Research shows that people with Parkinson’s disease (PD) are hospitalized more often, visit emergency rooms more frequently, and are more vulnerable to complications while hospitalized.

Exercise and physical activity not only help people with Parkinson’s maintain or improve mobility, flexibility and balance when it comes to managing symptoms, but regular movement can mean big benefits in the hospital. As a hospital patient, movement — often with support from physical and occupational therapy — is essential for preventing falls and minimizing complications.

A new study finds that staying active (inpatient mobility) in the hospital benefits people with Parkinson’s. Published in Parkinsonism & Related Disorders, the Parkinson’s Foundation-supported study looks at how University Hospitals (UH) located in Cleveland, OH, Move to Heal Program, a hospital system-wide mobility program that aims to mobilize all inpatients at least three times daily, affects patients with PD.

Inpatient mobility refers to safe movement during a hospital stay (in and out of bed) with the approval and support of a care team. Benefits include:

• Reduced muscle loss

• Better sleep

• Improved focus

A lack of mobility in older patients while hospitalized is associated with reduced mobility and increased mortality after being discharged.

Study Results 

To learn more about the outcomes of inpatient mobility for people with PD, the study used data from patients admitted at the hospital for more than 24 hours between February to September 2023, comparing 300 hospital patients with Parkinson’s to 12,000 patients without PD. Each group was further divided into an:

• Active group: three mobilizations or more per day. Mobilizations included active or passive range of motion performed in bed, sitting at the edge of the bed, sitting on a chair or bedside commode, standing and walking.

• Inactive group: less than three mobilizations per day.

Data showed that inpatients with PD in the active group had a shorter hospital stay and higher probability of returning home after hospitalization. This supports the Parkinson’s Foundation Hospital Care Recommendations, which advocates that people with PD mobilize three times a day under professional supervision.  

Notably, all patients who stayed active while hospitalized were 50% less likely to die within 30 days of being released from a hospital stay, and 30% lower odds within 90 days.

Hospitalized patients who stayed active were 74% less likely to be discharged to hospice care or die compared to inactive patients.

Overall, the study suggests that frequent mobilization significantly decreases length of stay and likelihood to be discharged home for patients with Parkinson’s, in hospitals with mobilization programs.

Highlights 

• The Parkinson’s Foundation partnered with University Hospitals to better understand how staying active in the hospital (called inpatient mobility) impacts people with Parkinson’s.

• Study data compared 300 hospitalized people with Parkinson’s with 12,000 hospitalized patients without Parkinson’s.

• People with Parkinson’s who were mobilized at least three times a day while admitted had a shorter length of stay and were more often discharged to home (rather than a care facility) than those who were not mobilized at least three times per day.

• Patients who stayed active while hospitalized had 50% lower odds of dying within 30 days of being released from a hospital stay, and 30% lower odds within 90 days.

• Both groups that were active (with and without PD) had shorter hospital stays than the inactive group, but the impact was more significant for those with PD. 

• Only the active PD group showed an increased likelihood of going home after discharge.

What does this mean? 

For people with Parkinson’s, staying mobile in the hospital can make an enormous difference when it comes to recovery and being more likely to go home instead of another care facility.

Mobility in people with Parkinson’s is an important aspect of managing PD symptoms, while at home and in the hospital. This study shows that people with PD are prone to longer hospital stays and increased mortality rates if not moving regularly in the hospital.

For many, it can be difficult to advocate for regular, scheduled movement when you are facing health concerns or complications that lead you to the hospital. This study supports Parkinson’s Foundation efforts to promote system-wide inpatient mobility programs, showing significant benefits to patients and hospitals — especially those with PD. Over time, these programs can help improve quality of care.

What do these findings mean to the people with PD right now? 

Each year more than 300,000 people with Parkinson’s receive care at a hospital in the U.S. Unfortunately, approximately one in six people with Parkinson’s are estimated to experience avoidable complications during a hospital stay.

However, there are many ways to advocate for yourself when preparing for or experiencing a hospital stay. The Hospital Safety Guide contains useful tools and information to help you during your next visit. This guide highlights five hospital care needs, with advice on how to talk with your care team regarding movement in the hospital and beyond.

Learn More 

The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about PD and mobility in our below resources, or by calling our free Helpline at 1-800-4PD-INFO (1-800-473-4636) for answers to your Parkinson’s questions. 

