Parkinson’s: What Are the Cognitive Changes?

photo of nurse comforting patient

Parkinson’s disease may cause changes in the way you think, focus, behave, remember, speak, or sense what’s happening around you. Your doctor will call these cognitive changes.

While cognitive changes are common in people who have Parkinson’s, most people have mild symptoms that don’t get in the way of living a full, independent life.

Some people with Parkinson’s have stronger cognitive changes, or dementia. These symptoms can disrupt your daily life.

 

What Cognitive Changes Should You Expect?

Between 20% and 50% of people with Parkinson’s have mild cognitive changes at some point, even early on. You may not even notice them if they don’t get in the way of with your daily life.

Mild cognitive changes with Parkinson’s may crop up as problems with:

  • Memory or recall
  • Doing normal tasks like using your coffee maker
  • Concentration
  • Speech, like finding the right word to describe something
  • Paying attention when you talk with a group
  • Solving problems
  • Executive function -- doing more than one task at a time or starting new tasks
  • Judging distances while you walk or drive
  • Avoiding objects in your way
  • Walking and talking at the same time

 

 

Why Do Cognitive Changes Happen in Parkinson’s?

Parkinson’s can cause a drop in brain chemicals called neurotransmitters. Dopamine is one neurotransmitter that helps control your movements. Lower dopamine levels disrupt your brain’s activity and cause mild cognitive changes.

Changes in the levels of other brain chemicals, like acetylcholine and norepinephrine, may play a role in some cognitive changes like memory lapses or executive function problems.

Diagnosis

Your neurologist will use many tools to help diagnose cognitive changes due to Parkinson’s.

Interviews. The doctor will talk with you about changes to your behavior, movements, recall, or speech. They may ask you to compare your cognitive function now to how you were before Parkinson’s. Talk about how your cognitive changes affect your daily life, work, or relationships. The doctor may also talk to your spouse, family members, or caregivers to find out what changes they’ve noticed in you.

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Cognitive screening tests. The doctor can give you questionnaires to measure your cognitive function, like:

  • Mini-Mental State Examination (MMSE)
  • Montreal Cognitive Assessment (MCA)

These screening tests only take 10 minutes or less to complete. The doctor will ask you questions and assess your memory, speech habits, awareness, concentration, problem-solving skills, and movements.

Referrals to specialists. A clinical neuropsychologist can give you more formal tests to figure out if you have mild cognitive changes due to Parkinson’s, or if your symptoms result from another condition like a stroke or Alzheimer’s disease.

Other Causes for Your Symptoms

Many people with Parkinson’s also have depression or anxiety. These conditions can affect your motor function, balance, memory, or recall. Treating your depression or anxiety may help improve cognitive symptoms.

Parkinson’s often causes sleep problems, like insomnia or waking during the night, or fatigue. Poor sleep and fatigue can affect your memory, walking, ability to complete tasks, alertness, or concentration.

A lack of vitamin B12 and thyroid problems can also cause cognitive symptoms. Your doctor will want to rule these out before making a diagnosis.

 

Treatment

Cognitive remediation therapy, where you use computer programs to help with recall and understanding, or occupational therapy, where you focus on tasks that are part of daily living, can help you learn new ways to cope with cognitive changes and function better.

Behavioral management therapy can help you adapt your home or routine so you can manage cognitive changes. Your therapist may suggest use of a nightlight to make it easier to see at night or setting a regular schedule for your daily activities.

 

Medications

Your doctor can prescribe drugs to help improve cognitive symptoms:

  • Rivastigmine (Exelon), the only drug approved for dementia in Parkinson’s
  • Donepezil (Aricept)
  • Galantamine (Razadyne)
  • Stimulants if your cognitive changes result from sleep problems or fatigue

 

Tips to Help You Manage

Try these things to make living with cognitive changes easier:

  • Add photos to contacts in your cellphone so you can put a face to the name when they call.
  • Place lists or reminders where you can find them easily.
  • Let your family members know to make eye contact with you when talking, to talk more slowly so you can follow along, and not to finish your sentences for you when you’re trying to find the right word or recall a name.
  • Promote brain health with a healthy food, exercise, plenty of rest, drinking alcohol only in moderation, and not smoking.

 

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on May 08, 2020

Sources

SOURCES:

Parkinson’s Foundation: “Cognitive Changes.”

American Parkinson Disease Association: “Cognitive Changes.”

The Michael J. Fox Foundation for Parkinson’s Research: “Ask the MD: Occupational Therapy and Parkinson’s,” “Memory and Thinking Changes.”

American Family Physician: “The Mental Status Examination.”

Clinical Trials.gov: “Cognitive Rehabilitation in Parkinson's Disease.”

 
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