Is your brain less agile and your memory less reliable? Compared to last year, are you more easily confused and slower to process information? While these types of cognitive changes are common in individuals with Parkinson’s disease, they are also part of the normal aging process. A significant number of the elderly live with some memory deficiencies, collectively known as age-associated memory impairment. While elders laughingly refer to these changes as “senior moments”, they are troubling to the individual. Older Parkinson’s patients should expect to experience many “senior moments”. Keys will be lost, learning is slower, and nouns fleetingly disappear in mid-sentence.
While senior moments are common, not long after diagnosis, many individuals with Parkinson’s disease report a noticeable change in their executive functioning skills. They may experience a generalized slowing in the cognitive process, poor attention spans and unexpected gaps in their working memory. The Parkinson’s patient typically reports having increased difficulties multi-tasking and slowness in processing information (a condition known as Bradyphrenia). Although today’s doctors are paying more attention to these types of non-motor symptoms, they tend to focus on treating the movement component.
Too often cognitive changes are under-treated or go untreated. Some may be related to or exacerbated by depression or stress. These are common and treatable occurrences in those diagnosed with a chronic disease. Loss of mental agility may be a side effect of your medications. Be sure to alert your doctor about these changes. Discuss possible treatments and coping mechanisms to adjust to changes in cognition.
While worrisome to the Parkinson’s patient, changes in executive function significantly impact the care partner. Care partners may interpret slowed responses as obstinacy. Their role within the relationship has changed. Prior responsibilities of the person with Parkinson’s such as: monitoring family finances, cooking or house repairs now clutter the “to do” list of care partners. While the care partner assumes these new and unfamiliar responsibilities, the Parkinson’s patient may become angry and grieve the loss of his or her role in the relationship. To mitigate care partner stress, grief and anger, be sure to openly discuss concerns and better prepare yourself and your family for change. Educate yourself about the directions PD might take. Studies indicate that people are better able to cope with change when they know what to expect.
The level of cognitive impairment varies significantly in people with Parkinson’s disease. The interruption of executive skills, as outlined above, may be minor. The cognitive trajectory ranges from Mild Cognitive Impairment (MCI) to severe dementia. MCI is a term used to describe mild changes which affect narrow aspects of thinking and memory. Severe dementia is a drastic interruption in cognitive skills. While the prevalence of Alzheimer’s disease and related dementias is astounding (half of those over age 85 have Alzheimer’s disease, the most common disease causing dementia) studies suggest that only 20% of Parkinson’s patients develop dementia. There is usually a minimal 10 to 15 year lag time between the Parkinson’s diagnosis and the onset of dementia. Additionally, older Parkinson’s patients are more likely to develop severe dementia. While the probability of dementia increases with age, motor impairment itself does not appear to be a reliable predictor of subsequent dementia.
The changes in the brain caused by Parkinson’s disease undoubtedly affect cognition. Sitting back and doing nothing will only exacerbate the impairments. Fighting cognitive losses is essential, and in many cases simple. Lifestyle and attitude choices may lessen the rate of decline.
For maximum output, brains must be fed, hydrated and well exercised. Eating habits make a difference whether or not you are living with Parkinson’s disease. Green leafy vegetables and fruits that are high in anti-oxidants, such as blueberries, are critical to maintaining a healthy brain. It is critical to water the brain frequently. Dehydration leads to temporary confusion and exhaustion - conditions that obviously affect cognition. Physical and mental exercises are effective agents for sharpening the mind. Physical exercise increases the oxygen flow to the brain and has been associated with greater neuroplasticity. Mental exercises boost your confidence and help focus your attention.
While the majority of individuals with Parkinson’s disease experience some cognitive change, dementia is not inevitable and complacency should not be an option. Maintaining a positive attitude is an essential component to living well with disease and change. Some people discover yoga or prayer nurtures optimistic behavior. Every person must determine which path will deliver the optimal outlook for them. When you and your loved ones choose to have a positive attitude and prepare for the cognitive changes associated with Parkinson’s your outcomes for dealing with these challenges should be easier to manage. Also remember, your physician is a partner in this journey and should be consulted regularly.
Cheryl A. Siefert, MNM
Thank you for this informative and hopeful article. My husband was diagnosed with Parkinson's in 2006 and within the past year has sunk deeper and deeper into cognition and dementia problems. He is 75 years old and was a brilliant civil engineer during his working career.
As his wife and care giver, I am able to deal with almost all aspects of Parkinson's except the now more frequent periods of psychotic behavior.
His Neurologist and Psychiatrist have withdrawn and replaced some of the Parkinson's medications in the hopes of helping these problems. Also Seroquel was added to his medications.
For brief periods of time the psychosis seemed to improve, but then it returns with surprising abruptness. He is receiving physical therapy in our home twice a week. I monitor his medications constantly and try to get him to eat healthy foods.
What am I missing? I'm nearing the point of despair especially since I'm concerned as to how much longer I can care for him in our home.
But again, I do see some hopeful ideas in your article especially as it pertains to more mental exercise and watching out for dehydration.
Thank you. Elaine Laue
Thank you for this article - I look forward to learning more about PD.
Thank you for this excellent piece on cognition & PD. We need to be more forthright in our discussions about this topic. Vitamin B12 deficiency is another factor that can mimic dementia. Glad you mentioned depression and anxiety. As you may know, not all MDS's are also specialists in cognition. I switched from Dr. Klepitskaya to Dr. Kluger due to issues in this area. Dr. Kluger is excellent for both movement disorder and cognition.
By the way, my research has shown that 25-40% of PD patients will eventually develop dementia. LBD symptoms often occur before or concurrently with PD symptoms. There has been discussion lately about the lines between PDD and LBD being blurred and they may, in fact, be the same disease.