• Safe Movement in the Hospital  

• Hospital Safety Guide

• How to Communicate Your 5 Parkinson’s Care Needs During a Hospital Visit

• For Professionals: Our Care Strategy: The Hospital Care Initiative

As Parkinson’s disease (PD) progresses, care needs become more complex. Advanced PD stages can bring greater changes in movement, thinking and daily function. For care partners, this stage can feel overwhelming, but with the right tools and support, you can provide care with confidence.

From managing daily routines to supporting your own well-being, this article covers practical tips for caring for a loved one with advanced PD:

Create a Steady Daily Routine

Having a routine often brings structure and reduces confusion for your loved one. A steady routine can create a sense of calm, helping your loved one feel more in control and at ease.

When creating a routine, try to keep consistent windows for waking up, taking medications, eating, resting and sleeping. Using tools to plan your day, like a dry-erase whiteboard or reminders on your phone can be effective.

If your loved one needs help with everyday tasks, consider asking their neurologist or movement disorders specialist to refer you to an occupational therapist (OT) familiar with Parkinson’s. You can also contact our Helpline at 1-800-4PD-INFO (1-800-473-4636) to find an occupational therapist near you.

Explore Advanced PD: Activities of Daily Living

Make the Home Safer to Prevent Falls

With the progression of PD, movement often becomes harder and the risk of falling becomes greater. To make the home safer, consider:

• Removing throw rugs and other clutter.

• Installing grab bars in the bathroom and using non-slip mats.

• Making sure walkways are clear and well lit.

• Easy access to seating to perform tasks such as brushing teeth or shaving.

• Securing loose cords and wires against walls.

A physical therapist (PT) can recommend mobility aids such as walkers or bed rails. Even small changes, such as using a shower chair or changing food textures, can make a big difference. Home safety is crucial, especially as Parkinson’s progresses and mobility becomes more limited. Making these changes can significantly reduce fall risks and support daily independence.

Communicate in Calm, Simple Ways

Advanced PD may affect your loved one’s speech and memory. Even if your loved one struggles to talk, they may still understand and want to communicate with you.

Try using short sentences, a calm tone and facial expressions. Listen to music together, look at family photos or sit quietly outdoors to stay connected. If your loved one experiences hallucinations or confusion, let their PD doctor know.

Explore The Care Partner Guide: How to Build Better Communications

Support Safe Eating and Drinking

In advanced PD, swallowing can become harder. This may cause weight loss or choking. A speech-language pathologist can check swallowing and suggest safer food textures.

Instead of three large meals a day, try offering small meals throughout the day instead. Also, keep your loved one upright when eating or drinking to avoid choking.

The Parkinson’s Foundation’s CareMAP video series can help care partners feel more confident and prepared. These short, topic-based videos provide instructions on managing all aspects of Parkinson’s care, including advanced care, and offer solutions to common challenges.

Care partners can watch videos on:

• Eating and swallowing

• Home safety

• Thinking and memory changes

• End of life care

Stay in Touch with the Care Team

Keep in contact with doctors, therapists and other healthcare professionals on your loved one’s care team. Report any new symptoms or concerns. A care team can help:

• Adjusting medications

• Recommending home care services

• Answering questions about mobility, mood and more

If your loved one needs supportive care, ask their doctor about palliative care. While the term itself can be overwhelming, it is all about supporting the person with Parkinson’s and their family through every stage of the disease. Palliative care is designed to ease discomfort and help navigate physical, emotional, and spiritual challenges.

Take Care of Yourself

Caring for someone with advanced PD can be demanding. Many care partners can feel stressed or tired, which can quickly lead to caregiver burnout. It is crucial to care for your own health, too.

Our Care Partner Guide shares tips on:

• Setting boundaries

• Taking breaks

• Finding emotional support

Download the guide now.

You can also call the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (1-800-473-4636) to get connected to services in your area.

Plan for What’s Next

It can help to talk with your loved one and their care team about the future. Consider bringing up topics such as:

• Home safety updates

• Support for daily tasks

• Assisted living or long-term care

Make sure to take time to organize important documents, discuss future care preferences, and ensure you understand your loved one’s wishes for end of life care.

Consider More Support

As Parkinson’s progresses, your loved one may need additional help. If you already receive support from friends, family or home aides, ask the care team if more help could improve daily life. This might include full-time in-home care or moving to a facility that offers more support.

