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Parkinson’s and Cognitive Impairment

Mild cognitive impairment, such as memory loss, can be part of the normal aging process. However, some symptoms can also be caused by Parkinson’s disease.

Parkinson’s disease slows down all movement of the body. This general slowdown also affects cognitive abilities. Memory, orientation, attention, concentration, the ability to learn, abstract thinking, judgment and language can be affected. 

Mild cognitive impairment is characterized by difficulty:

  • Paying attention
  • Following a complicated conversation
  • Concentrating to read
  • Planning complex activities
  • Finding solutions to problems
  • Taking decisions
  • Formulating your thoughts
  • Finding the right words
  • Keeping information in memory
  • Learning new things
  • Imagining things
  • Orienting yourself
  • Doing several things at the same time

These mild cognitive impairments, although disturbing, do not compromise the performance of daily activities. Their appearance doesn’t mean that you have dementia or that it will develop later on. Occasionally forgetting phone numbers or names when you’re over 70 is perfectly normal.

Dementia is diagnosed when problems with memory and thinking take up more space in your life and prevent you from performing everyday tasks.

Infographics : Mild cognitive impairment affects around 1/3 of people with Parkinson’s disease.

Cognitive impairment is usually due to the presence of Lewy bodies in certain regions of the brain responsible for different cognitive abilities, causing neurons in these regions to degenerate. 

Certain risk factors contribute to the development of cognitive impairment in some people living with Parkinson’s disease:

  • Over 65 years old
  • Advanced stage of Parkinson’s disease
  • Family history of dementia
  • Depression
  • Restless dreams
  • Hallucinations

Chronic insomnia also causes problems with the articulation of thoughts. Deprivation of the deep phases of sleep does not allow the brain to rest and organize thoughts during waking phases. Sleep apnea, which you may not be aware of, can contribute to this phenomenon.

Cognitive impairments progress slowly over several months. Their sudden onset may be associated with taking new drugs (ex: anticholinergics for the treatment of prostate disorders, muscle relaxants, antihistamines) or with the development of other diseases (ex: major problems with the thyroid, liver, kidneys).

Forgetting information from time to time is normal with age and does not mean that you have cognitive impairments. When memory or decision-making issues affect your daily routine, these issues should be evaluated. Discuss it with your doctor or neurologist. Several tests are commonly used to screen for cognitive impairment. You might also meet with a neuropsychologist for a more in-depth assessment.

Your goal is to keep yourself active and independent. 

Physical activity increases the size of the areas of the brain responsible for memory (hippocampus) and thinking (cortex). Research has shown that active people have a lower risk of developing cognitive impairment or dementia.

Mental exercises are also important for maintaining cognitive abilities.

  • Do puzzles
  • Play cards
  • Do sudokus
  • Read books
  • Join a book club
  • Go to shows
  • Take up a new hobby

You can also, with the help of your neurologist, optimize your antiparkinsonian treatment in order to limit the episodes of slowing down of thought (bradyphrenia) that often accompany the off episodes.

Use visual cues  

By taking notes and posting them on calendars, on clocks, or on bulletin boards, you can help jog your memory. You can stick Post-Its on the walls of your home to help with your daily organization.

Develop a routine and be organized around that routine

By developing a clear daily routine and organizing your daily activities into that routine, you can stay more focused and reduce your stress levels.

To-do lists are great reminders and are very satisfying to use when checking off what you’ve accomplished that day.

Prioritize the things you have to do throughout the day and don’t try to do everything at once. You will be more efficient. By giving your full attention to the tasks that you consider important, you have a better chance of doing them well, feeling in control and reducing your stress.

Some drugs, such as rivastigmine (Exelon) and donepezil (Aricept), have a mild to moderate effect on cognitive impairment. However, they cause frequent side effects such as nausea, vomiting and stomach upset.

Be patient. Cognitive impairment can be very frustrating, both for you and for your loved one. 

These mild cognitive impairments, such as memory loss or slowness in formulating thoughts, do not affect your loved one’s identity or ability to think. They can become irritants and complicate your helping relationship.

By developing tricks together, you will strengthen your relationship and allow your loved one to stay active and independent for longer.

Encourage them to stay active physically, but also mentally. Play cards, do sudokus, discuss books you’ve read or the news of the day. All of this will help train their brain.

Cognitive impairment usually starts after the age of 65. The course of these impairments is variable (return to normal cognitive functioning, stabilization or degradation). Just because you have a cognitive impairment doesn’t mean you will develop dementia. However, it is an additional risk factor.

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