Cognitive and emotional changes in Parkinson's disease
Written in association with:
Psychologist
Published: 10/01/2025
Edited by: Jessica Wise
Parkinson’s disease is a progressive neurological condition classified as a movement disorder. Historically the focus has been the motor symptoms (tremor, slow movement) associated with the condition, but in this article, Dr Simon Prangnell, an expert consultant neuropsychologist, outlines the cognitive and emotional symptoms that many people with Parkinson’s experience.
Parkinson’s disease is caused by a loss of dopamine within the basal ganglia. As well as controlling movement, this area of the brain plays an important role in thinking and regulation of mood. The basal ganglia is important for processes such as sustaining concentration, filtering distractions and switching between different tasks. It has widespread connections with other areas of the brain important for memory, decision making, judgement and controlling impulses.
Cognitive symptoms in Parkinson’s
Many people with Parkinson’s experience at least mild changes in thinking processes. The most common cognitive problems include:
Slower thinking speed Difficulty concentrating Losing one’s train of thought ForgetfulnessThese problems can sometimes fluctuate according to medication, so when medication wears off people feel that there thinking becomes slower or clouded (akin to brain fog).
Cognitive changes can be frustrating and may start to affect work or activities at home. They can affect people’s confidence to manage social or work situations.
How can neuropsychology help?
A neuropsychologist can conduct an assessment to investigate the extent of cognitive changes and use this information to identify strategies that can be used to overcome or manage these problems in day to day life. The sorts of techniques that are helpful can vary from person to person according to their interests, activities and preferences which is why it is important to take an individual approach to planning that is informed by a neuropsychological assessment.
Changes in mood and emotions in Parkinson’s
Many people with Parkinson’s experience a degree of anxiety and low mood, with some people suffering depression or severe anxiety. These symptoms can sometimes predate a diagnosis as part of a ‘Parkinson’s prodrome’. Feeling low or anxious in mood is also common after a diagnosis, when thinking about the possible progression of the condition in future or the impact of symptoms on a person’s day to day life.
Whilst changes in mood are common in long term conditions, Parkinson’s poses particular challenges. For example, people who experience fluctuations in their condition according to medication have to manage a high degree of uncertainty in their ability to manage everyday tasks. Uncertainty is a significant factor in predicting anxiety. It is common for emotional changes such as anxiety and low mood to worsen physical symptoms. For example, people with a tremor often notice it becomes worse when they experience emotional stress. Social anxiety, or loss of confidence in social situations (for example, feeling concerned about other people’s reaction to changes in gait or tremor) can lead to people becoming socially isolated which in turn can lower a person’s mood.
What can neuropsychology offer to help?
A neuropsychologist can undertake a holistic assessment to understand the interaction between the symptoms the person is managing and the changes in mood they have noticed. This may be informed by a neuropsychological assessment (see above) to address any additional cognitive changes as well.
This assessment can be used to identify options for therapy. This may involve talking therapy with a neuropsychologist, or referral to another professional (e.g. to a physiotherapist to manage fears of falling).
If you believe you may have Parkinson’s disease, you can consult with Dr Prangnell via his Top Doctors profile.