Make sure everyone helping with care understands your loved one’s current needs and wishes. Stay in touch with the care team and share any concerns.

Some families may also consider hospice for comfort near the end of life. While the decision can be difficult, hospice may better manage health issues like infections, pain, and advanced dementia. When you and your loved one are ready, speak with their doctor to start the process.

Know You Are Not Alone

Thousands of families are caring for someone with advanced Parkinson’s. You do not have to do it alone. The Parkinson’s Foundation is here to help with free resources, guides and expert tools.

Whether you are managing daily routines, caregiving from afar or making long-term plans, support is available to help you feel more prepared and less overwhelmed. You are doing meaningful work, and we are here to support you every step of the way.

Visit the Advanced Parkinson’s page to find more videos, care strategies and resources today.

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.

Algunas personas con la enfermedad de Parkinson (EP) experimentan cambios en el pensamiento o la memoria, lo que se conoce como deterioro cognitivo. Mientras que a algunos les cuesta concentrarse en una tarea, otros tienen dificultades para recordar información. Los cambios cognitivos pueden predominar cuando se trata del Parkinson y el envejecimiento, pero cada persona tiene experiencias y síntomas únicos.

El deterioro cognitivo está relacionado con el Parkinson porque las personas que viven con esta enfermedad experimentan una disminución del nivel de dopamina en el cerebro, el neurotransmisor que sirve para regular el movimiento corporal y mantener la memoria de trabajo.

Todos deberían saber estas 10 cosas acerca del Parkinson y los cambios cognitivos:

1. El deterioro cognitivo es frecuente en el Parkinson.

En las personas con Parkinson, el deterioro mental y el del movimiento tienden a suceder a la vez. Los síntomas de deterioro cognitivo leve no suelen interferir en la vida doméstica y laboral. Los cambios cognitivos que acompañan al Parkinson en sus inicios tienden a limitarse a una o dos áreas mentales, con una gravedad que varía en cada persona. Las áreas más afectadas son la atención, la velocidad de procesamiento mental, la resolución de problemas y los problemas de memoria.

2. Los cambios cognitivos pueden producirse al principio de la enfermedad.

Los médicos solían creer que los cambios cognitivos no se desarrollaban hasta las fases intermedias a avanzadas de la EP, pero investigaciones recientes sugieren que los cambios leves pueden estar presentes en el momento del diagnóstico.

3. El cambio cognitivo es diferente de la demencia.

El deterioro cognitivo no es demencia, que es cuando las alteraciones cognitivas se producen en más de un área de la cognición. La demencia lleva a una pérdida más grave de las capacidades intelectuales que interfiere en la vida diaria. Aunque el deterioro cognitivo leve puede afectar a un 20-50% de las personas con la EP, no todos los casos resultan en un diagnóstico de demencia.

4. Los cambios en la función ejecutiva pueden ser frecuentes en el Parkinson.

Uno de los cambios cognitivos más destacados en el Parkinson es el deterioro de la función ejecutiva. Esto puede afectar la planificación, la organización, la multitarea y la toma de decisiones. Los seres queridos pueden ayudar a la persona con la EP dándole indicaciones, recordatorios y una mayor estructura en la actividad.

5. Los problemas de memoria a corto plazo están asociados a cambios cognitivos.

Los ganglios basales y los lóbulos frontales del cerebro (ambos ayudan al cerebro a organizar y recordar la información) pueden dañarse en la EP. La memoria a largo plazo suele verse menos afectada; sin embargo, la memoria a corto plazo y la capacidad de recordar información reciente suelen verse afectadas. Esto puede dificultar la realización de tareas comunes como preparar café, revisar el correo electrónico, etc.

La investigación ha demostrado que estas estrategias pueden ayudar a mantener la memoria ágil:

• Ejercicio: encontrar una actividad que disfrute y en la que pueda participar con regularidad es fundamental para vivir con la EP. Se ha demostrado que hacer ejercicio con regularidad mejora la cognición y los problemas de memoria. El Viernes de Ejercicio de la Parkinson’s Foundation ofrece una variedad de ejercicios cuyo objetivo es ayudar a las personas con Parkinson.
• Busque pasatiempos que estimulen la mente: la lectura, los rompecabezas, la jardinería y el arte son ejemplos de pasatiempos que pueden mantenerlo entretenido mientras agudiza su mente. Es importante que las personas con Parkinson encuentren pasatiempos que fomenten la estimulación mental.

