The cognitive and emotional impact of Parkinson's disease

Parkinson’s disease is a neurological condition in which sections of the brain deteriorate over many years. It is best known for its physical symptoms, but in this article, an expert consultant neuropsychologist explains the cognitive and emotional impact on patients with Parkinson’s.

Parkinson’s disease is caused by a lack of dopamine which occurs due to the loss of brain nerve cells in the substantia nigra, a part of the brain structure that controls the body’s movement and plays a role in information retention and acquisition, moods, judgement and decision-making processes. It most commonly manifests in people older than the age of 60, and men are more likely to develop it than women.

The major, physical symptoms of Parkinson’s include:

• Involuntary tremors
• Slow or reduced movement
• Stiffness and rigidity

The cause of nerve cell loss is not always clearly explained. It is theorised that it can occur due to factors such as ageing, genetics, and the environment (like exposure to pathogens and toxins).

There are five stages of Parkinsons:

1. Mild symptoms like slight tremors or imbalance on one side of the body may affect posture, gait, and facial expressions.
2. Symptoms from Stage 1 intensify and spread to the other side of the body. The patient may still be self-sufficient but limited
3. Loss of balance, walking issues, poor posture, and unsteadiness
4. Symptoms have become disabling and the patient may need walking aids for their safety, and will likely need assistance to complete daily tasks.
5. Muscular stiffness will make independent movement impossible or very dangerous, and the patient is likely confined to wheelchair usage or is bedridden. They will need full-time caretaking.

But Parkinson’s does not only physically manifest – it can also take its toll on cognition and emotions.

Cognitive impact of Parkinson’s

The depletion of brain nerve cells and dopamine does not only impact motor function, but also can result in delays in cognition. This is thought to be because of the disruption in the neural networks.

Some patients may experience things akin to brain fog and struggles with memory recall, making daily tasks and social interactions difficult and distressing. Other patients may have mild symptoms (mild cognitive impairment) of this that are noticeable to others or may be written off as a result of ageing, especially in the earliest stages

As the disease progresses, so will the cognitive issues. Patients will find it difficult to devote attention to tasks and conversations, multitask, plan and execute activities and ideas, remember the order of operation for basic tasks (like making coffee or operating a laundry machine), struggle with anomia and auditory processing, and have distorted depth of vision.

These symptoms are similar to those of Alzheimer’s disease or dementia, and while these conditions can be comorbid, they are not guaranteed to overlap. However in the latest stages of Parkinson’s disease, around 40 per cent of patients develop dementia.

Treatment and management

A neuropsychologist can conduct cognitive evaluations to assess the extent of cognitive impairment using tests and assessments covering aspects such as sleep quality, memory, problem-solving, focus, vision and other senses, and reaction time.

To manage cognitive changes, it is recommended that patients keep to-do lists and planners to keep engaged and on top of tasks, and regularly do mental exercises. These could be in the form of puzzles, card games, Sudoku, reading, learning choreography, and playing with building blocks. These activities are mentally stimulating and strengthen memory recall and problem-solving capabilities, while also having the added benefit of being socially executed (if the patient wishes).

Emotional impact of Parkinson’s

Patients with Parkinson’s are highly likely to experience anxious and depressive feelings after a diagnosis. This can be temporary while the patient processes, but it is very common to become a longer-term depression or anxiety – possibly exacerbated by the chemical upheaval in their brains, as the lack of dopamine is proven to be connected to clinical depression and anxiety disorders. Furthermore, there are many negative aspects to deal with once diagnosed – like the financial strain of care, the loss of employment and educational opportunities, and the idea of living the rest of their life with a chronic, debilitating illness – that the development of depression or anxiety is not entirely unexpected, with around 40 per cent of patients experiencing depression and anxiety or at least display symptoms of them.

Parkinson’s patients with depression and anxiety will be grappling with feelings of powerlessness, stress, fear and worry, and may isolate themselves. They may be irritable and frustrated especially as they begin to lose mobility and capability in their daily lives, and their relationships with others can become fraught as they and their loved ones deal with the weight of Parkinson’s.

Not everyone in a patient's life will be willing to support the patient through their illness, further compounding the patient’s sentiments of hopelessness and worthlessness that are characteristic of depression and anxiety.

Treatment and management

Partaking in relaxing and enjoyable activities is proven to regulate mood, lower stress, and uplift the spirit. Those who are in the earlier stages and still have mild symptoms should engage in physical hobbies and sports like swimming and cycling, whereas those further along can still benefit from walking, meditation, and simple stretches. It is important to not let the patient withdraw, and they should be encouraged to partake in the things they liked before their diagnosis all the same.

For some patients, they can be prescribed anti-anxiety and antidepressant medicine should their doctor believe they may benefit from it. Psychotherapies where patients can have a safe space to unpack their feelings also can be helpful, as well as connecting with other patients living with Parkinson’s, who can be found through online communities or in local support groups.

If you believe you may have Parkinson’s disease, you can consult with a specialist on Top Doctors today.