Written for Parkinson's Disease but helps further explains
cognitive changes which are also applicable to Huntington's Disease
Cognitive Changes in Parkinson's-Margery H. Silver, Ed.D.
With Parkinson's, change may be seen in a number of cognitive functions.
I will discuss these briefly, describing how they affect behavior. Then I will present some cognitive strategies that can
help individuals manage or circumvent these changes.
Cognitive changes in PD:
- Bradyphrenia.
This means slow thinking, just as bradykinesia means slow movement. This is why people with Parkinsons often need
extra time to answer questions or make decisions. They can usually think things out; it just takes more time.
- Attention and concentration. Attention is often affected by reduced metabolism in the frontal areas of the brain, which are not receiving enough
dopamine. This affects the ability to concentrate and to ignore distractions. Often what seem like memory problems are really
attention problems. If someone's attention is not focused, he or she is not going to remember.
- Executive functions. This refers to a group of thinking abilities that "oversee" many activities of the brain. It has been said that impairment
of executive functions "knocks on the door of personality." For example, if a brilliant successful businessman sits around
the house because he is unable to plan his day, it does seem like a personality change. If we don't understand the role of
Parkinson's, we might think he is being unmotivated and stubborn.
Executive functions include the abilities to initiate a task or activity
on one's own, to plan (for instance, what you will do during the day), to organize tasks and materials, to sequence (arrange
items or things to do in order), to prioritize, to shift between activities and conversational subjects, and to inhibit (stop
or refrain) an action.
- Memory.
In Parkinson's disease, it is usually the retrieval of information that is impaired. Unlike Alzheimer's patients who cannot
store things in memory, people with Parkinsons can get memories into storage (if they've paid attention), but they have difficulty
recalling them. If they are given hints or multiple choices, they can usually remember accurately.
Visual-spatial abilities. This term refers not to vision per se, but to how the brain interprets a visual image. People with Parkinsons may
have difficulty judging distances and relationships between objects. This can interfere with reading maps, judging where the
lines are when driving, or assembling things.
Cognitive strategies can be very effective for circumventing or managing
the cognitive changes in Parkinson's. Here are some suggestions that can help.
1. Bradyphrenia. Speak more slowly and repeat if necessary
to compensate for slower mental processing.
2. Attention and concentration. Be sure that the person's attention
is engaged before starting a discussion or giving information. (You can't recall what you haven't really heard.) Talk yourself
through a task to keep your attention focused.
3. Executive functions. Since planning and prioritizing are
difficult, talk things over together and write down a plan with steps in order. Since getting started is hard, cueing may
help; for example, "Let's start by brushing your teeth." Use reminding devices like alarm clocks or alarm watches to help
get started (and help memory). To help a person with Parkinsons switch mentally to a new topic or task, announce clearly that
you are now going to talk about (or do) something new.
4. Memory. Remind frequently of things to be done. Write lists
and put them in a prominent place. Always put items, like car keys in the same place so you do not have to recall where they
are. An excellent book filled with memory strategies is Managing Your Memory from National Rehabilitation Services.
5. Visual-spatial problems. Use verbal cueing-- that is, warn
in advance of a curb or a turn when a person with Parkinsons is walking. Always give the person with Parkinsons verbal directions,
not a map, to compensate for visual-spatial problems.
These strategies can be very helpful, but understanding is still the
most important ingredient. Understanding why my husband does certain things, and that those behaviors are related to PD, has
helped both my husband and me. It is easier for him when he understands that what's happening is caused by the disease, and
it gives us the basis for sitting down together and trying to figure out our own strategies for dealing with these problems--as
partners.
Dr. Silver is a neuropsychologist and Clinical Instructor in the Department
of Psychiatry at Harvard University Medical School. She is co-author of Living
to 100: Lessons in Living to your Maximum Potential at Any Age and Co-Editor of the Journal of Geriatric Psychiatry.
She lives in Boston with her husband who has Parkinsons disease.
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