Understanding and Managing Cognitive Health in Parkinson’s Disease

By Kate Fiorianti | June 11, 2024

When it comes to Parkinson’s Disease (PD), understanding and managing cognitive health is crucial for maintaining quality of life. During our recent Empowering Minds: Parkinson’s Mental Wellness for Patients, Families and Caregivers, Dr. Kaltra Dhima from Vanderbilt Medical Center, alongside MyLiveability Occupational Therapists Dr. Carlene Johnson OTD/OTR/L and Tori Vik shed light on the intricacies of cognition in PD and offered valuable strategies for maximizing long-term brain health.

What is Cognition?

Cognition, or “thinking,” encompasses various domains essential for daily functioning, including

memory
attention
thinking speed
language
visuospatial function
executive function

Cognitive decline can vary significantly, ranging from mild to severe.

No cognitive decline indicates no deviation from the baseline, which is normal for age.
Mild Cognitive Impairment (MCI) involves cognitive decline from baseline, beyond normal aging, with no significant impact on daily tasks.
Dementia, or Major Neurocognitive Disorder, signifies significant cognitive decline from baseline, affecting the ability to perform daily tasks independently.

Causes and Symptoms of Cognitive Changes

Cognitive changes in PD can be attributed to several factors. Changes in dopamine levels can cause mild cognitive changes, while the same brain changes responsible for motor symptoms also impact cognition. The presence of Lewy bodies is linked to significant cognitive changes and dementia. Additionally, stress, medications, and unmanaged depression can exacerbate cognitive issues.

Specific cognitive challenges in PD include difficulties with attention, such as multitasking, shifting focus, and completing complex tasks. Speed of mental processing slows down, resulting in delayed verbal responses and increased time to complete tasks. Executive functioning problems affect planning, task completion, and mental flexibility. Memory issues present challenges with routine tasks, recalling memories, and managing finances. Language changes involve struggles with word-finding, speaking under stress, and comprehension. Visuospatial difficulties include problems with depth perception and navigating in low light or complex environments.

Proactive Health Management

Engage with healthcare providers to address cognitive health effectively. Reviewing medications for their impact on cognitive function, such as sedatives, antihistamines, and opiates, is essential. Lab tests to check for deficiencies and health risks like B12, thiamine, and thyroid function are important. Managing risk factors, including blood pressure, cholesterol, diabetes, and kidney/liver health, is crucial. Addressing sleep apnea symptoms like breathing pauses, snoring, and daytime sleepiness can prevent further complications.

Early and accurate diagnosis is crucial for effective management. Testing options include cognitive screening, a quick assessment lasting a few minutes, and a comprehensive neuropsychological evaluation, which takes 2-5 hours and involves interviews, standardized tests, and feedback sessions to identify causes and provide recommendations.

Research shows that newly diagnosed PD patients are about twice as likely to develop MCI. Within three to five years post-diagnosis, 20% to 57% of PD patients develop MCI. Additionally, 30% of PD patients may develop dementia at any given point, with the cumulative prevalence rising to over 75% after 8-10 years, and up to 83% after 20 years.

Lifestyle Modifications

Adopting lifestyle modifications can significantly impact cognitive health. Moderate alcohol consumption, avoiding smoking and substances, and following a healthy diet such as the Mediterranean or MIND diet are recommended. Staying physically active and engaging in cognitive and social activities, can help maintain cognitive function.

Managing Apathy and Anxiety

Low motivation, or apathy, is common in PD. Creating a daily schedule and setting weekly goals for activities provide structure. Focusing on small tasks and encouraging participation in hobbies and exercise are effective strategies. Ensuring adequate sleep and engaging in enjoyable physical activities are crucial for overall well-being. Anxiety in PD is manageable with techniques such as deep breathing, shifting focus, thinking grateful thoughts, repeating positive affirmations, and engaging the five senses. Progressive relaxation, which involves tensing and relaxing different muscle groups, can also release tension.

Care Partner Strategies

Care partners play a crucial role in managing cognitive changes in PD. Providing prompts and reminders, such as using sticky notes and labels around the home, can be helpful. Offering help only when needed in mild to moderate stages and assisting with medication management are important strategies. Consistency in keeping frequently used items in the same place and exercising patience by allowing time for responses or word-finding can make a significant difference.

By understanding and addressing cognitive changes, individuals with Parkinson’s Disease can take proactive steps to maximize their long-term brain health and maintain their quality of life.

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