10 Facts about Cognitive Change in Parkinson’s

Some people with Parkinson’s disease (PD) experience changes in thinking or memory — known as cognitive impairment. While some may struggle focusing on a task, others have difficulty remembering information. Cognitive changes can be common when it comes to Parkinson’s and aging, but every person’s experiences and symptoms are unique to them.

Cognitive impairment is related to Parkinson’s because people living with this disease experience a decrease in the level of dopamine in their brain, the neurotransmitter that is involved in regulating the body’s movement and maintaining working memory.

Here are 10 things everyone should know about Parkinson’s and cognitive changes:

1. Cognitive decline is common in Parkinson's.

Mental and movement decline tend to happen together for people with Parkinson’s. Symptoms of mild cognitive impairment often do not interfere with home and work life. The cognitive changes that accompany Parkinson’s early on tend to be limited to one or two mental areas, with severity varying from person to person. Areas most often affected include attention, speed of mental processing, problem-solving and memory issues.

2. Cognitive changes may occur early in the disease.

Doctors used to believe that cognitive changes did not develop until the middle- to late- stages of PD, but recent research suggests that mild changes may be present at the time of diagnosis.

3. Cognitive Change is different than Dementia.

Cognitive impairment is not dementia, which is when cognitive impairments occur in more than one area of cognition. Dementia leads to a more serious loss of intellectual abilities that interferes with daily living. While mild cognitive impairment can affect 20-50% of people with PD, not all lead to a dementia diagnosis.

4. Executive function changes can be frequent in Parkinson’s.

One of the most prominent cognitive changes in Parkinson's is impairment of executive function. This can impact planning, organizing, multitasking and decision-making. Loved ones can help the person with PD by providing cues, reminders and greater structure of activity.

5. Short-term memory problems are associated with cognitive changes.

The basal ganglia and frontal lobes of the brain (both help the brain organize and recall of information) may be damaged in PD. Long-term memory is typically less impacted, however, short-term memory and the ability to recall recent information are often affected. This can result in difficulty with common tasks such as making coffee, checking your emails, etc.

Research has shown that these strategies can help keep your memory sharp:

• Exercise: Finding an activity that you love and can partake in regularly is critical to living with PD. Exercising regularly has been shown to improve cognition and memory problems. The Parkinson’s Foundation’s Fitness Fridays provide a variety of exercises that aim to support those with Parkinson’s.

• Find Mentally Stimulating Hobbies: Reading, puzzles, gardening and art are all examples of hobbies that can keep you entertained while sharpening your mind. It’s important for people with Parkinson’s to find hobbies that can promote mental stimulation.

6. Cognitive Change may alter attention and concentration abilities.

​​​​​​​People with Parkinson’s may have difficulty sustaining attention or concentrating on tasks for extended periods. This can lead to having issues with mental calculations or concentrating during a task.

Here are some tips to help your attention skills:

• Set timers while completing a task to help keep your attention span for the time being. The Pomodoro Technique helps improve focus by working in 25-minute intervals with short breaks in between tasks.

• Nourish your body with foods that promote brain health, such as the “MIND” Diet including food groups like whole grains, berries, and vegetables. Prioritize sleep. A minimum of six hours a night is needed to keep your attention and concentration sharp. Try to stick to a consistent sleep schedule every night, going to bed at the same time, to help your body make it a habit.

7. People in the early stages of PD may have trouble with depth perception.

Subtle visual-perceptual problems may contribute to visual misperceptions or illusions. During early stages of Parkinson’s, people often have trouble measuring distance and depth perception. When PD advances, people with PD face problems with processing information about their surroundings or environment.

8. Up to 50% of people with Parkinson's experience depression.

Up to half of people with PD experience a form of depression during the disease. Depression is more likely to occur in people with Parkinson’s who face severe cognitive impairment. Those suffering with depression can find it harder to control motor symptoms. However, depression is often treatable. Talk to your PD doctor about this symptom.

9. Sleep issues are common in Parkinson’s and can impact cognition.

Problems with falling and staying asleep are very common in people with PD. The effects of sleep problems throughout the night can result in physical and cognitive fatigue throughout the day.
The four main sleeping problems related to PD are:

To address sleep issues, talk to your PD doctor who may prescribe medication or a sleep specialist. Some natural remedies include creating a sleep ritual, avoiding screen time before bed, running a warm bath and more.

• Issues staying asleep and early morning awakening (insomnia).

• Involuntary movements and pain that interrupt sleep.

• Increased nighttime urination.

• Nighttime agitation, vivid dreams and visual misperceptions or hallucinations.

10. There are different treatments to address cognitive changes.

While researchers are still discovering new ways to address cognitive change in people with PD, doctors often recommend a combination of treatments to help with cognitive change.
They can include:

• Cognitive remediation therapy: this treatment emphasizes teaching alternative ways to compensate for memory or thinking problems. It involves using information from neuropsychological testing to identify cognitive strengths that can be used to help overcome weaker areas of thinking.

• Behavioral management: Making changes in the home environment can help minimize memory, visual-perceptual or orientation difficulties.

• Talk to your PD doctor: Your doctor can help you come up with treatments options to address your most bothersome cognitive symptoms. They can also refer a psychiatrist, neuropsychologist, speech or occupational therapist for more assistance.

• Create a support system: Work on building your own support network. Support groups are often amazing resources.