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.

Environmental factors, such as chemical exposure, likely contribute to Parkinson’s disease (PD) risk. Golf courses consume large quantities of these chemicals, including herbicides, pesticides and insecticides. A new study from researchers using the Mayo Clinic–driven Rochester Epidemiology Project shows that living near golf courses could increase the risk of Parkinson’s.

Over the last 20 years, evidence has linked certain chemicals used in agriculture to PD. Farm-workers exposed to the weed-killer paraquat or the insecticide rotenone, for instance, develop Parkinson’s at rates two- to three-times higher than people who have never handled those chemicals. In lab settings, research shows that low doses of these compounds can damage dopamine-producing neurons in the brain — the same cells that are impacted in Parkinson’s.

While golf courses are known to be heavily treated with similar chemicals, no research has directly investigated the potential relationship between PD risk and proximity to golf courses.

This new study on golf courses and chemicals covers 25 years of medical data, from 1991 to 2015, and examines residents of several counties in southeastern Minnesota — a region where there are detailed municipal records, well‐depth charts and groundwater maps. Investigators used this information to study whether people who live close to golf courses face higher Parkinson’s risk. Additionally, they explored whether nearby public water systems explain any extra risk.

Study Results

The research team identified 419 men and women whose Parkinson’s diagnosis occurred during the study window (from 1991 to 2015) and matched them with more than 5,000 people of the same age, sex, race and neighborhood who did not have Parkinson’s.

Researchers then calculated the straight-line distance from each participant’s home to the nearest golf course on the date of PD diagnosis. Those addresses were added on maps of municipal water-service areas, the locations and depths of public wells, and geological charts highlighting regions where groundwater is considered “vulnerable,” meaning the soil or bedrock allows surface chemicals to migrate quickly downward.

Overall, the analysis revealed that people who lived within one mile of a golf course were 126% (or 2.26 times) more likely to receive a Parkinson’s diagnosis than those whose homes were six or more miles away. Being farther from the fairway seemed to help; risk steadily tapered off beyond one mile, with the odds of PD diagnoses decreasing by 9% for each mile of distance from a golf course.

Distance is only part of the story. When researchers looked at households served by a public water system that contained at least one golf course, Parkinson’s risk was 96% higher compared to households whose water systems did not have a golf course within their boundaries, and about 50% higher than people who use private wells. Additionally, when a golf course was in an area with groundwater vulnerable to contamination, the risk of Parkinson’s was 82% higher than in less vulnerable areas with a golf course.

Taken together, the findings suggest that the pesticides and herbicides used to keep putting greens immaculate may be leaching into drinking water, increasing Parkinson’s risk for the surrounding area.

Highlights

• Using medical records from 1991 to 2015, researchers pinpointed 419 Minnesotans with a Parkinson’s diagnosis and compared them to a group of more than 5,000 neighbors who were alike in age, sex, race, and residential area with no history of PD.

• For every person in the study, researchers measured how close they lived to the nearest golf course, then overlaid addresses onto maps showing city water-service districts, well water depths and locations, and areas where groundwater is more easily polluted.

• Those living within one mile from a golf course were 2.26 times more likely to be diagnosed with PD compared to those living 6 or more miles from a course. The odds of PD diagnosis decreased by 9% for each mile of distance from a golf course.

• People living in a public-water district with one or more golf courses had almost double the odds of developing Parkinson’s compared to those without a course, and about 50% higher odds than those using private wells.

• When a course was on land more vulnerable to pesticide contamination into the community water source, the risk of Parkinson’s was 82% higher compared to regions with a golf course located on more protective geology.

What does this mean?

This study suggests a strong association between living within close proximity to a golf course with an increased risk of developing PD. Additionally, it highlights water sources surrounding golf courses as a primary means of exposure to the chemicals routinely used on golf courses.

However, this study does not prove cause and effect, and the investigators emphasize that more work is needed before drawing firm conclusions. The research lacks direct measurements of pesticide levels in the water over time, and it cannot rule out the impact of other environmental factors related to golf courses, such as higher-income neighborhoods or traffic patterns.

Still, the clear patterns drawn from this study — highest PD risk closest to golf courses, next-highest in the water systems that share ground with a course, and more risk in areas where contaminants travel easily — gives researchers more compelling evidence about how environmental risks play a role in Parkinson’s. 

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

The connection between golf courses and increased PD risk may help some people living with Parkinson’s better understand one cause — exposure to environmental contaminants, potentially through drinking water. However, the environmental risk factors for PD that golf courses present are potentially preventable, by individuals and regulators. People can choose not to live near golf courses, knowing that it may put them at an increased risk for developing PD. On the other hand, regulators can also acknowledge the potential risks and improve safety measures surrounding golf courses and water sources.

The prevalence of Parkinson’s is on the rise. These findings — and new, similar studies that will most likely result from this one — highlights the need to push for mitigating risk factors for PD. Studies like this one that tie environmental factors to increased risk are shaping the future of PD research by helping people trace a contributor to their diagnosis — and help identify ways to reduce risk for future generations.

Learn More

The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about PD and the topics in this article through 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.

• Environmental factors

• Episode 122: Environmental Factors and Parkinson’s

• Plastic Waste Contaminants Could Promote Parkinson’s