Changes to the way you think (cognitive impairment)

Definitions

• ‘Cognition’ is the term used for the complex processing of information carried out by our brains. It includes memory, emotion, planning, judgement and other skills.
• ‘Mild cognitive impairment’ is where there are mild changes in these processes but they are not severe enough to impact significantly on day-to-day life.’
• Dementia’ is the medical term given when cognitive impairment impacts on the ability to live life normally.

Thinking in Parkinson’s

Parkinson’s is one of the many causes of cognitive impairment and dementia. People who have had Parkinson’s for a long time can start to notice some changes in their ability to think and recall information and find that their ability to process information slows down. They might find it hard to come up with ways of solving problems, to plan ahead, respond quickly and recall memories.  Around 80% of people with Parkinson’s will notice some change to their thinking as time goes on.  A related, but less common condition (Lewy Body Disease) can cause these symptoms to appear much earlier.

Parkinson’s can be different from other causes of cognitive impairment.  Memory may be less of a problem than in Alzheimer’s disease.  There are certain features that are more common in Parkinson’s or Lewy Body disease:

• Apathy – a lack of interest, enthusiasm or concern
• Hallucinations (seeing, hearing or feeling something that is not there) – visual hallucinations are the most common of these
• Delusions (believing things that are not true)
• Erratic sleeping patterns

These can range from mild and un-concerning, to more troublesome or even frightening.  These problems can be caused by the condition itself.  They may however be a side effect of medications. Speaking to the GP or Parkinson’s specialist team about these symptoms is important as sometimes reducing or changing a medication may be enough to make them disappear.  Where these symptoms are felt to be due to the condition itself, consideration may be given to starting specific medications that can help with speed of thinking, recall of information and reduction in hallucinations.  Many of these medications are proven to be helpful, and are also used in other conditions (e.g. Alzheimer’s disease)

Not all memory and thinking problems in people with Parkinson’s are due to the Parkinson’s. Depression, infections and other medical problems can mimic dementia. This is more likely if there has been a sudden or dramatic change.  It is important to discuss with the GP or Parkinson’s team as it is important to rule out other factors.

Treatment plans are made on an individual basis and may include medication changes. Often input from other team members can be helpful, for example Occupational Therapy and Clinical Psychology.

Top Tips

When anyone is worried, tired or in a rush it is harder to think clearly. This is especially true in Parkinson’s.

• Allow plenty of time
• Try to avoid stressful situations
• Simplify information
• Concentrate on what is most important
• Try to do one thing at a time and not to multitask
• Use diaries, written reminders, alarms and noticeboards to help

When someone with Parkinson’s develops problems with thinking, reasoning and remembering, family or carers may wrongly think that the person is being lazy or obstinate. Understanding that these symptoms are part of Parkinson’s can make life easier for everyone.

If you are worried about your memory or that of a family member then speak to your GP or the specialist Parkinson’s Nurse. They can review medication and see whether that may be contributing, look for non-Parkinson’s causes of memory and thinking problems and if appropriate organise further tests.