Cognitive Disorders in PD

Gary Larson, The Far Side

Totally wrapped up in fear over impending dementia, I have become obsessed with every occurrence of memory loss and brain fog that envelopes my day.  It's not unusual for people to start worrying about memory loss at my age, but we always console each other with reminders about how much stress we're under trying to cram life, work, and the challenges of aging into 24 hour days.

My neurologist has said several times that she sees no signs of dementia in me. What is happening, instead is called Cognitive Impairment in Parkinson's Disease.  Research shows that cognitive impairment often accompanies the early stages of PD and is already part of the progressive disease process manifest in movement disorders. They go together--cognitive impairment and tremors, falls, and life in slow, awkward motion.

For this blog, I am highly recommending Cognitive Impairment in Parkinson's Disease, a web site from American Parkinson's Foundation that includes 2 articles devoted to the unique problems we PD patients face, how it isn't dementia, and what can be done NOW.  Emphasis is on close patient/physician communication, because we know when it's happening to us.  There are also suggestions for people in our lives.  For me,  this is an epiphany. Since everyone's PD is unique, to a point, and since I often get questions, I am adding a FAQ to this blog in hopes that it well help others who grapple with PD daily or those who have tremors and they wonder if it's PD.

When I first went to a neurologist in 2000, I got the one and only "diagnostic" memory test too many people with movement disorders get. At the beginning of the exam, he said "barn, dog, France" and told me to remember those words. I would have to repeat them later. For the next hour, all I could think was "barn, dog, France, barn, dog, France, barndogFrance....I passed, walked out of the enormous medical complex, and (a) couldn't remember which car I had driven, (b) where I had parked it, or (c) where I was supposed to go if and when my car materialized.  He said it wasn't Parkinson's Disease; he was wrong.

I now take medications to help keep me focused and, at the really rough times, coherent.  Just as tremors get worse at the end of the day, cognitive impairment takes on a whole new dimension. I often can't follow any TV program, and I am apt to either forget what I am watching or fall asleep watching it. Forgetting what I am watching, doing, or saying and wandering into verbal oblivion are the most painful aspects of PD for me--worse even than imbalance and falling and throwing glasses or orange juice on total strangers at a breakfast buffet. But a combination of medications also used for Alzheimer's patients has proven very successful for those of us with Parkinson's. They include Exelon, available in patch or pill, and NamendaXR.

FAQ

Q. My hands shake. My doctor says it isn't PD, but Essential Tremor Disorder. How do you know you have PD? 

A. This is a frequent question, and I am writing this blog today for one friend who shakes worse than I do, but isn't diagnosed with PD. First, you need a neurologist you trust, and that means one who listens and watches every move you make. Second, it's important to understand that tremors are only one possible indicator of PD, but they are also side effects of a host of medications. Third, most lay people and many doctors who aren't trained in neurology think of PD exclusively in terms of movement disorder.  Even then, many people aren't aware of the constellation of movement disorders we have: Bradykinesia or slow movement, stiff arms, restless legs, emotionless face, to name a few. 

Q. You don't seem to always have bad tremors during the day. What other problems do you have?

A.  You should see me at night! If you have seen our beloved Michael J. Fox (hero to all PD patients and a man who puts his money into research) interviewed on TV or playing a role in a series, you know how wild movement disorder can get. When it's late, when I am tired, that's me.

Q. What are the other symptoms?

A. Here's where Cognitive Impairment in Parkinson's Disease is so important to understand. For me, it manifests as confusion, memory loss, being at a loss for words, totally losing my train of thought when interrupted, saying things that [I am told] make no sense.  I am just learning how this works.

When I first went to a neurologist in 2000, I got the one and only "diagnostic" memory test too many people with movement disorders get. At the beginning of the exam, he said "barn, dog, France" and told me to remember those words. I would have to repeat them later. For the next hour, all I could think was "barn, dog, France, barn, dog, France, barndogFrance....I passed, walked out of the enormous medical complex, and (a) couldn't remember which car I hafe the challenge acd driven, (b) where I had parked it, or (c) where I was supposed to go if and when my car materialized.  He said it wasn't Parkinson's Disease; he was wrong.

Q. Are there treatments for the cognitive problems?
A.  Yes. Many people have benefited from medications like Exelon and Namenda. Ask your neurologist about these and other medications. But I cannot overemphasize trying to challenge your brain throughout life, especially as you get older and/or face the challenge of Parkinson's. Many people work puzzles, math problems, or study other languages. Physical exercise also puts things in perspective and has demonstrable positive effects on the brain and cognitive processes.