6. El cambio cognitivo puede alterar la capacidad de atención y concentración.

Las personas con Parkinson pueden tener dificultades para mantener la atención o concentrarse en tareas durante periodos prolongados. Esto puede provocar problemas de cálculo mental o de concentración durante una tarea.

Estos son algunos consejos para ayudar a manejar sus habilidades de atención:

• Establezca alarmas mientras realiza una tarea para ayudar a mantener su capacidad de atención por el momento. La técnica Pomodoro ayuda a mejorar la concentración trabajando en intervalos de 25 minutos con breves descansos entre tareas.
• Nutra su cuerpo con alimentos que promuevan la salud del cerebro, como la dieta "MIND” que incluye grupos de alimentos como cereales integrales, bayas y verduras. Dé prioridad a dormir. Se necesita un mínimo de seis horas por noche para mantener la atención y la concentración. Intente mantener un horario de sueño consistente cada noche, acostándose a la misma hora, para que su cuerpo lo vuelva un hábito.

7. Las personas en las primeras fases de la EP pueden tener problemas con la percepción de la profundidad.

Los problemas de percepción visual sutiles pueden contribuir a las percepciones visuales erróneas o a las ilusiones. Durante las primeras fases del Parkinson, las personas suelen tener problemas para medir la distancia y con la percepción de la profundidad. Conforme avanza la enfermedad, las personas con la EP enfrentan problemas para procesar la información acerca de su entorno o medio ambiente.

8. Alrededor de un 50% de las personas con Parkinson experimentan depresión.

Hasta la mitad de las personas con la EP experimentan algún tipo de depresión durante la enfermedad. La depresión es más frecuente en personas con Parkinson que experimentan un deterioro cognitivo grave. Las personas que experimentan depresión pueden tener más dificultades para controlar los síntomas motores. Sin embargo, la depresión suele ser tratable. Hable con su médico especialista en la EP acerca de este síntoma.

9. Los problemas de sueño son frecuentes en el Parkinson y pueden afectar la cognición.

Los problemas para conciliar y mantener el sueño son muy frecuentes en las personas con la EP. Los efectos de los problemas de sueño durante la noche pueden provocar fatiga física y cognitiva a lo largo del día.

Los cuatro principales problemas de sueño relacionados con la EP son:

1. Problemas para mantenerse dormido y con despertar muy temprano por la mañana (insomnio).
2. Movimientos involuntarios y dolor que interrumpen el sueño.
3. Aumento de la micción nocturna.
4. Agitación nocturna, sueños vívidos y percepciones visuales erróneas o alucinaciones.

Para tratar los problemas de sueño, hable con su médico especialista en la EP, que puede recetarle medicación o mandarlo con un especialista del sueño. Algunos remedios naturales incluyen la creación de un ritual para dormir, evitar el uso de pantallas antes de acostarse, tomar un baño caliente y más.

10. Existen diferentes tratamientos para abordar los cambios cognitivos.  

Aunque los investigadores aún están descubriendo nuevas formas de atender el cambio cognitivo en las personas con la EP, los médicos suelen recomendar una combinación de tratamientos para ayudar con el cambio cognitivo.

Pueden incluir:

• Terapia de recuperación cognitiva: este tratamiento hace hincapié en la enseñanza de formas alternativas de compensar los problemas de memoria o pensamiento. Incluye el uso de la información de pruebas neuropsicológicas para identificar los puntos cognitivos fuertes que pueden usarse para ayudar a compensar las áreas más débiles del pensamiento.
• Manejo del comportamiento: realizar cambios en el entorno doméstico puede ayudar a minimizar las dificultades de memoria, visoperceptivas o de orientación.
• Hablar con su médico de la EP: su médico puede ayudarle a encontrar opciones de tratamiento para sus síntomas cognitivos más molestos. También puede mandarlo con un psiquiatra, neuropsicólogo, terapeuta del habla y el lenguaje o terapeuta ocupacional para obtener más ayuda.
• Crear un sistema de apoyo: trabaje para crear su propia red de apoyo. Los grupos de apoyo suelen ser recursos increíbles.

Aprenda más

Descubra más acerca de los cambios cognitivos con estos recursos:

• Bienestar mental: abordar los cambios en el pensamiento en el Parkinson
• Herramientas para abordar las alteraciones del pensamiento y la memoria en la EP
• Episodio 22: Cambios cognitivos