Dementia and cognitive change
Cognition or cognitive function is a term used to describe the thought processes of your brain.
Cognition includes judgement, reasoning, problem-solving and memory. It is thought that the majority of people with Parkinson’s experience some changes to their cognition. This is known as cognitive impairment. In people living with Parkinson’s the level of cognitive impairment is mild in most cases.
The cognitive changes experienced by people with Parkinson’s vary from person to person. Possible cognitive symptoms linked with early stage Parkinson’s include:
- Difficulty multi-tasking
- Difficulty concentrating and becoming easily distracted
- Difficulty learning new skills
- Difficulty remembering certain things
As Parkinson’s progresses these symptoms can worsen and new symptoms might appear. Possible impairments later in the course of the condition might include:
- Difficulty with problem-solving
- Deteriorating short term memory
- Difficulty finding the right words during conversation
- Problems with making decisions
- Difficulty perceiving potential dangers
- Difficulty judging distances and directions
Mild cognitive impairment
Mild cognitive impairment refers to a decline in memory and thought processes that is not as severe as dementia. It normally involves many of the symptoms outlined above, although their impact on daily life is not as profound.
Advise your GP or specialist if you have noticed changes in cognition, even if the symptoms are only mild.
Although cognitive impairment is common in people with Parkinson’s, comparatively few people develop dementia. Dementia refers to a decline in intellectual functioning severe enough to interfere with participation in daily social and physical activities.
Generally, dementia is more likely to occur in the later stages of Parkinson’s.
Typically, dementia does not respond to normal Parkinson’s medications. If you have noticed significant cognitive change you should inform your GP or specialist.
Parkinson’s and Lewy Body Disease
Lewy body disease occurs when there is an abnormal build up of a protein called alphasynuclein in the brain. Depending on where the proteins accumulate, Lewy body disease can lead to impairments in movement, thinking and behaviour.
Lewy body disease includes three overlapping disorders:
- Dementia with Lewy bodies
- Parkinson’s disease dementia
This overlap results in the disease being called a spectrum disease.
In people with Parkinson’s a large number of Lewy bodies appear in an area of the brain known as the substantia nigra. This area of the brain is responsible for movement, so the Lewy bodies are likely to cause impairments in movement.
Some people may go on to develop dementia with Lewy bodies. In this form of the disease, the clumps of protein occur in the cortex (outer layer of the brain). This part of the brain is responsible for many cognitive processes, so the Lewy bodies are likely to result in cognitive impairments like those described under the symptoms heading above. It can result in symptoms similar to those seen in Alzheimer’s.
Dealing with cognitive impairments
In some circumstances medications can help to lessen cognitive symptoms. You should speak to your GP or specialist about the options available. There are also various other health professionals who can provide professional support for dealing with cognitive impairments.
Cognitive impairment can be a big challenge for family, friends and carers, as well as those with the symptoms. Some practical tips for dealing with the daily challenges of cognitive impairments include:
- Keep to a daily routine
- Try to use familiar objects and phrases
- Avoid unfamiliar environments
Preventing and delaying cognitive change
To overcome the cognitive changes linked to Parkinson’s, it is recommended that you keep as active and stimulated as possible - physically, mentally and socially. It is important to stimulate all the different parts of the brain. Some useful tips include:
- Undertake regular exercise (daily if possible)
- Complete simple arithmetic and crosswords
- Listen to and play music
- Participate in a social group
- Do volunteer work
- Maintain paid employment if possible
- Learn new skills
Advance Care Planning
If cognitive impairments begin to emerge, early advance care planning is a very important consideration. Contact the Parkinson's Victoria Health Team on 1800 644 189 for more information.