What are the cognitive changes seen in Parkinson's

08/18/2010

Am I losing my mind?

Past the age of 20, all people begin to slow a little in thinking speed, the efficiency and reliability in memory, and with word finding. These changes become more noticeable to individuals in their forties and fifties and later in life. For the most part, we dismiss them as “senior moments” but many people worry whether they are developing some abnormal mental or “cognitive decline.” The word “cognitive” refers to thinking abilities like attention, learning, memory, problem solving, language, and visual-spatial capabilities.

The term “dementia” is a scary word and concept. The origin of the word comes from the Latin prefix “De” (a decline in) and “Mens” (mental functioning). As we become adults, it seems like we are all experiencing some amount of mental decline, but it is not necessarily dementia unless it is unusually severe. To remove some of this confusion, the label of “dementia” will likely soon be changed to “Major Cognitive Disorder.” This new term makes more sense as there are different degrees of cognitive decline. We already use the diagnosis “Mild Cognitive Impairment.”

What are the cognitive changes sometimes associated with Parkinson’s disease?

With Parkinson’s disease, there are usually changes in cognitive functioning, but for most people the main complaint is with thinking speed and difficulties with multitasking. The reductions in speed affect word finding, keeping up with conversations, and performing complex tasks, and dividing one’s attention and concentration. Memory abilities with Parkinson’s may be less efficient, but are usually not affected as much as Alzheimer’s patients are affected. People affected by Parkinson’s usually benefit from reminders and memory prompts, but may recall moments or hours after it was needed.

Common cognitive changes include:

Slowed thinking speed- give yourself time to complete a task.
Word finding difficulties- this is sometimes described as finding the right word or name for an object or person. Don’t let anxiety make this worse.
Trouble with multitasking- focus on one important task at a time rather than trying to do two things at once.
Difficulty organizing complex tasks, steps or instructions- try to keep tasks simple when possible.
Memory problems- appointment reminders, alarms, task organizers and task or event calendars help you remember important information.

What is the chance that I will get Parkinson’s disease?

Many people worry what their chances are for developing a major cognitive disorder; those with Parkinson’s are no exception to these worries. It is difficult to say to what degree Parkinson’s disease heightens this risk, as aging is one of the greatest risk factors for developing major cognitive problems. Most studies find an incidence of about a 30% risk for dementia with Parkinson’s, but a University of Washington study found a similar prevalence rate of dementia brain changes for individuals in their 70’s and 80’s (people who did not have a prior diagnosis of Parkinson’s or Alzheimer’s and died of some other cause). Advancing age is a large part of dementia risk, and most people with Parkinson’s are older.

How are changes measured?

Measuring cognitive changes is tricky. Without a baseline measure of a person’s abilities, it is impossible to know how much a person has changed; people tend to have relative strengths and weaknesses, and very few are average for all capabilities. Cognitive testing can be done in as little as five minutes or as long as six hours, providing differing levels of information. Neuropsychological evaluations can provide a comprehensive comparison of intellectual, memory/learning, attention, language, problem solving, and visual spatial functioning. The trick is what to do with this information.

People generally cope better if they know what to expect, and how much to be concerned about a problem. Very often, we find that a person’s cognitive changes are mild, and par for the course with aging and Parkinson’s. The cognitive slowing will be a nuisance and cause inefficiency, but often does not appear to be a major cognitive disorder. In the situations where we do find a higher risk of a developing major cognitive disorder, medications may be implemented to slow future decline. Sometimes depression and anxiety magnify the problems with thinking; treating the psychological difficulties can improve thinking speed and memory abilities.

Most people want to know how to preserve their cognitive abilities. It appears that the most important strategy is to protect you body and brain so it is not damaged in the first place. Good nutrition, exercise, avoidance of alcohol and toxic substances, preventing head injuries, and managing medical risk factors like high blood pressure, high cholesterol and diabetes are very important. Being socially, physically, and mentally active likely help preserve abilities better that those who do not stay active in these activities. There has been no significant evidence that any particular supplement is protective against cognitive decline, although many make these claims. Vitamin D is however, proving to be very important as is a diet rich in green leafy vegetables and other colorful fruits and vegetables. The axiom “use it or lose it” still applies! These and other recommendations are found in Sharpen Your Pencils.

Author: Jeff Shaw, Psy.D. Neuropsychologist at the Booth Gardner Parkinson’s Care Center.

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