Minds Changing in the Shadow of Parkinson's

After a diagnosis of Parkinson's disease, life begins to slowly change for both you and your loved ones. While physical signs like muscle tremors and slowed movements are often discussed, there's another area that is frequently overlooked, perhaps even hesitated to talk about: mental changes. You may notice your loved one can't think as quickly as before, sometimes struggles to find words, or feels frightened when they hear words they don't understand. In this article, we'll try to understand the cognitive changes that arise in people with Parkinson’s. My aim is to explain the scientific facts in plain language, while also extending a friendly hand to the anxiety or loneliness you may feel at home.

Why and How Do Mental Processes Change in Parkinson's Disease?

Parkinson's is, at its core, a chronic disease marked by the reduction of a brain chemical called dopamine. Dopamine affects not only movement, but also learning, attention, planning, and emotion regulation. In other words, Parkinson’s quietly transforms the mind as much as it does the body.

According to scientific data, about 30-50% of people with Parkinson's experience notable cognitive changes. These mental changes often become more evident during the middle or advanced stages of the disease. However, some mild symptoms can be observed even in the early stages.

Common Signs of Mental Changes

• Difficulty with Attention and Concentration: The person may have trouble maintaining focus or switching from one task to another.

• Memory Problems: Especially with recalling recent events. Routines may be forgotten or the same questions may be asked repeatedly.

• Slowed Thinking (Bradyphrenia): Thoughts seem to progress in slow motion. It may take longer to receive a response when you ask a question.

• Problems with Judgment and Planning: It may become harder to sequence daily activities, make decisions, or adapt to new environments.

• Emotional Changes: Changes in mood such as anxiety, depression, restlessness, or sometimes apathy (emotional dullness) may also occur.

Parkinson's and Dementia: Are All Mental Changes Dementia?

Naturally, as a family member, you may worry, "Has Parkinson's become dementia?" However, it's important to know that the mental changes caused by Parkinson’s do not always mean dementia. Cognitive slowing, word-finding difficulties, and planning problems generally accompany the progression of the disease itself, and do not necessarily lead to dementia.

Only in some Parkinson’s patients, especially in advanced stages, does "Parkinson’s-related dementia" develop. This condition leads to more widespread and severe memory loss, disorientation, and sometimes delusions.

Recognizing Mental Changes: Observation and Empathy

Sometimes everything begins quietly. A spouse or parent who forgets to bring the salt to the table, can't recall the name of their favorite TV show, or returns from shopping with missing items. Seemingly small things—like telling the same story over and over, struggling to find certain words in a sentence, or being unable to follow a conversation from start to finish—can actually be signs of a slowdown in brain processes.

The most important thing here is to approach with empathy. Taking these issues personally or getting angry will only increase the burden on both your patient and yourself. Instead, finding a new way together to learn and support each other will make the process more bearable.

How Does the Brain Change? Biological Background

Sometimes, understanding a loved one’s behavior begins with knowing what’s happening in their brain.

The reduction of dopamine-producing cells in Parkinson’s slows or disrupts the flow of information throughout many areas of the brain, especially the "fronto-striatal" circuits. Attention, memory, and executive functions (planning, organizing, multitasking) are the areas most frequently affected. Additionally, some research shows that changes in other brain chemicals (such as reduced acetylcholine) contribute to these issues.

Frequently Asked Questions and Answers

• How often should cognitive assessments be performed?
  World Parkinson’s Associations recommend at least one neurological and cognitive assessment each year. This allows for early detection of changes.

• Can mental changes be reversed with medication?
  Medications for Parkinson's are usually effective for motor symptoms; for cognitive changes, only mild improvements are possible in some cases. However, in some situations, additional treatments (such as acetylcholinesterase inhibitors) may help with more advanced mental changes.

• Are physical exercise and social activities beneficial?
  Yes. Walking, light sports, group conversations, and brain exercises can help protect brain health and support mood.

A Roadmap for Approaching Mental Changes

1. Acceptance: It's important to accept mental changes as they are and understand that they are a part of the disease.

2. Monitoring and Record-Keeping: Noting the cognitive issues you encounter in a notebook will help you explain them easily to your doctor.

3. Protective Approaches:

   • Speaking in clear and simple sentences

   • Maintaining daily routines and minimizing complexity

   • Solving puzzles and playing memory games together

   • Taking frequent rest breaks

4. Professional Support and Comprehensive Care: Working with neurologists and geriatricians and, if needed, seeking support from professionals like psychologists and speech therapists can be helpful.

Emotional Tips for Caregivers

• Let Go of Guilt: Some days your patience may be tested, or you may feel helpless. Remember, you are not alone in these feelings, and they are completely human.

• Celebrate Small Successes: Sometimes a two-word sentence, a laugh, or a suddenly remembered old memory becomes immensely valuable. Hold on tight to these moments.

• Make Time for Yourself Too: Try not to let fatigue or disappointment take over your life. Even talking to a friend who cares or taking short walks can make a big difference.

When is More Help Needed?

If mental changes increase to the point where daily life is disrupted—for example, if the person becomes forgetful regarding self-care, gets lost, or displays dangerous behavior at home—you should definitely consult your doctor.

You Are Not Alone

Loving someone with Parkinson’s also means embracing their memories, hopes, and weaknesses from both their past and present. Sometimes they may not find the right words, or may misunderstand you, but know that your support is one of the strongest medicines between you. If you continue to have questions and concerns, seeking professional help is the healthiest route for both the patient and yourself.

Remember:

• These are part of the disease.

• With clear communication, patience, and love, you can make the process more meaningful.

• You can walk this path together without neglecting yourself.

Resources

• Goldman JG, Postuma R. Premotor and nonmotor features of Parkinson’s disease. Curr Opin Neurol. 2014;27(4):434-441.

• Litvan I, et al. Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: Movement Disorder Society Task Force guidelines. Mov Disord. 2012;27(3):349-356.

• Parkinson’s Foundation. Cognition & Thinking Changes. https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Cognition-Thinking-Changes

• Poewe W, Seppi K, et al. Parkinson disease. Nat Rev Dis Primers. 2017;3:17013.