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Dr. Caitlin Bender

December: Cognition


Written by: Dr. Caitlin A. Bender, OTD, OTR/L


Dopamine’s Role

It is now recognized that Parkinson’s Disease is defined by more than its motor symptoms. Parkinson’s Disease also represents a spectrum of diverse nonmotor symptoms, including cognitive dysfunction.  Dopamine, the key neurotransmitter affected by Parkinson’s Disease, plays a role in processes throughout the brain that can boost working memory as well visuospatial and attention processing, suggesting that dopamine plays a key role in overall cognitive function. However, the mechanisms underlying cognitive changes in Parkinson’s are complex and remain unclear. Recent studies believe that not only neurochemical changes in the dopaminergic systems, but also neuropathological components such as cortical Lewy bodies, mitochondrial dysfunction, neurotrophic factors, inflammation, and more, may play a role in cognitive decline with Parkinson’s Disease. These changes can occur at even the early stages of PD and may significantly impact overall quality of life, however understanding how cognitive dysfunction impacts daily life, and implementing strategies for managing these changes can help to maintain independence and boost your overall well-being. 


Daily Impact

  • Attentiondifficulty with completing complicated tasks, difficulty with multitasking, difficulty shifting attention, difficulties concentrating.

  • Speed of Mental Processing: thinking may be slower, delayed verbal responses, increased length of time to complete tasks, difficulty retrieving information from memory.

  • Executive Functioning: trouble planning activities, difficulty completing activities, difficulties grasping and forming different ideas and concepts, less mental flexibility, difficulties with problem solving.

  •  Memory Issues: difficulty with common tasks such as keeping a morning routine, making breakfast, keeping finances, difficulties recalling both short and long term memories. These more advanced memory issues are associated with the development of dementia and severe cognitive changes.

  • Language Changes: difficulties with word finding, difficulties with speaking when under high levels of stress, difficulty comprehending sentences or conversations, slurred speech, difficulties with naming objects or people (more common with dementia or severe cognitive changes).  

  • Visuospatial Difficulties: decreased depth perception, difficulties seeing in low light such as at night, as well as 

    • Early PD: difficulty with measuring distance and depth perception. This may interfere with parking a car or walking up and down stairs. 

    • Advanced PD: difficulty processing details and information about the environment and surroundings.

 

Strategies for managing cognitive function

  • Exercise: Exercise plus mental activity appears to increase blood flow and drive production of cerebral growth factors, such as BDNF, a neurotrophic factor which is found in locations such as the hippocampus. BDNF plays an important role in long- term memory, learning and higher thinking. Neurotrophins help to stimulate and control neurogenesis or the creation of new neurons during adult life. Such cerebral growth factors have also been shown to slow cognitive decline with age. Exercise that is cognitively complex has been demonstrated to be more beneficial than equivalent movement of a repetitive and unchallenging nature. The cognitive element of exercise appears to enhance memory by way of regular priming of decision making during new learning. It has also been suggested that exercise appears to improve the speed of learning, by priming more efficient encoding.

  • Adapting the Environment 

    • Put essential information/dates on a white board keep all keys, wallets, or glasses in the same place 

    • Attach all important items to the person (glasses on a neck cord, wallet/phone on a belt clip) 

    • Labeling cabinets with what is inside 

    • Labeling perishable foods with expiration dates 

    • Labeling doors to various rooms 

  • Using External Memory Aids for Important Information

    • Large and visible calendars

    • Diaries or datebooks

    • Lists

    • Alarm clocks

    • Pill reminder boxes

    • Wall charts

    • Sticky notes

  • Following a Set Routine

    • Utilize the same basic schedule for every week. Decide what days and times certain tasks such as grocery shopping, religious functions, fun outings, social outings, exercise classes, etc. will occur. Once this basic schedule has been decided, print it out and post it in the home for you and others  to reference. 

    • Keeping morning and evening routines the same every day is also a useful tool.

  • Take Small Steps

    • Break tasks down into smaller steps. Allowing yourself  to focus on just one step at a time allows for greater focus and independence.


References


Aarsland, D., Batzu, L., Halliday, G.M. et al. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers 7, 47 (2021). https://doi.org/10.1038/s41572-021-00280-3


Aragon, A., & Kings, J. (2010). Occupational Therapy for People with Parkinson’s Disease: Best Practice Guidelines.


Fang C, Lv L, Mao S, Dong H, Liu B. Cognition Deficits in Parkinson's Disease: Mechanisms and Treatment. Parkinsons Dis. (2020) doi: 10.1155/2020/2076942. 


Parkinson’s Foundation. (n.d.) Cognitive changes. Parkinson’s Foundation. https://www.parkinson.org/understanding-parkinsons/nonmovement-symptoms/cognitive

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