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Does Parkinson’s Affect Memory

When People Talk About Parkinsons They May Mention The Effects It Has On The Substantia Nigra But Did You Know That There Are Other Areas Of The Brain That Are Affected By The Condition

Parkinsons is a condition that causes the gradual loss of the dopamine-producing brain cells of the substantia nigra an area of the brain located just above where the spinal cord meets the midbrain. It is these cells that produce and release the neurotransmitter dopamine, which has a key role in turning thought about movement into action.

While this definition of the condition is useful to briefly explain Parkinsons, the whole story is somewhat more complex. Over the last 30 years, it has become accepted that Parkinsons also causes a number of non-motor symptoms, such as changes in sleep, smell and even the way we think, which likely involve other areas of the brain.

Now scientists are looking at the broader effects of the condition on the brain in an attempt to better understand why people experience different symptoms. The finding could lead us to new treatments that tackle more than just the motor symptoms of the condition.

What Is Alzheimer’s Disease

Alzheimer’s disease , the most common form of dementia among older adults, is an irreversible degeneration of the brain that causes disruptions in memory, cognition, personality, and other functions that eventually lead to death from complete brain failure. Genetic and environmental factors including diet, activity, smoking, traumatic brain injury, diabetes, and other medical diseases contribute to the risk of developing this form of the disease. The hallmarks of Alzheimer’s disease are the accumulation of beta-amyloid plaques between nerve cells in the brain and neurofibrillary tangles, which are twisted fibers found inside the brain’s cells). These tangles consist primarily of a protein called tau.

Causes And Risk Factors

PD is idiopathic, meaning that a doctor does not know why a person has the condition. However, according to Johns Hopkins Medicine, early-onset Parkinsons disease has links to genetic inheritance from a parent.

Researchers have identified several risk factors that may make a person with Parkinsons disease more likely to experience dementia.

These risk factors include:

  • advanced age at time of diagnosis
  • experiencing excessive daytime sleepiness
  • hallucinations before the onset of other dementia symptoms
  • having a specific Parkinsons symptom that causes a person to have difficulty starting to take a step or to halt mid-step while walking
  • a history of mild thought impairment
  • more severe movement impairment symptoms than most people with Parkinsons disease

However, researchers do not know why some people with Parkinsons disease develop cognitive difficulties as well as movement problems.

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.

What Are The Complications Of Parkinson Disease

How Parkinson

Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.

Parkinson disease dementia can cause problems with:

  • Speaking and communicating with others
  • Problem solving
  • Forgetfulness
  • Paying attention

If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.

Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.

How Parkinsons Disease Affects The Body

Life with Parkinsons is challenging, to say the least. This progressive disease starts slowly, and because theres currently no cure, it gradually worsens how you think and feel.

Giving up may seem like the only solution, but it certainly isnt. Thanks to advanced treatments, many people are able to continue living healthy, productive lives with Parkinsons.

Take a glance at this infographic to get a visual picture of how Parkinsons can affect everything from your memory to your movement.

What Is The Outlook For Persons With Parkinsons Disease

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

  • Using stem cells to produce new neurons, which would produce dopamine.
  • Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
  • Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

Disentangling The Role Of Working Memory In Parkinsons Disease

  • 1Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
  • 2Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
  • 3Turku Institute for Advanced Studies, University of Turku, Turku, Finland
  • 4Department of Psychology, Åbo Akademi University, Turku, Finland
  • 5Department of Applied Educational Science, Umeå University, Umeå, Sweden
  • 6Department of Psychiatry, Visby County Hospital, Visby, Sweden
  • 7Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
  • 8Turku PET Centre, University of Turku, Turku, Finland
  • 9Turku Brain and Mind Center, University of Turku, Turku, Finland

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

Are There Medicines To Treat Pdd

Though there is no cure for PDD yet, there are medications that help manage the symptoms. These medications are called cholinesterase inhibitors, and they can help if a person with PDD is having memory problems. Some examples of these medicines are donepezil, rivastigmine and galantamine. Sleep problems may be managed by sleep medications such as melatonin.

Because people with PDD are usually very sensitive to medications, any new medication, even one that is not being used for the brain, needs to be reviewed with the persons provider to avoid potential contraindication.

Diagnosis Of Parkinsons Disease

A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.

There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.

Measures Of Global Cognitive Abilities

TELE

In this interview protocol , 17 items, including altogether 23 questions, screening for early dementia are presented. The items assess orientation to personal information and time, long-term memory, short-term memory, and abstraction. The questions and tasks are rated either on a 00.5 point scale or on a 01 point scale , depending on the item. The dependent variable was the sum score , and lower scores indicated more difficulty. The cut-off score for dementia was 16 as suggested by Gatz et al. , who reported good sensitivity and specificity for this cut-off. TELE has also been shown to exhibit good sensitivity and specificity for detecting cognitive impairment among aging Finnish subjects and to correlate with clinician-made assessments .

