An article by Andere Zalbidea Botrán and Víctor Isidro Carretero, from the
The Parkinson’s disease is the second most common neurodegenerative disorder in the world., whose origin is still unknown. In this pathology, the same brain changes that seem to cause motor symptoms can also influence the appearance of a certain slowness in memory and thinking. Therefore, people who suffer from the disease have a high risk of developing cognitive impairmentbeing considered one of the non-motor symptoms that most affect the quality of life of those affected.
Cognitive symptoms are frequent in Parkinson’s disease, affecting approximately 40% of people with the pathology (Batum, Kisabay Ak, Semih Ari, & Selçuki, 2021). We call mild cognitive impairment or mild neurocognitive disorder (MCI) to the syndrome of cognitive impairment that is greater than what would be expected of an individual based on their educational level and age, but does not affect the ability to carry out activities of daily living (Gauthier et al., 2006). This concept emerges as a intermediate stage between normal cognition and dementia (major neurocognitive disorder), the latter being considered an aggravation of cognitive deficits that ultimately causes an impact on the affected person’s daily functioning.
People with Parkinson’s have a high risk of developing cognitive impairment, being one of the non-motor symptoms that most affect their quality of life.
Characteristics of cognitive impairment in Parkinson’s disease
There is a wide variety of classifications of cognitive impairment, in terms of type (number of cognitive domains affected) and progression (evolution or not, from MCI to dementia, as well as the time that occurs during the course). However, recent studies suggest that, in Parkinson’s disease, the Non-amnestic type MCI (without memory impairment) could be more frequent than that of the amnestic type (Kalbe et al., 2016).
Broadly speaking, the cognitive domains and aspects in which the affected person can experience alterations are:
- Orientation
Partial disorientation, especially at a temporal level (referring to difficulties in the ability to situate oneself on a specific day, hour, month, year, etc.).
- Attention
Attention difficulties, especially in the most complex and demanding types of attention (divided, alternating attention…). On a day-to-day basis, they would prevent the affected person from carrying out activities such as driving, or other processes that require attention to several environmental stimuli at the same time or even alternating attention between stimuli.
- Processing speed
Slowdown may appear. In everyday performance it could translate into needing a longer amount of time to provide a response to verbal or visual stimuli (such as during a conversation or a task).
- Memory
Frequently it is not usually the predominantly affected domain, but deficits can be evidenced in immediate memory (information presented seconds ago) and delayed memory (minutes or hours ago). They may repeat ideas mentioned a few minutes ago, stop in the middle of a conversation without knowing what they were going to express, change objects and not remember their location, etc.
- Language
Deficits in specific linguistic functions, such as verbal fluency or object naming. During daily activities, difficulties appear to find specific words during casual conversations, poor or non-specific vocabulary to refer to objects.
- Visuospatial skills
Difficulties related to the processing of visual information, such as facial recognition, recognition of colors and contrasts, the ability to build or draw figures, and space analysis and shape distinction. On a day-to-day basis, it can lead to difficulties in identifying people who are not so close, in measuring the distance and calculating the depth of objects at home or on the street, etc.
- Executive functions
Inability to plan and sequence actions to achieve a specific goal, to manipulate temporarily stored information, lack of mental flexibility in the face of changing (or unexpected, novel) situations, etc. For example, if the person misses a bus, he may not know how to fix it or have trouble generating an alternate plan.
Guidelines and strategies to combat cognitive decline
From the family interaction and immediate environment A series of guidelines can be applied that benefit the cognitive functioning of the affected person, such as:
- propose a context rich and varied in stimuli, in which the person can manifest themselves actively and in which, in addition to daily routines, they can carry out rewarding activities related to their values (behavioral activation). A proper balance between routines and novel situations is the key.
- respect the pace and speed of thought It is key for communication to be complete and fluid. Successful communication is more likely to happen if we allow enough time to organize thoughts and produce a response.
- In the face of reluctance to interact with people who are not so close, encourage participate in these social situationsfacilitating security and keys in the form of accompaniment.
- Physically adapt the environment in which the person lives to their difficulties in visuospatial perception can make the person feel safer to move around and carry out their activities of daily living (corridors and floors without obstacles, well lit, etc.).
- Provide the necessary physical and personal support, but promoting autonomy so that the person can carry out tasks on their own. The use of physical supports such as agendas, calendars, planning notebooks, etc., can be very beneficial when it comes to compensating for alterations in executive functions. Find a gap in the week to do the planning.
- Offer alternatives so that the person can choose cognitive activity that you feel like most each day, avoiding feelings of boredom or frustration (crossword puzzles, word searches, board games, exercise books, watching a movie or a radio program and then having a debate, taking a walk and memorizing a path that we did not know, etc.).
Adding these guidelines to the person’s day-to-day will make it easier for cognitive abilities to remain active. However, sometimes we may not have enough perseverance or the necessary time to support the person with Parkinson’s disease on the long path of the disease. For this, there are professional supports such as those existing in the Parkinson’s Association Madrid, where group activities are taught with specific objectives to maintain and preserve the cognitive state of the person. There are also options for individual intervention in Cognitive stimulation, both face-to-face and telerehabilitation. Cognitive stimulation allows training specific cognitive domains in an interactive and dynamic way through varied and diverse activities.
The telerehabilitation It represents a novel system in this time of pandemic, since rehabilitation services are provided through electronic systems, based on information and communication technologies. This makes it possible to access this type of therapy from various places, without the need to travel to a specific place.
References
Batum, M., Kisabay, A., Ari, MS, & Selçuki, D. (2021). Evaluation of cognitive functions in idiopathic Parkinson’s disease and multiple system atrophy. Neurology Asia, 26(1), 85-93.
Gauthier, S., Reisberg, B., Zaudig, M., Petersen, RC, Ritchie, K., Broich, K., … Winblad, B. (2006). Mild cognitive impairment. Lancet, 15(367), 1262-1270. doi: 10.1016/S0140-6736(06)68542-5.
Kalbe, E., Rehberg, SP, Heber, I., Kronenbuerger, M., Schulz, JB, Storch, A., … Dodel, R. (2016). Subtypes of mild cognitive impairment in patients with Parkinson’s disease: evidence from the LANDSCAPE study. Journal of Neurology, Neurosurgery and Psychiatry, 87(10), 1099-1105. doi: 10.1136/jnnp-2016-313838.