Tuesday, November 29, 2022

Cognition And Parkinson’s Disease

Cognition Caring And Coping

Ask the MD: Cognitive Impairment and Parkinson’s Disease

This 1-hour virtual panel begins with a series of short presentations on cognitive changes in people with Parkinsons by four speakers with different experiences in this topic: a registered nurse, a social worker, and a person with Parkinsons with his caregiver husband. Following the presentations, the discussion and question and answer period was focused on the role of PD caregivers when a person with PD is experiencing cognitive changes.

Other Possible Contributors To Cognitive Decline In Parkinsons

Hearing is not the only modifiable contributor to cognitive decline. Consider reviewing this list with your doctor to make sure that you do not need to be evaluated for any of these conditions:

Tips and Takeaways

  • Although cognitive decline can be a feature of PD itself, there may be other medical issues that are contributing. Being evaluated for these issues is crucial as modifying them can have a positive impact on cognition and your quality of life.
  • Therefore its very important that you tell your doctor about any changes you notice in your cognitive function so potential corrective action can be taken as early as possible.
  • Hearing loss can be a treatable contributor to cognitive decline. If hearing loss is suspected, consider asking your doctor for a referral for an audiogram. Hearing aids will likely improve your well-being and may improve cognitive decline as well.
  • There are many other treatable contributors to cognitive decline including: medication effects, infection, thyroid abnormalities, low Vitamin B12 levels, strokes, head trauma, orthostatic hypotension, and sleep apnea.

Cognitive Domains And Neurotransmitters

Detailed mechanisms underlying the cognitive impairment in PD are not fully understood. However, it has been well established that PD patients have early cholinergic degeneration in the basal forebrain, which provides cholinergic innervations to the entire neocortex . In addition, the abnormalities in the prefrontal dopaminergic system and other neurotransmitter systems play a role . Pathology in brain regions associated with cognitive functions include Lewy bodies, Lewy neurites, coexistent Alzheimers pathology , and ischemic changes affecting the microvasculature .

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How Can Speech Therapy Help With Thinking Changes In Parkinson’s

Darla Freeman, SLPD, took about 20 minutes to explain that speech pathologists can help with speech enunciation and voice volume, and also with cognitive problems, memory, word finding, the ability to think of what you want to say, and drooling. She provided some tips for each of those challenges and talked abouthow speech therapy is conducted before answering listener questions for the rest of the hour.

Parkinsons Diseasemild Cognitive Impairment : A Useful Summary Of Update Knowledge

Cognitive Decline Greater In Male Parkinson
  • 1Laboratories of Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
  • 2School of Medicine, University of Pisa, Pisa, Italy
  • 3Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

Mild cognitive impairment is a common feature in Parkinsons Disease , even at the time of diagnosis. Some levels of heterogeneity in nature and severity of cognitive impairment and risk of conversion to Parkinsons Disease Dementia exist. This brief overview summarized the current understanding of MCI in PD, by considering the following major points: historical development of the clinical entity, evaluation, epidemiology, predictors and outcomes, neuroimaging findings, pathophysiology, treatment, and pharmacological and non-pharmacological intervention. MCI in PD represents a concept in evolution and plays a pivotal role in advancing our understanding of the disease mechanisms, with the ultimate goal of building effective strategies to prevent conversion into PDD. Challenges for future research are also discussed.

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Attention Difficulties In Parkinsons

Attention involves filtering information, and people with PD who experience attention difficulties have trouble maintaining focus, especially as the complexity of a situation increases. Attention difficulties can affect both intellectual pursuits and everyday activities, such as walking and holding a conversation at the same time.1,3

What Causes Parkinson Disease

Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.

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Cognitive Changes Are Common In Parkinsons

Cognitive difficulties are a common non-motor symptom in Parkinsons disease and can affect many facets of everyday life. Executive function, or the ability to plan and organize multi-step activities can specifically be affected in PD. Visuo-spatial skills, which allow a person to navigate in three dimensions, estimating distances and maneuvering around obstacles, can also be impacted. In addition, memory, attention, and language can be impaired as well. Although there are medications that can be prescribed, the cognitive benefits of these medications in clinical research studies have been modest.

