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:

1. 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.
2. 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.
3. 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.

1. 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.
2. 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.

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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