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How does Parkinson's affect cognition? What can be done about it?

Wednesday February 06, 2013
Cognitive changes associated with Parkinson’s  are mostly a category of thinking skills called executive function. Although many people with Parkinson’sexperience some sort of cognitive change, dementia or signficant problem impacting daily life and function is less common – occurring in about 30%.  The more common thinking abilities are:
  • Speed of movement
  • Word finding and naming problems
  • Multitasking
  • Performing complex tasks or skills
  • Abstract thinking abilities
  • Visual-spatial skills

Behavioral problems that can be associated with cognitive problems include:

  • Apathy or loss of motivation
  • Depression

 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.  

Cognitive changes are treatable. It is important to remember that medicines can worsen confusion and cause hallucinations in people with cognitive problems. When this occurs, it is important to balance the medicines that are most effective for movement with those that have greater thinking related side effects.  Amantadine, selegeline and dopaminergic agonists such as Mirapex (pramipexole), Requip (ropinirole), Neupro have a greater risk of associated i thinking problems and /or hallucinations.
Treatment of cognitive changes includes:
1. Review with your doctor all medicines that can impact thinking such  including Parkinson’s medicines, pain medicines, muscle relaxants, anxiety and depression medicines to be sure that they are all needed, reduce or eliminate theones that are not.
2. Check for other medical problems that can worsen thinking problems including strokes, sleep apnea, thyroid problems, vitamin D and B12 deficiency, poor diabetic glucose control, heart problems, low blood pressure.
3. Memory enhancing medicine such as Exelon (rivastigmine) can be tried.
4. Stay mentally active
5. Be mentally engaged
6. Get more exercise especially  higher intensity aerobic exercise if possible. 
7. Eat healthy including foods high in omega 3s (fish oil), vitamin B6 and B12.
8. Reduce stress
9. Simplify life tasks
10. Challenge yourself – learn new things, explore new experiences
11. Stay socially active
12. Do what you love
Most important get the help and professional advice you need. See your doctor and consider a referral to a Neuropsychologist and/or Occupational therapist
Learn more about hallucinations.

Monique L. Giroux, MDMonique L. Giroux, MD
Guest Blogger, Former Medical Director of NWPF

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