If you have Parkinson’s disease (PD), or know someone who does, you likely know that PD affects dopamine levels in the brain. But did you know that PD also alters serotonin, norepinephrine and A chemical messenger (neurotransmitter) in the striatum area of the brain. It is involved in many brain functions, such as memory and control of motor activity. It is believed that acetylcholine and dopamine maintain a delicate balance in the brain. Lack of dopamine in people with Parkinson’s disrupts this balance. Anticholinergic medications block acetylcholine. levels? All are chemicals in the brain that affect mood, thinking and behavior.
Not everyone with Parkinson’s will experience cognitive change. And for the 30 percent of people who report changes in thinking and memory, these changes are not universal. Still, thinking changes can impact on quality of life for people with Parkinson’s as well as caregivers, so it is helpful to understand potential cognitive effects.
Cognition and PD
Cognition is the action or process of acquiring knowledge and understanding through thought, experience and senses. For many people, it can be hard to separate what changes are a result of Parkinson’s and what is due to the normal aging process. The first signs of cognitive change in PD are generally changes in memory and executive thinking abilities, like planning, organizing and scheduling.
If you or a loved one notice any changes in your memory or thinking, here are some questions you can answer to help your health care team figure out what is happening:
- What am I having trouble doing or remembering?
- How often do I experience these changes?
- Does anything trigger the change (isolation, time of day, noise, medications)?
- Could something else (age, illness, sleep problems) cause these changes?
- Did these changes happen gradually or appear suddenly?
Mild cognitive impairment is the decline in mental processing skills beyond what can be expected due to normal aging. In people with PD, it is common for executive functions to slip — making it difficult to plan your day, manage your time, remember details, pay attention or switch focus. Other symptoms, such as problems with word-finding and processing information about surroundings, may also develop.
It is important to remember that:
- Not everyone with PD experiences cognitive changes.
- Not everyone who has cognitive changes experience every symptom.
- PD-related change happens gradually. If symptoms suddenly occur, talk to a health care provider immediately as there is likely another cause.
Treatment for Changes in Cognition
The newest Parkinson’s Foundation book, Cognition: A Mind Guide to Parkinson’s Disease, explains more about potential thinking changes in PD and how you can cope with them. First, it is important to discuss any changes with your care team. Neuropsychological testing can help assess the severity and specificity of these changes. Some of the tests can be done in-office, while others require a specialist.
Often, care teams begin by determining if your prescribed medications can impact cognition. Certain drugs that help motor symptoms can cause confusion and memory problems, especially in older people. Currently, there are no medications that treat the decline in executive function, though there some that treat memory problems. Your care team will help you find the best medication regimen to maintain good motor symptom control and address non-motor symptoms.
Counseling and behavioral therapy can help you and your caregiver understand and cope with cognitive changes. A mental health professional can provide different techniques to identify patterns of thought and behavior, then adapt and reframe them to be more positive and productive.
A counselor can also offer specific coping strategies and compensation techniques for you, your caregiver and family. For example, set alarms for medication times, write down appointment times and place notes around the home to remind you where you left the keys.
Exercise is a necessity. The same parts of the brain that control motor function also control executive function. This means that exercise improves how we perform a movement and how we think about the movement, improving motor and cognitive skills.
Neuroplasticity is when we teach our brains a new pattern —a new exercise, being comfortable in a new place or practicing a new way of thinking. When you do these things or try to get better at something you already do, the brain forms new connections and neurons, making its network of communication more efficient.
Just like it’s never too late to start exercising the body, it is also crucial to exercise the mind! Puzzles and Sudoku, reading a book or magazine, visiting a museum, attending a play or concert and socializing with friends can provide a mental workout, helping sustain cognitive skills.
Tips for Caregivers
Dealing with your loved one’s changes in mental status is challenging. These tips from Cognition: A Mind Guide to Parkinson’s Disease can help caregivers manage day-to-day life with someone experiencing thinking changes:
- Write out and stick to a routine.
- Stay calm and be patient. A smile and pleasant manner can invite cooperation.
- Administer medications on time and use exercise, diet and rest to keep your loved one healthy.
- Speak slowly, use simple sentences and try to avoid open-ended questions.
- Find others to help care for your loved one, so you can take a break.
- Be kind to yourself and support yourself emotionally. This may be through professional counseling or a creative outlet, such as journaling.
Cognition: A Mind Guide to Parkinson’s Disease is the Parkinson’s Foundation newest research-based educational book that explains cognitive changes across the stages of PD, as well as treatments and coping options. Read Cognition: A Mind Guide to Parkinson’s Disease online or order your free copy from our Helpline at 1-800-4PD-INFO (473-4636) or firstname.lastname@example.org.