Impaired Thinking and Dementia

Often referred to as mild cognitive impairment, a person with Parkinson's may have trouble remembering, concentrating, making decisions, or learning new things. 30% of persons with PD may experience some degree of cognitive impairment at some point during Parkinson's disease progression. Common symptoms of impaired thinking, include:

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• Slowed mental processing speed

• Diminished concentration and attention spans

• Difficulty making decisions or solving problems, multi-tasking, or planning

• Short-term memory loss

• Producing language

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Dementia refers to difficulty with thinking and memory that impairs day-to-day function and the ability to live independently. Dementia often develops in people with advanced PD.  The medications used for Parkinson's-related dementia are cholinesterase inhibitors. This means they increase the amount of acetylcholine, which is involved in thinking and memory. These medications often have a modest benefit. They can also sometimes help with reducing freezing of gait. These medications are all approved for Alzheimer's, which is a different type of dementia. Possible side effects include nausea, vomiting, diarrhea, dizziness, and tremor.

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In some cases, mild cognitive impairment may indicate an additional diagnosis of Parkinson's Disease Dementia (PDD) if the symptoms interfere with the person's ability to function appropriately. Should you notice increased symptoms of cognitive impairment, it is important to discuss them with your doctor and ask for a cognitive function evaluation.

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Medications that are approved for people with PD dementia, include Acetylcholinesterase Inhibitors and Glutamate Antagonists. Acetylcholinesterase Inhibitors commonly known as Rivastigmine (Exelon) medication have been effective in addressing cognitive impairment symptoms. Most common side effects include tremor, drooling, and bladder issues. This treatment has also been shown to help with apathy which is common in patients experiencing dementia.

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Glutamate Antagonists is a medication more commonly used in Alzheimer's patients, but may help with some cognitive symptoms experienced in PD. Other stimulants such as methylphenidate and modafinil may be used for excessive daytime sleepiness or fighting fatigue and improving alertness.