loss of smell, constipation, and REM behavior sleep disorder. It is hypothesized that the lack of dopamine that affects movement also defines these personality traits.
It is important to point out that depression and anxiety are extremely common non-motor feature of PD and can be present in the pre-motor stage as well. It is possible that the presence of depression and anxiety in people diagnosed with PD, drives the tendency towards reporting more negative personalities. A medical professional would be able to assess the difference between these entities, but it might be hard for the person themselves or family members to distinguish. If you are concerned that depression and/or anxiety might be at play, then bring these traits to the attention of your health care provider.
B. Side effects of medications that can affect personality
Taking medications that increase dopamine can induce impulsiveness or compulsivity, which can be perceived as changes in personality. Dopamine agonists (such as pramipexole and ropinirole) are the most likely to cause this type of side effect. Gambling, hypersexuality, and compulsive shopping have all been reported. Compulsivity can be manifest in any activity or hobby (including work or exercise), so it is important to consider whether this is something that affects you or your loved one throughout the day and if so, whether the compulsivity has a negative effect on your quality of life or the quality of life of your care partner or loved one.
For example: hypersexuality may or may not be problematic to the person with PD and also may or may not be problematic to the sexual partner of the person with PD. Both must be assessed to determine if a medication change is warranted. Keep track of these changes and take note of when and how often you observe them so you can best explain what’s going on to the doctor.
C. Non-motor symptoms of PD that can affect personality
Sometimes, a care partner may describe a change in their loved one that they consider to be a personality change. However, when they describe that change to the health care provider, they may consider that to be a non-motor symptom of PD. These non-motor symptoms can appear throughout the trajectory of the disease and can include depression and anxiety (as mentioned before) as well as apathy, irritability, and paranoia.
Many of these more profound mental health concerns, which can be perceived as personality changes, occur as PD advances and can be very distressing to the care partners and family members. You can read more about these topics in two past blogs: part one and part two of Mental Health Concerns in Advanced PD.
To better explain these types of non-motor symptoms and mental health concerns, here are some observations that care partners of people with PD have described and asked me about, seeking to understand the changes that they are witnessing:
- “Quick to anger, easily frustrated, impatient, stubborn, and argumentative”
- “No coping skills”
- “Verbally abusive and inconsiderate”
- “Believes things that are not true”
- “Speaks without thinking about what she’s saying”
- “Is unrealistic about their abilities – volunteers to do things they are physically incapable of doing”
- “Exaggerates complaints”
- “Is anxious”
There are not always easy answers for how to improve these symptoms, but treatments may be available, so discuss anything you notice with the health care provider. A good first step is to understand that these particular changes are non-motor symptoms of PD and can affect some people with PD in much the same way as constipation, blood pressure dysregulation, and other non-motor symptoms. In this way, the person with PD and their care partners can use patience and calm to help navigate these changes, instead of blame.
Tips and Takeaways
- Personality traits (for all people) are due to brain activity – neurons talking to each other in specific parts of the brain using specific brain chemicals.
- Personality changes of PD may be due to side effects of PD medications, pre-motor symptoms of PD, or non-motor symptoms of PD.
- Understanding the reasons for personality changes in PD can help the person with PD and their care partner better navigate these changes.
- It is important to take note of any personality changes and address them with the health care team. In some cases, there are treatments, medications, or other ways of mitigating these issues, which can increase quality of life for both the person with PD and the care partner.