TICS-m

How Is Parkinsons Disease Diagnosed

Parkinsons and Delay the Disease

Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as or scans, may be used to rule out other disorders that cause similar symptoms.

To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.

If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.

Cognitive And Psychiatric Symptoms

  • depression and anxiety
  • mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
  • dementia a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there and believing things that are not true

Working Memory Affective Symptoms And Everyday Cognition

The MIMIC model with the group as a covariate tested the effect of PD on task-based WM, self-rated affective symptoms, and self-rated everyday cognitive difficulties, as well as the connections between these variables . The model fit was good, Chi-Square , and RMSEA , CFI , as well as SRMR were all within the desired range. Only TLI was slightly below the recommended value .

Group had a significant effect on task performance in one of the WM domains, namely selective updating . Having PD predicted lower performance on tasks of selective updating. PD did not, however, predict performance on tasks tapping continuous monitoring or maintenance of information , although there was a trend towards statistical significance for maintenance. The performance on tasks of the three WM subdomains was significantly correlated . Additionally, there was a significant group effect on self-rated affective symptoms as well as on self-rated cognitive dysfunction . Hence, the PD patients reported more affective symptoms and cognitive dysfunction than the controls. The amount of self-rated affective symptoms was also correlated with the amount of self-rated cognitive dysfunction . Neither the amount of self-rated affective symptoms nor self-rated cognitive dysfunction correlated with any WM subdomain.

What Are The Symptoms Of Parkinsons Disease

Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:

Other symptoms include:

  • Decreased facial expressions: You may not smile or blink as often as the disease worsens; your face lacks expression.
  • Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
  • Handwriting changes: You handwriting may become smaller and more difficult to read.
  • Depression and anxiety.
  • Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
  • Pain, lack of interest , fatigue, change in weight, vision changes.
  • Low blood pressure.

Background Characteristics And Group Comparisons For Single Measures

The groups were comparable on all demographic characteristics, as well as on motivation and alertness evaluations throughout the test sessions . The age of the PD group ranged from 45 to 72 years and they had an average education of 14.8 years . The mean age at disease onset had been 59.5 years , while the average disease duration had been 5.6 years . The age of the control group ranged from 50 to 73 years and they had an average education of 14.2 years .

There were some differences between the groups in cognitive performance, global cognitive abilities, self-reported everyday cognition, and self-reported affective symptoms . As shown in Table 2, the PD patients performed significantly worse than the healthy controls on SRT , CPT , and the Wordlist recall task . Sentence recall was the only non-WM task that systematically correlated with the WM tasks within the PD group .

Table 2. Group differences for computerized tasks between the PD patients and the healthy controls.

The PD patients exhibited also general cognitive impairment , and reported more everyday cognitive difficulties as well as depressive symptoms as compared to the controls. The PD patients did not, however, differ from the controls on the other global cognitive ability measure or on the self-reported apathy rating .

Difficulties With Memory And Thinking May Develop In Some People With Parkinson’s

January 7, 2011

Dear Mayo Clinic:

Does Parkinson’s disease affect memory and thinking? My 70-year-old husband has this condition and is showing signs of cognitive impairment.

Answer:Unfortunately, Parkinson’s disease is not simply a problem of tremor, walking and movement. With advancing age, and the longer a person has the disease, difficulties with memory and thinking may surface. Typically, these problems are subtle at first, but may become progressively worse in some people with Parkinson’s disease.

Parkinson’s disease is a disorder of the nervous system that develops gradually over time. The development of cognitive problems reflects the progressive nature of the disease process. Early in the course of the disease, most symptoms such as tremor, muscle rigidity and difficulty with movement are usually mild and can often be effectively managed with medications.

After many years of Parkinson’s disease, though, symptoms may become less responsive to medication, and new problems can develop. New symptoms can include additional movement problems and cognitive difficulties, as well as bladder and bowel issues and, in some people, low blood pressure.

Physicians should also review patients’ drug lists, as medications for other health problems may sometimes compromise mental clarity. Finally, adequate sleep is important to sound thinking, and occasionally treating sleep disorders, such as sleep apnea, can improve cognition.

How Can We Manage Hallucinations

It may not be necessary to treat all hallucinations of a person with PDD. Hallucinations are often harmless, and it is okay to allow them to happen, as long as they are not disruptive or upsetting to the person or surroundings. Sometimes, recognizing the hallucination and then switching the topic might be an efficient way of handling frustrations that occur because of a hallucination. If hallucinations need medical treatment, your provider may be able to discuss and suggest some options. However, many of the medications used to treat hallucinations may make movement symptoms worse.

How Is Parkinsons Disease Treated

There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.

Can Parkinsons Disease Be Prevented

Parkinson

Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.

Other Reasons For Cognitive Symptoms

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.

The Profile Of Memory And Cognitive Changes

Even in the very early stages of Parkinson’s disease people can have difficulty with their thinking processes. Most authorities agree that the primary difficulty lies with the so-called executive cognitive functions.

