The Movement Disorder Specialist
Cognitive changes in Parkinson’s are common and can be frustrating. Focus on the ways that you can maximize your abilities. Here are some things to consider.
Talk with Your Doctor. Your doctor may order blood work to make sure that any reversible causes of cognitive decline can be discovered — such as low thyroid levels or low levels of Vitamin B12. He or she may order formal testing to assess your difficulties and may prescribe medications to ease symptoms.
Ensure Depression is Adequately Treated. Depression is a common symptom of Parkinson’s disease and needs to be addressed, at times with the use of a medication. Depression can sometimes masquerade as pseudodementia, a cognitive disability that improves along with improvement of mood.
Keep the Body and Mind Active. The brain stays nimble through novelty and activity of all forms — physical, mental and social. Try to make sure that varied activities fill all the days of the week. Move in whatever way you can as often as you can. Stimulate your mind by learning something new. Listen to music. Engage socially with others, in and out of the home.
Rebecca Gilbert, M.D., Ph.D., Clinical Associate Professor of Neurology, NYU Langone Medical Center, Parkinson’s and Movement Disorders Center, New York, NY.
Most people with PD experience some degree of cognitive change during the course of the disease. Common complaints include slowed thinking, memory problems, difficulty with attention and issues with executive dysfunction (e.g., problems with multitasking).
Identify and Treat Reversible Causes. Talk to your doctor about conditions (e.g., infections) and medications, including those for PD, that can cause or aggravate cognitive changes. Common offenders include anticholinergics, dopamine agonists, benzodiazepines and opiates.
Plan Ahead. Pace your activities and get adequate rest. Focus on one thing, topic or task at a time. Do more challenging cognitive activities during the times of the day when your PD symptoms are optimally controlled. Talk to family and friends about how to communicate in ways that reduce frustrations.
Play to Your Strengths. Focus on your abilities, rather than your impairments. This allows for successes and helps maintain a positive attitude. Treating depression and anxiety with medications and/or behavioral therapies helps keep a positive attitude, and can reduce cognitive change associated with mood.
Laura Marsh, M.D., Executive Director, Mental Health Care Line, Veterans Affairs Medical Center & Professor of Psychiatry, Baylor College of Medicine, Houston, TX.
The Care Partner
We often think of PD as a disease of subtraction. It can also be one of addition. Even with loss of cognitive abilities, there are ways for you and your partner to add to life with PD.
Take Care of the Care Partner. Cognitive changes can be an added stressor on a relationship. Care partners, it is essential for you to stay healthy. Find a care partner support group or start one. Arrange for an alternate care partner to relieve you one hour a day or during an emergency. Ensure that this person has all PD medical information. The break will relieve stress and enable you to spend more time enjoying each other’s company.
Keep Your Partner Involved. Care partners may feel that the responsibility for household tasks rests on their shoulders, but there are still many things the person with PD can accomplish. Ensure the partner with PD still participates in activities, such as folding towels, sorting photos or drying dishes. Encourage their involvement in exercise, crafts, audiobooks, walking and swimming. Even better? Find something you can do together.
Stay Compassionate. Laugh Together. Compassion and humor will carry the day. None of us chooses PD. Keep calm and ask ‘how would I want to be treated if the situation were reversed?’ Find the humor in everyday life. Chuckle with the ups and downs that PD brings. If all else fails, put on some music and dance or sing.
Elaine Casavant, R.N., member, PDF People with Parkinson’s Advisory Council, care partner, Lansing, MI.