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By Real World Health Care Editorial Staff  |  Apr 8, 2020

Navigating Cognitive Changes in Parkinson’s Disease

Editor’s Note: The following has been excerpted, with permission, from Navigating Cognitive Changes in Parkinson’s Disease, published by The Michael J. Fox Foundation for Parkinson’s Research (MJFF). It was written by MJFF Vice President of Medical Communications and movement disorder specialist Rachel Dolhun, MD, in collaboration with Parkinson’s experts, the patients and families who live with the disease, and the clinicians who care for them. Real World Health Care invites our readers to read the free guide for more information around different forms of cognitive changes, including mild cognitive impairment, Parkinson’s disease dementia and dementia with Lewy bodies.

Rachel Dolhun

Rachel Dolhun, MD, Michael J. Fox Foundation

“The goal of this guide is to encourage people with Parkinson’s and their loved ones to learn more about cognitive changes and to take action—whether that’s opening a discussion to lessen fear and improve care or practicing habits that boost brain health,” said Dr. Dolhun. “There’s a lot you can do right now if you notice or worry about cognitive changes.”

Parkinson’s Disease and Brain Health

Not everyone with Parkinson’s disease (PD) experiences cognitive issues, and when and how they occur is unique to each person. But for people and families with PD, changes in thinking and memory are among the most concerning potential symptoms and, unfortunately, also some of the least talked about.

Cognitive changes with PD often are different or more than expected with age. As you get older, it may be normal to leave your keys in the door, forget something at the grocery store or miss an occasional bill payment. But age alone doesn’t usually cause a person to forget what their keys are for or how to use them, how to get to and around their usual grocery store, or how to balance the checkbook and transfer money between bank accounts.

Tracking Cognitive Changes

When PD affects cognition, it typically impacts executive functions, such as multi-tasking, organizing and decision-making, more than memory.

How can people with PD know when they and their loved ones should be concerned about signs of cognitive changes? Consider the activities below and whether there has been a major change in many or most of them.

Paying Attention. Do you have trouble participating in or following the flow of group conversations? Is it harder to read books or watch movies because of difficulty following storyline or plots?

Making Decisions and Solving Problems. Is it nearly impossible to make decisions, such as what to do with a free afternoon? Do you make poor decisions, such as not wearing your seatbelt or spending large amounts of money you don’t have? Do you have difficulty solving problems, such as how to reroute through a traffic jam or what to do about dinner when there is no food in the house?

Remembering. Do you forget important appointments or social engagements? Do you regularly forget who called and why? Do you lose track of the season or time of year? Do you often need reminders of how to do things that were previously second nature, such as how to turn on the television or use the computer?

Taking Medication. Are you able to describe which medications you take for what and when? Do you need help from your spouse or care partner to take the right medications at the right time?

Behaving. Have you or others noticed changes in your manner? What about your personality or mood? Are you more outspoken or withdrawn than you used to be?

Managing Money. If you manage the household finances, do you pay bills on time, write checks correctly and balance the checkbook? Have you started regularly buying things you can’t afford or don’t need?

Working. Do you have trouble focusing or need more time than usual to complete tasks? Is it hard to switch between tasks? Do you have difficulty multi-tasking or juggling several things at once? Are you disorganized? Is it hard to follow instructions?

If you or your loved ones notice differences in how you think, remember, act or do regular daily activities, talk with your doctor. Together, you can evaluate what’s happening and figure out the best path forward.

Boosting Brain Health

Researchers have not yet proven ways to prevent or slow cognitive changes, but current evidence suggests that what is good for your body is good for your brain:

  • Exercise: Work with your doctor and physical therapist to find an exercise you enjoy, feel safe doing and will do regularly.
  • Be socially active: Spending time with friends and loved ones prevents isolation and lets you practice learning new names and discussing current events.
  • Eat a healthy, balanced diet: Aim for a variety of fruits and vegetables, whole grains, and more fish and poultry than red meat. (In the style of the Mediterranean diet.)
  • Get involved in the community: Attend a neighborhood event or join a PD support group.
  • Train your brain: Play online “brain games,” do a crossword or jigsaw puzzle, learn to speak a second language or start a new hobby.
  • Reduce stress: Meditate, practice mindfulness, go for daily walks, or spend time gardening or relaxing in nature.
  • Sleep well: Not getting enough rest can make it harder to manage PD. Ask your doctor about ways to improve your rest and keep a regular schedule for going to bed and getting up.
  • Take care of medical conditions: Diabetes, high blood pressure and high cholesterol can damage your brain’s blood vessels and lead to thinking and memory problems.
  • Check on mood and motivation: Depression, anxiety and apathy (lack of motivation) can cause or contribute to cognitive changes. Pay special attention to these symptoms right after being diagnosed, during a hospitalization and around the holidays.
  • Drink alcohol in moderation: Too much can cause cognitive changes as well as walking and balance problems.
  • Don’t smoke cigarettes: Cigarette smoking is associated with Alzheimer’s, stroke and other diseases that cause thinking and memory problems.
  • Review your medications: Certain prescriptions and over-the-counter medications (including the PD drug trihexyphenidyl, or Artane) can cause confusion in some people.

Starting a Dialogue

Avoiding discussions about cognitive changes can increase fear, misperception and misinformation—and lessen quality of life. It can also slow much-needed research into when these changes happen and how to treat and ultimately prevent them. By opening the conversation, people with Parkinson’s and their loved ones can take steps to keep their brains healthy and recognize changes if they happen.

Patients and families are encouraged to download the free guide at michaeljfox.org/cognitionguide.

The Michael J. Fox Foundation for Parkinson’s Research has an ambitious goal — find a cure and go out of business. Donations go directly to the Foundation’s high-impact research programs to speed better treatments and a cure for the millions of families impacted by the disease. Together, we can end Parkinson’s at MichaelJFox.org.

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