Cognitive rehabilitation is a collection of different types of therapies that aim to improve cognition. An occupational therapist typically performs this type of rehabilitation.

Other Reasons For Cognitive Symptoms

Dr. Gilbert Hosts: Cognition & Parkinson’s disease with Kathleen Poston, MD | APDA

Besides PD, there are other important causes of cognitive dysfunction to keep in mind. Medical illnesses such as thyroid disease or vitamin B12 deficiency can cause cognitive symptoms. Urinary tract infections or pneumonia can acutely cause confusion or hallucinations. In these settings, the cognitive symptoms are generally reversible after the infection or medical condition is treated. One should be aware that some medications for pain or bladder problems may cause sedation/sleepiness or confusion, and, thereby, impair cognitive function.

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Degeneration Of Neurotransmitter Systems

More widespread dopaminergic deficits in the brain

By definition, all patients with PD have a moderate-to-severe loss of dopaminergic neurons in the nigrostriatal projection pathway. More widespread degeneration of dopaminergic terminals in the striatum particularly denervation of dopaminergic terminals in the associative dorsal caudate nucleus occurs in those with PD-MCI than in those with PD without cognitive impairment . However, in patients with PD-MCI, there is relative preservation of other dopaminergic systems in the brain, whilst those with PDD have a considerable loss of the lateral dopaminergic system to frontal, parietal and temporal cortical regions . In healthy individuals, cortical dopamine modulation can boost working memory as well as visuospatial and attentional processing, and promotes cognitive effort,, suggesting a key role for dopamine in cognitive function.

Fig. 2: Neurotransmitter deficits associated with cognitive decline in PD and DLB.

Other pathology

Cognitive Changes In Pd

Cognitive symptoms in Parkinsons disease are common, though not every person experiences them. In some people with PD, the cognitive changes are mild. In others, however, cognitive deficits may become more severe and impact daily functioning. Similar to slowness of movement , people with Parkinsons disease often report slower thinking and information processing . Attention and working memory, executive function, and visuospatial function are the most frequently affected cognitive domains in PD.

Cognitive deficits that are mild and do not impair ones ability to carry out activities of daily living have been termed mild cognitive impairment. Studies estimate that mild cognitive impairment occurs in about 20-50% of patients with PD. We now recognize that mild cognitive changes may be present at the time of Parkinsons disease diagnosis or even early in the course of PD. They may or may not be noticeable to the person. They may or may not affect work or activities, depending on the demands of specific tasks and work situations.

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Brain Boost: A Conversation On Thinking

In this 1-hour webinar a panel of experts and a person with Lewy Body Dementia answered moderator questions about cognitive changes typical in those with Parkinson’s Disease and Lewy Body Dementia . They discussed what’s normal and what’s not, the impact cognitive changes have on everyday life, what you can do to preserve brain health, strategies for both the person with PD and care partners to cope with cognitive changes, and what researchers know about predicting who is likely to suffer significant cognitive change with PD.

Psychiatric & Cognitive Complications In Parkinsons

Cognition &  Parkinsonâs Disease: The Patientâs Perspective

Depression, anxiety, cognitive decline, psychosis and impulse control can be common in people with Parkinsons. They affect quality of life for both people with Parkinsons and care partners. In this webinar Dr Daniel Weintraub discusses these issues, the correlation between mood, motor function and Levodopa levels, and more. Registration is required, but it is free.

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Managing Cognitive Impairments In Parkinsons

After a thorough evaluation to rule out other causes of cognitive impairment, patients with PD may be treated with medication, occupational therapy, and/or speech therapy. The medications used to treat cognitive impairments in people with PD are based on treatments used for Alzheimers disease. Occupational therapy can help a person with PD by providing adaptive strategies for daily activities. Speech therapy can help with language functions, as well as information processing. 3,4

Cognitive Problems And Parkinsons

Many people with Parkinsons experience some mild memory loss and thinking problems. Symptoms vary widely and may fluctuate through the day. Research has shown that cognitive problems tend to be more severe in people with Parkinsons with more pronounced bradykinesia and rigidity, and less severe in those with more pronounced tremor.

