Parkinson’s disease (PD) progression, aging and medications can all sometimes impact mental well-being and memory. Identifying what’s behind thinking changes and prioritizing wellness can help you live optimally with Parkinson’s.
This article is based on the Parkinson’s Foundation Expert Briefing presentation Mental Well-being and Memory, with Gregory Pontone, MD, MHS, Director, Parkinson’s Neuropsychiatry Clinical Programs, Johns Hopkins University School of Medicine, a Parkinson’s Foundation Center of Excellence, and Lisa Cone, retired healthcare services executive, Parkinson’s Research Advocate and People with Parkinson's Council member.
Parkinson’s and Cognitive Changes
Parkinson’s disease progression can cause thinking, memory and mood changes for some people. It’s important to address cognitive changes with your PD doctor, especially time and place disorientation, poor judgment or forgetfulness. While these symptoms can indicate disease progression, they can be treated.
Executive function changes – decreased ability to pay attention, multitask and solve problems – can be frequent in Parkinson’s disease. Take the time needed for tasks.
Memory can also be impacted, such as the ability to learn new information, store and retrieve it. Prompts or clues can be helpful to someone with Parkinson’s.
Some people with PD may have difficulty with familiar tasks, such as using a remote control or computer, organizing medications, or even finding the right word.
Research has shown these strategies can also help keep your mind sharp:
- Exercise – especially aerobic – is critical to living well with PD and aging well, too. It’s been shown to improve cognition and minimize medical risk factors for dementia. Find an activity you love and do it regularly.
- Engage in mentally stimulating hobbies such as reading, puzzles, board games, playing an instrument or learning a new language. There's increasing evidence that video games can increase your processing speed, visual-spatial perception and reaction time, too.
- Connect through meaningful social interaction: going to dinner with friends, having people over or joining in community activities can improve memory and boost emotional well-being.
- Sleep well – a minimum of 6 hours nightly is important for attention and executive tasks. Create an 8-hour sleep opportunity window and make it habit to go to bed and wake up at the same time every day. If you nap, try to do it on a schedule. Sleep helps us stabilize memories, retain learning and allows our brains to perform essential glymphatic system operations – brain waste clearance critical to healthy cognitive function.
PD cognition concerns include sudden changes over hours, days, or weeks. These are usually not Parkinson’s related. Often due to a medical issue, acute mental status changes should be quickly addressed. Abrupt disorientation or confusion requires immediate medical attention. Causes can include infections, dehydration and medication side effects.
Other possible cognition challenges can include depression. While not always an emergency, depression can also cause a somewhat sudden change in people's cognitive ability.
Neurogenic orthostatic hypotension – a condition where blood pressure drops sharply when someone stands up getting out of bed or rising from a chair – affects up to 70% of people who live with PD. Its side effects can include dizziness and difficulty thinking.
Other Causes of Cognitive Change
Aging, medications or other influences can cause mental and memory changes in PD, too.
As we age, we tend to maintain our long-term know-how. Vocabulary and general knowledge can remain stable, or even increase, throughout a person’s 70s. Visual perception of objects also remains stable and older people may be more accurate in judging distances than younger folks. Language remains stable, too, at least until age 70.
Aging, however, can impact:
- Focused and divided attention – such as multitasking.
- Working memory – remembering directions or instructions, for example.
- Multitasking abilities.
- Processing speed.
Reversible cognitive impairment issues can impact thinking, also. They can include:
- Sleep disturbances, such as obstructive sleep apnea.
- Vitamin B12 deficiency, diagnosed through a simple blood test.
- Hypothyroidism, which can also be detected through blood tests.
- Depression, or severe depression, which can masquerade as dementia.
Medications can impact PD too. Parkinson’s results in the loss of dopamine-producing neurons in the brain. Anything that further interferes with dopamine production can worsen cognition and other symptoms. Parkinson’s is also associated with a lower level of the brain chemical acetylcholine, important to cognition. Anticholinergic medications – used in many therapies, including some asthma, antihistamine and antidepressant medications – block acetylcholine.
Other medications can interfere with cognition too, including:
- Some psychiatric and antipsychotic therapies.
- Certain bowel motility (movement) medications.
Work with your doctor, who can help pinpoint what’s behind any cognitive changes, recommend the best therapy and make medication changes or adjustments.
- Cognition: A Mind Guide to Parkinson’s Disease
- More Than Movement: Addressing Cognitive and Behavioral Challenges in Caring for PD
- Do You See What I See Hallucinations and Parkinson’s Disease
The Parkinson's Foundation is here for you at every stage of your journey. Call our Helpline at 1-800-4PD-INFO (473-4636) or Helpline@Parkinson.org for expert resources near you or answers to your questions.