Cognitive Changes in Parkinson’s Disease

1. Cognitive Changes in Parkinson’s Disease Paul Short, Ph.D. Licensed Clinical Psychologist The Parkinson’s Coach

2. PD & Me: Clognition • Members of the PD community have coined a term “clognition” for functional changes in brain processing (http://www.clognition.org/): • Combination of mental and behavioral symptoms of Parkinson's Disease including: • depression & obsessive-compulsive disorder • cognitive dysfunction

3. PD and Me: Cognition • Common Cognitive Concerns with PD • Attention/concentration/working memory • Memory • Executive Function

4. It All Comes Down to the CEO • All of the PD cognitive problems have a substantial input from the higher level brain processes we call executive function • Attention/concentration/working memory • Memory • Executive Function

5. What Can I Do About “Clognition” • Altered cognitive processes can be addressed by • Identifying areas of weakness • Planning and developing strategies for effective response • “Train the brain”

6. What Can I Do About “Clognition” • Attention/concentration/working memory • Break up interactions into shorter periods • Listen as if there will be a test later • Use active living techniques

7. What Can I Do About “Clognition” • Memory • Actively process information • Encode with multiple modalities • Rehearse, rehearse, rehearse

8. What Is Executive Function? • Vaguely defined, even by experts • Common definition: • Executive function allows us to interact with the world by: • Evaluating circumstances inside and outside of us • Planning, executing, and modifying purposeful activities • Maintaining attention and directing mental processes • Effectively processing information so it can be recalled

9. What Can I Do About “Clognition” • Redefine Executive Function: • “Higher Order Cognitive Function” involving: • The frontal lobes, particularly the prefrontal cortex • Other areas of the cortex • The basal ganglia and other deep brain structures • All those nerve tracts connecting these areas

10. What Can I Do About “Clognition” • Common Executive Function Problems • Motivation • 1. Make your plan a day or two before • 2. Don’t think, DO IT • 3. Repeat Step 1

11. What Can I Do About “Clognition” • Common Executive Function Problems • Perseveration (“sticky behavior”) • 1. If your solution isn’t working stop and take stock • 2. Ask someone you trust to check your reasoning/approach • 3. Form a new plan

12. What Can I Do About “Clognition” • Common Executive Function Problems • Metacognition (Thinking about your thinking) • 1 Take your time, this isn’t a race • 2. Ask someone you trust guide you when you are stuck or lost • 3. Don’t get flustered

13. What Can I Do About “Clognition” • Common Executive Function Problems • Prospective Memory (Remembering to do something in the future • 1 Use checklists, calenders, and timers • 2. Set aside a regular time to reflect upon what you need to do

14. What Can I Do About “Clognition” • Remember- • Cognitive change is common with PD but it is not the same thing as dementia!