If you are experiencing changes in your thinking and mental abilities, its natural to be concerned. You may worry you could go on to develop dementia however, this happens to comparatively few people. One study found that after ten years with Parkinsons, 80% of people with the condition experienced some cognitive difficulties, but less than 20% had developed dementia – known as Parkinsons disease dementia . The symptoms of PDD are very different from those of Alzheimers disease.

Some Parkinsons symptoms can make speech and facial communication difficult, and slowed thinking will often make things even harder. As the ability to remember words is affected, your vocabulary can become limited and humour may be less understood. It can also get harder to follow conversations, and this can result in you not making sense, or forgetting what you have said and repeating things.

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Memory Difficulties In Parkinsons

The most common difficulty for people with PD is remembering information that has previously been learned. Memory has several different processes and types, and people with PD have trouble recalling information but their long-term memory function generally remains intact. Memory cues or choices can help people with PD to retrieve information from the brains long-term storage.3,4

Dealing With Cognitive Impairments

Everything Parkinson’s: Cognitive Symptoms in Parkinson’s Disease

In some circumstances medications can help to lessen cognitive symptoms. You should speak to your GP or specialist about the options available. There are also various other health professionals who can provide professional support for dealing with cognitive impairments.

Cognitive impairment can be a big challenge for family, friends and carers, as well as those with the symptoms. Some practical tips for dealing with the daily challenges of cognitive impairments include:

  • Keep to a daily routine
  • Try to use familiar objects and phrases
  • Avoid unfamiliar environments

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Dementia And Parkinson’s Disease

In this 2-hour webinar geriatrician Naaz Parmar provides an understanding of dementia as a disease, the different subtypes of dementia, and how they affect a person with concurrent PD. This webinar also gives an overview of treatment options with lifestyle changes and medications. Coping strategies for a person with dementia and their loved ones, will also be discussed.

Living With Parkinson Disease

These measures can help you live well with Parkinson disease:

  • An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
  • High protein meals can benefit your brain chemistry
  • Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
  • If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.

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Cognition And Mood And How To Manage Them

In this 50-minute webinar Greg Pontone, MD, distinguishes the cognitive changes commonly seen in those with dementia from the cognitive changes seen in Parkinson’s disease . He shares medications used to treat dementia and highlights those that are more effective for the cognitive changes in Parkinson’s. Dr. Pontone also talks about depression and anxiety specifically, the impact depression has on quality of life, and meditations to treat it, and how increased feelings of anxiety can be directly related to the wearing-off of medications.

Causes Of Cognitive Impairment In Parkinsons Disease

Neuropsychological and clinical heterogeneity of cognitive impairment ...

One cause of cognitive changes in patients with Parkinsons disease is a drop in the level of dopamine, the neurotransmitter that is involved in regulating movement as well as cognition, memory and learning, attention, and sleep. However, the cognitive changes associated with dopamine declines are typically mild and circumscribed.

Other brain changes also are likely involved in cognitive decline in Parkinsons disease. Researchers believe that changes in two other chemical messengers, acetylcholine and norepinephrine, could be linked to memory and executive function loss in Parkinsons disease.

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Cognition Deficits In Parkinson’s Disease

Cognitive dysfunction is one of the major clinical nonmotor symptoms of PD with insidious onset, including mild cognitive impairment and dementia, especially for executive dysfunction with coexisting other cognitive domains impairment such as speech dysfunction, visual spatial ability, and memory impairment. Cognitive dysfunction is increasingly found prevalent in PD individuals and even in clinical newly diagnosed PD patients . Emerging epidemiologic study indicates that the cumulative prevalence of Parkinson’s disease dementia in 8 years is as high as 78.2% . Roughly 40% of PD subjects at an earlier stage have co-existing mild cognitive impairment, boosting the risk of converting to PDD . Cognitive deficits in PD has certain heterogeneity as described in Kehagia’s proposed dual syndrome hypothesis . PD with cognitive impairment can be divided into two broad categories: one is given priority to planning, working memory, and executive dysfunction that is related to the frontal lobe-striatum loop coupled with decreased dopamine levels and the other is disturbances of attention, semantic verbal fluency, and visual spatial ability with involvement of not only the temporal lobe but the posterior cortical dysfunction.

