by Jeffrey Wertheimer, Ph.D., ABPP-CN, our Chief Consultant and Chief of Neuropsychology Services at Cedars-Sinai Medical Center, LA, CA.
Cognitive changes can impact people’s everyday lives as much, and sometimes more than, the physical symptoms of PD. While discussing this topic with Margaret Tuchman, our next survey topic was developed. The Cognition and Parkinson’s Disease survey is now available at our DBS4PD.org website. The objective of this survey is to deepen our understanding about the perspective of individuals with PD pertaining to cognition and its relationship to day-to-day activities. Anyone diagnosed with Parkinson’s should take this survey by clicking here.
Cognition includes the ability to choose, understand, remember, and use information. More specifically, cognitive functions involve:
- Attention and concentration
- Speed of processing
- Processing and understanding information
- Initiating, planning, organizing, dual tasking, and sequencing
- Reasoning, problem-solving, decision-making, and judgment
- Controlling impulses and desires and being patient and calm
- Memory
- Communication (i.e., expression and comprehension)
- Visuospatial processing – (perception of the spatial relationships among objects within the field of vision; visual scanning)
Although cognitive difficulties in individuals with PD can vary in pattern, affecting to a greater or lesser extent different domains of cognition, a typical pattern for individuals with PD involves reduced processing speed, executive dysfunction (difficulties with initiation and managing complex information), difficulties with attention (i.e., working memory), memory, and complex visual scanning/visuospatial processing. Cognitive impairment in PD also varies in severity. Although cognitive impairment in PD exists on a continuum of severity, it is often divided into two categories (albeit an oversimplification): Mild cognitive impairment and PD dementia, based on the extent to which the impairment interferes with activities of daily living. Mild cognitive impairment refers to cognitive decline that does not significantly interfere with activities of daily living, social engagements, or occupational functioning. In contrast, “PD dementia” involves cognitive impairment in 2 or more cognitive domains that result in interference with daily function (separate from motor disturbance that interferes with independent performance in activities of daily living).
Cognitive difficulties may be present from the early stages of PD, and in most cases, cognitive difficulties get worse over time. While physicians are increasingly recognizing the importance of addressing cognitive and other non-motor symptoms, many still primarily focus on treating the motor symptoms of PD. Cognitive changes may go under-assessed and undertreated or even untreated, despite its high prevalence.
Cognitive changes in PD can be attributable to multiple causes. Indeed, PD itself can cause changes in cognitive processing. Importantly, however, cognition can be impacted by medication effects (dopaminergic medications related to “on” vs “off” states; non-PD medications), sleep disturbance/fatigue, psychological distress (i.e., depression and anxiety), and pain. It is very important that treatment providers understand how to address factors that impact cognition, and even prevent and directly treat cognitive difficulties. It is equally important that people with PD and their families understand what types of changes to look for in order to communicate concerns to their treatment providers. Cognitive difficulties can be addressed by an interdisciplinary treatment team, such as a neurologist, neuropsychologist, speech therapist, and occupational therapist. Increased awareness and treatment of cognitive difficulties can lead to improved quality of life for people with PD and their families.
In order to facilitate treatment, assessment of cognition is crucial. Mode of onset and the course of symptoms, the context within which they develop, as well as the presence of co-existing medical illnesses and possible medication effects that can contribute to cognitive difficulties should be assessed and guide the approach to intervention. As for intervention, a thoughtful approach tailored to the individual is indicated. In some cases, treatment may not be necessary. In others, behavioral intervention (i.e., scientifically proven approaches to cognitive rehabilitation; addressing psychological factors) may be the primary intervention, while in other scenarios, behavioral intervention coupled with pharmacological intervention (medication changes or medications intended to treat cognition) may be beneficial.
Again, anyone diagnosed with Parkinson’s should take our survey on cognition by clicking here. The information you provide will benefit individuals with PD and caregivers as well as treatment providers so that they can better help you. Please know that all information you provide will be kept strictly confidential.
