Symptoms
In the early stages of Parkinson’s
To begin with you may be aware of finding it difficult to concentrate and/or complete tasks, for example losing your train of thought or forgetting what you were doing part way through an activity. Also, the ability to recall information may deteriorate and learning new things can become harder.
Unfortunately, sometimes these difficulties are wrongly interpreted as a resistance to the changes that life with Parkinson’s brings, rather than specific problems that need addressing.
As Parkinson’s progresses
Increased difficulty with the following can occur:
- word finding (often known as ‘tip of the tongue’ phenomenon – when someone is confident that they know an answer but are unable to produce the word)
- decision making
- problem solving
- memory, particularly of the immediate and short term - remembering the sequence or timeline of recent events can be difficult
- judging distances or direction - describing how to get from one place to another might be hard
- planning complex activities and multi-tasking.
Visual hallucinations may also occur and can be associated with delusions1. Unfortunately, these difficulties can also impact on a range of lifestyle activities, such as shopping, paying bills, dressing, eating and speaking.
Communication
Some Parkinson’s symptoms can make communication difficult and cognitive problems will often make things even harder. As the ability to remember words is affected, vocabulary can become limited and humour may be less understood. In turn, it can get harder to follow conversations and this can result in a person not making sense, or forgetting what they have already said and repeating things.
Diagnosis
Memory and other cognitive problems are generally diagnosed by talking with the person and their carer or family and discussing their concentration, memory, language and problem-solving skills.
Recognised ‘rating scales’ are also used and these are comprised of carefully chosen questions, the responses to which score points indicating whether or not difficulties are present. Rating scales are also useful in monitoring improvement or decline during and after treatment .
For more subtle or complex difficulties a neuropsychologist - a psychologist with expertise in how to evaluate behaviour and cognitive abilities – may also make a more detailed assessment. This can be particularly helpful in differentiating Parkinson’s from illnesses which give rise to more severe difficulties such as Alzheimer’s disease, stroke or Dementia with Lewy Bodies.
Other factors, such as the onset of cognitive problems in the very early stages of living with Parkinson’s, agitation and delusions may suggest that Parkinson’s is not the sole cause. In such cases your doctor may recommend brain scans and blood tests to search for other treatable causes such as thyroid disease or vitamin B12 deficiency.
Cognitive problems in person with Parkinson’s can be difficult to identify and monitor because:
- the disease’s itself can affect facial expression and body language and slow down thought processes and responses - this could make cognitive problems appear worse than they really are or, alternatively, reduced facial expression may mask them
- people are not always aware of or able to recognise any problems they might have.
For these reasons, any observations from carers and family can be very helpful in accurately pin-pointing problems and assessing their progress.