Parkinsons And Lewy Body Disease

Lewy body disease occurs when there is an abnormal build-up of a protein called alphasynuclein in the brain. Depending on where the proteins accumulate, Lewy body disease can lead to impairments in movement, thinking and behaviour.

Lewy body disease includes three overlapping disorders:

  • Dementia with Lewy bodies
  • Parkinsons disease dementia

This overlap results in the disease being called a spectrum disease.

In people with Parkinsons a large number of Lewy bodies appear in an area of the brain known as the substantia nigra. This area of the brain is responsible for movement, so the Lewy bodies are likely to cause impairments in movement.

Some people may go on to develop dementia with Lewy bodies. In this form of the disease, the clumps of protein occur in the cortex . This part of the brain is responsible for many cognitive processes, so the Lewy bodies are likely to result in cognitive impairments like those described under the heading above. It can result in symptoms similar to those seen in Alzheimers.

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Understanding Thinking Changes In Parkinson’s Disease

In this 1-hour webinar listeners will learn key features of cognitive impairment in Parkinsons disease, including what symptoms may occur and why they may develop. Strategies for dealing with cognitive changes will be discussed, along with medications and potential research interventions in the field. An interdisciplinary approach regarding cognitive impairment in Parkinsons disease will be highlighted with the role of the movement disorders neurologist on the team.

Prodromal Pd Phenotypes And Conversion

Cognitive & Psychiatric Disorders in Parkinson’s Disease – Andrew Ridder, MD

Recent evidence suggests that individuals with prodromal features of PD, such as hyposmia , REM sleep behaviour disorder and reduced dopamine transporter binding, may present with worse cognitive performance compared with people without any or with only one of these features,,. Interestingly, prodromal PD and DLB may overlap and it is not yet known how to distinguish between those who will develop PD versus those who will develop DLB. Of note, cognitive deficit has been recently defined as a new prodromal marker and has been included in the last update of the research criteria for prodromal PD.

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Cognition: A Mind Guide To Parkinsons Disease

There are many aspects of cognition: thinking, understanding, learning, remembering, problem solving, language and more. This guide explains what affects your thinking and what cognitive changes can happen in Parkinsons disease. It includes coping tips for both people with Parkinsons and care partners and stories that show strategies others use to manage their thinking changes.

For more insights on this topic, listen to our podcast episode Neuropsychological Evaluations for PD.

Pharmacologic Management Of Pd

To date, it is surprisingly slow in the advancement of therapeutic interventions specifically developed for PD-MCI. Not only that, but existing pharmacological and nonpharmacological measures have been identified to be typically marginal and nonsustained coupled with potential adverse effects.

As mentioned earlier, the pathogenesis of PD-MCI may involve the changes of cholinergic neurotransmitter, which may provide a theoretical basis for its pharmaceutical therapy. There is ample evidence that the disturbed cholinergic system may be the important cause of cognitive decline in patients with PD. Donepezil is the second acetyl cholinesterase inhibitor developed for improving cognitive function of PD patients, which has been approved by the FDA. It can selectively inhibit the degradation of acetylcholine in the central nervous system and effectively increase the concentration of acetylcholine in the synaptic cleft of nerve cells and delay progressive cognition impairment of PD patients with less adverse reaction and more obvious clinical safety and good tolerance. One clinical research trial has reported that cholinesterase inhibitors can benefit PD patients with cognitive impairment by significantly slowing the loss of Mini-Mental State Examination score, but the treatment with memantine does not work, both of which can improve the overall clinical symptoms of PD patients .

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