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Memory and Parkinson’s Disease — Part 1

Why Memory Feels Different with PD


Written by: Kristi Riker, OTD, OTR/L


If you live with Parkinson’s disease (PD), you may notice changes in how your brain processes information. Many people describe experiences such as:


  • “I know it, but I can’t recall it quickly.”

  • “I lost my train of thought.”

  • “My brain just feels slow.”


These changes can be frustrating and concerning—but they are also very common in Parkinson’s. Importantly, they do not always mean true memory loss.


How Memory Problems Show Up in Parkinson’s


The three most common memory-related challenges in PD include :

  • Bradyphrenia (slowed thinking)

  • Working memory difficulties

  • Problems retrieving information


 Bradyphrenia (Slowed Thinking)


Bradyphrenia is not memory loss. Instead, it slows access to information that is already stored in the brain. This can look like:

  • Taking longer to recall information

  • Needing extra time to make decisions

  • Slower critical thinking or mental math

  • Increased mental fatigueYour brain still has the information—it just needs more time to get there.


Attention and Working Memory Problems


Working memory is your brain’s “mental sticky note.” It allows you to hold information briefly while using it—such as reading a recipe and then adding the correct amount of seasoning.


Working memory challenges may cause difficulty with:

  • Following multi-step directions

  • Keeping track of conversations

  • Multitasking

  • Remembering why you walked into a room

  • Staying focused after interruptions

Stress and distractions can shut down working memory very quickly in PD.


Difficulty Retrieving Information


Parkinson’s often affects dopamine pathways involved in pulling information out of storage, rather than storing it in the first place. This may result in:

  • “Tip-of-the-tongue” moments

  • Difficulty naming people or objects quickly

  • Needing cues to remember

  • Remembering better later, once relaxed


 Why Do These Memory Changes Happen?


Several neurological changes contribute to memory challenges in Parkinson’s:

  • Neurotransmitter Imbalance: Parkinson’s affects acetylcholine, a key chemical for memory and cognition, disrupting brain communication (Zhang, 2021).

  • Lewy Bodies: Misfolded alpha-synuclein proteins form Lewy bodies, damaging brain cells involved in thinking and memory (Stefanis, 2012).

  • Brain Circuit Disruption: Damage to the frontostriatal system impairs attention and the ability to filter distractions (de la Fuente-Fernández, 2011).

  • Cortical and Subcortical Changes: Neuron loss in cholinergic cells, the basal ganglia, and frontal lobes contributes to cognitive decline (Mack, 2017).


What Can Make Memory Worse?

Memory difficulties often increase during:

  • Medication “off” periods

  • Stress or anxiety

  • Poor sleep (especially REM sleep loss)

  • Fatigue

  • Over stimulation

  • Illness or dehydration

  • Certain medications (BMJ, 2018)


Parkinson’s and Dementia


Over time, Lewy bodies may spread to brain areas responsible for cognition, leading to Parkinson’s disease dementia (PDD). PDD is closely related to Lewy body dementia (LBD)—the key difference is timing.

  • Lewy Body Dementia (LBD): Cognitive symptoms appear before or within one year of motor symptoms.

  • Parkinson’s Disease Dementia (PDD): Motor symptoms are present for more than one year—often many years—before dementia develops.


Not everyone with Parkinson’s will develop dementia, and many memory challenges are manageable with the right strategies.

As we close out part one, it is important to remind yourself that memory changes in Parkinson’s can feel unsettling, frustrating, and at times even frightening. But it’s important to understand that many cognitive challenges in PD are related to slowed processing and retrieval—not the loss of who you are or what you know. Your brain is still working; it simply needs more time, the right environment, and the right support.


The encouraging news is that memory and thinking are not passive processes. The brain remains adaptable, and there are effective strategies that can reduce frustration, improve daily function, and restore confidence. In Part 2, we will focus on practical, research-backed tools—from simple environmental changes to targeted exercises—that help support memory, improve attention, and strengthen thinking skills in everyday life. Keep up the incredible FIGHT!



Resources:



BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1315 Anticholinergic drugs and risk of dementia: case-control study (Published 25 April 2018)


De la Fuente-Fernández R. Frontostriatal cognitive staging in Parkinson's disease. Parkinsons Dis. 2012;2012:561046. doi: 10.1155/2012/561046. Epub 2011 Dec 6. PMID: 22191070; PMCID: PMC3236592.


Mack J, Marsh L. Parkinson's Disease: Cognitive Impairment. Focus (Am Psychiatr Publ). 2017 Jan;15(1):42-54. doi: 10.1176/appi.focus.20160043. Epub 2017 Jan 11. PMID: 31975839; PMCID: PMC6519621.


Stefanis L. α-Synuclein in Parkinson's disease. Cold Spring Harb Perspect Med. 2012 Feb;2(2):a009399. doi: 10.1101/cshperspect.a009399. PMID: 22355802; PMCID: PMC3281589.


Yan-Feng Zhang, Stephanie J. Cragg, Revisiting dopamine-acetylcholine imbalance in Parkinson’s disease: Glutamate co-transmission as an exciting partner in crime, Neuron, Volume 109, Issue 7, 2021, Pages 1070-1071, ISSN 0896-6273


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