Executive cognitive functions refer to such thinking processes as memory retrieval, planning, generation of words or concepts, attention, and monitoring and adjustment of non-routine and goal-directed behaviors. The common denominator in all of these executive functions is that they require cognitive control in order to operate smoothly.

The term cognitive refers to processes or operations involved in the processing of all kinds of information. So cognitive control processes are those processes that are used by the mind and brain to regulate the storage, retrieval, and usage of information .

Problems with executive functions are typically mild in early PD. They usually involve a generalized slowing of cognitive processing speed and subtle deficits in attention and working memory. It may be difficult, for example, to hold two different pieces of information in the mind at the same time, or to efficiently generate words and concepts as quickly as one used to. As the disease progresses, these executive cognitive deficits are made more severe by common Parkinson-related mood disorders and Parkinson-related emotional problems such as depression and anxiety.

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 Do These Symptoms Look Like

You might have problems with activities such as planning, multitasking and moving quickly from one activity to another, or doing tasks in a particular order.

This may mean you feel less efficient or less organised than you used to be, or you may get confused, particularly if youre feeling stressed.

Problems with attention and concentration can also make everyday activities more difficult, such as reading a newspaper article from start to finish. 

You might experience slowed thinking, so it could take you longer to make decisions or respond to questions.

If youve had surgery for Parkinsons, such as deep brain stimulation , you may have some specific symptoms, such as problems with talking, concentration and complex thinking. But some people find that the surgery improves their memory.

Researchers are working to understand why mild memory and thinking problems happen in Parkinson’s. 

It’s thought that these symptoms are caused by problems in the brain pathways that pass messages from one area of the brain to another. 

There may also be other explanations for these symptoms. These include:

What Medications Are Used To Treat Parkinsons Disease

Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.

Medications combat Parkinsons disease by:

  • Helping nerve cells in the brain make dopamine.
  • Mimicking the effects of dopamine in the brain.
  • Blocking an enzyme that breaks down dopamine in the brain.
  • Reducing some specific symptoms of Parkinsons disease.

Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .

Other Computerized Cognitive Tests

Simple Reaction Time

This task was adapted from the one developed by Mueller . In this task, a square is presented in a fixed spot on the screen, at variable time intervals between 250 and 2,500 ms. The participants task is to press the respond key as quickly as possible upon spotting the square stimulus. The dependent variable was the mean reaction time over all responses.

Sentence Recall

In this computerized sentence recall task, words of a sentence were presented successively on a screen at a rate of one word per 1,000 ms. Immediately after all the words had been presented, the participant was prompted to reproduce the sentence by typing it in an empty column. The participant was to recall a total of five sentences that were presented in a randomized order. The proportion of correctly recalled words, regardless of the order they were recalled in, was used as the outcome variable. See Fellman et al. for details.

Wordlist Recall

In this task, 10 words were displayed one at a time for 1,000 ms. The task was to memorize each word in correct serial order, and finally recall them by typing down the words in empty columns. The participant completed altogether three trials, each trial consisting of the same 10 words. However, the order of the words in the list was randomized in each trial. We employed a true recall scoring as the dependent variable, that is, the total number of correctly recalled words in the three trials minus repetitions, perseverations, and additions.

Stroop

Signs Of Parkinsons Disease

In 1817, Dr. James Parkinson published An Essay on the Shaking Palsy describing non-motor, as well as, motor symptoms of the illness that bears his name. Parkinsons is not just a movement disorder, explained Dr. Shprecher. Constipation, impaired sense of smell, and dream enactment can occur years before motor symptoms of Parkinsons. The latter, caused by a condition called REM sleep behavior disorder, is a very strong risk factor for both Parkinsons and dementia . This has prompted us to join a consortium of centers studying REM sleep behavior disorder.

Memory Difficulties In Parkinsons

Research Roundup: Cognition Changes and Parkinsons 101 ...

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

How Can I Help Myself

Keeping physically active and mentally stimulated is very important when living with both Parkinsons and cognitive problems.

Avoiding stress is also important. Anything that puts you under pressure is likely to worsen memory problems, so try to take each day at a steady pace. Allow time for rest and relaxation, and make time to do the things you enjoy. Relaxing effectively can help to improve your concentration, attention span and ability to plan. Complementary therapies such as yoga and Tai Chi, together with exercise such as swimming may help with this.

We can all be forgetful and while this is often frustrating, a good quality of life can still be enjoyed if you make some adaptations.

You could begin by adapting your home and work environments to accommodate your needs. For example, removing clutter will reduce the number of visual distractions and make it easier for you to find your way around. Keeping furniture in the same place and having a regular daily routine may be helpful. At night, you may find it useful to keep a low-level night light on to minimise possible disorientation if you wake.

As time passes, carrying out more complex tasks is likely to become harder. Try writing down the various steps you have to go through in order to complete specific tasks, and follow these steps one by one.

The following tips may also help maintain brain function and improve quality of life:

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