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.

Living well with Parkinson’s takes a team, and some of the most valuable members may not be who you would typically expect. Healthcare professionals, such as physical and occupational therapists, are essential members of your Parkinson’s care team. They help you maintain mobility, independence and communication, working hand-in-hand with movement disorders specialists and neurologists to create a comprehensive, well-rounded care plan that supports your individual needs and overall well-being. 

To showcase these key members of your Parkinson’s care team, we’re highlighting recent podcast episodes that explore the unique benefits of working with a diverse group of medical specialists.

Who should we talk to next? Let us know

Speech-Language Pathologist

Episode 176: The Challenges of Speech and Swallowing Issues

Parkinson’s affects more than just movement, it can also impact the small muscles in the face, mouth, throat and chest. These changes may impact your ability to eat, speak and swallow, and can influence your confidence in conversations.  A speech-language pathologist will assess speech and swallowing challenges and create a treatment plan to help manage these symptoms.

Melissa Grassia Chisholm, MS, CCC-SLP, a licensed speech pathologist and a voice-swallow airway expert, talks about the importance of getting a baseline evaluation with a speech-language pathologist early on in your PD diagnosis and explains how personalized treatment plans can help address speech and swallowing challenges as your needs evolve.

Physical Therapist

Episode 171: Physical Therapy Recommendations for Exercising Safely

As Parkinson’s progresses, overall movement, balance, and coordination may become more challenging. A physical therapist helps you stay active by developing a custom training plan that meets your goals and physical needs.

Patricia S. Brown, PT, DPT, NCS, of Chapman University in California, a physical therapist who specializes in neurological diseases, shares her recommendations on staying motivated and choosing an exercise program that matches your lifestyle goals.

Pharmacist

Episode 167: Exploring Carbidopa-Levodopa for Treating Parkinson’s Symptoms

Managing Parkinson’s symptoms often involves taking multiple medications, making ongoing conversations with your doctor essential. When questions arise, pharmacists can be readily accessible experts who can help address concerns, identify potential drug interactions, and make you feel more confident about your medications.

Emily Peron, PharmD, MS, and Leslie Cloud, MD, MSc, from Virginia Commonwealth University, a Parkinson’s Foundation Center of Excellence, explain the long-term use considerations of carbidopa-levodopa, the different formulations available, and how to recognize when medication adjustments may be needed.

Episode 181: What to Know Before Taking Nutritional Supplements for Parkinson’s

In addition to prescribed Parkinson’s medications, people with PD may explore complementary or alternative therapies, such as herbs or nutritional supplements. Although often available without a prescription, these supplements can pose risks, especially when taken alongside PD medications. That’s why it’s always advisable to speak with your healthcare provider before starting a new medication or over-the-counter supplement.

Angela Hill, Pharm. D., CRPh, a pharmacist and professor at the University of South Florida, a Parkinson’s Foundation Center of Excellence, talks about the potential side effects and drug interactions that can happen with nutritional supplements, and offers tips for reading and evaluating food labels so you can better understand what you’re taking.

Social Worker

Episode 179: Understanding Depression, Anxiety, and Apathy

Social workers are often the go-to resource for connecting you with specialists and services that can help you navigate the day-to-day realities of Parkinson’s. They offer a wealth of guidance and support to ensure that your voice is heard.

Lauren Zelouf, MSW, LCSW from Penn Medicine’s Parkinson’s Disease & Movement Disorders Center, a Parkinson’s Foundation Center of Excellence, tackles the often-overlooked topic of mental health. She breaks down the differences between depression, anxiety and apathy, and offers coping strategies for managing symptoms and finding support.

Managing Parkinson’s involves a team-based approach. Each healthcare professional brings specialized expertise that can help you move better, speak more confidently, and feel better supported throughout your Parkinson’s journey.

Coming Soon: We’re excited to feature another essential member of the Parkinson’s care team—an occupational therapist—in an upcoming episode.

Subscribe to our podcast. Search for “Substantial Matters: Life and Science of Parkinson’s” on your favorite podcast platform.

Listen to every episode at Parkinson.org/Podcast.