Advanced Thinking Changes & Parkinson’s

Changes in thinking are common in Parkinson’s disease (PD). Thinking may feel slower or it may be harder to focus. As PD advances, some people develop dementia, which means thinking problems begin to interfere with daily life.

It’s normal to feel worried, frustrated or scared about dementia. Resources and support can help you understand these symptoms and manage day-to-day challenges.

Quick Facts

• In Parkinson’s dementia, attention and problem solving are often affected before memory.

• Thinking problems usually develop gradually over time.

• Other health or medication issues can worsen thinking.

Signs of Dementia in Parkinson's:

• Thinking problems that affect daily living

• Changes in alertness and attention

• Depression, anxiety or irritability

• Trouble interpreting what is seen, especially in low light

• Trouble finding words or following conversations

• Getting lost, even in familiar places

• Hallucinations (seeing or hearing things that are not there)

• Delusions (strong beliefs not based in reality)

• Sleep problems

Types of Dementia in Parkinson's

There are two main types of dementia that involve PD symptoms. Both are linked to abnormal protein buildup in the brain called Lewy bodies. These conditions can look similar, which can make them hard to tell apart. The key difference is timing.

Parkinson’s Disease Dementia (PDD)
Dementia develops a year or more after movement symptoms start — often many years later.

Dementia with Lewy Bodies (DLB)
Dementia and movement symptoms start at the same time or within a year of each other. DLB may also include changes in attention and alertness that come and go.

How Dementia Is Diagnosed

Doctors diagnose dementia by reviewing symptoms, medical history and medications. They may also use brain scans or thinking tests. Neurologists and psychologists can also play a role in diagnosis.

Other issues, such as depression, infections or sleep problems, can cause similar symptoms or worsen thinking and need to be ruled out. Dementia usually develops slowly. Sudden thinking changes often point to another cause, such as a urinary tract infection.

Treatment Options

There is no cure for dementia, but treatment and support can help people manage symptoms and stay engaged in daily life. Treatment often focuses on thinking changes and other symptoms that can come with dementia, such as mood changes or hallucinations.

Medications

• Some Alzheimer’s medications may help PD-related dementia.

• Antidepressants may help with mood symptoms.

• Certain antipsychotic medications may help with hallucinations.

Some medications can worsen thinking or cause hallucinations. These include PD drugs that boost dopamine (especially at higher doses), anticholinergics, older antidepressants and some allergy medicines, such as Benadryl. A doctor may adjust or stop these if needed.

Non-Medication Strategies

• Thinking and communication support: Psychologists and speech therapists (also called speech-language pathologists) can offer thinking exercises and help with communication.

• Consistent routines: Regular times for meals, sleep, medication and activities can reduce confusion and stress.

• Safety and home changes: Occupational therapists can suggest ways to make the home safer and easier to move around in.

• Physical activity: Movement such as walking and stretching can support mood, sleep and thinking.

• Meaningful engagement: Music, art, puzzles, hobbies and time with others can help people stay engaged in activities they enjoy.

Tips for Living with Dementia

• Find new ways to connect. As thinking and communication change, look for different ways to spend time together, such as music, quiet activities, support groups or gentle touch.

• Plan ahead. Talk about routines, care preferences and legal matters, such as wills and powers of attorney. An elder law attorney can help guide this process.

• Support the care partner. Breaks, support groups, movement and help from trusted people can ease stress and reduce burnout.