1. www.davisphinneyfoundation.org Cognitive Changes in Parkinson’s Disease Paul Short, Ph.D. Licensed Clinical Psychologist The Parkinson’s Coach

2. www.davisphinneyfoundation.org PD & Me: Clognition Members of the PD community have coined a term “clognition” for functional changes in brain processing (http://www.clognition.org/): Members of the PD community have coined a term “clognition” for functional changes in brain processing (http://www.clognition.org/): Combination of mental and behavioral symptoms of Parkinson's Disease including: Combination of mental and behavioral symptoms of Parkinson's Disease including: – depression & obsessive-compulsive disorder – cognitive dysfunction

3. www.davisphinneyfoundation.org PD and Me: Cognition Common Cognitive Concerns with PD Common Cognitive Concerns with PD – Attention/concentration/working memory – Memory – Executive Function

4. www.davisphinneyfoundation.org It All Comes Down to the CEO All of the PD cognitive problems have a substantial input from the higher level brain processes we call executive function All of the PD cognitive problems have a substantial input from the higher level brain processes we call executive function – Attention/concentration/working memory – Memory – Executive Function

5. www.davisphinneyfoundation.org What Can I Do About “Clognition” Altered cognitive processes can be addressed by Altered cognitive processes can be addressed by – Identifying areas of weakness – Planning and developing strategies for effective response – “Train the brain”

6. www.davisphinneyfoundation.org What Can I Do About “Clognition” Attention/concentration/working memory Attention/concentration/working memory – Break up interactions into shorter periods – Listen as if there will be a test later – Use active living techniques

7. www.davisphinneyfoundation.org What Can I Do About “Clognition” Memory Memory – Actively process information – Encode with multiple modalities – Rehearse, rehearse, rehearse

8. www.davisphinneyfoundation.org What Is Executive Function? Vaguely defined, even by experts Vaguely defined, even by experts Common definition: Common definition: – Executive function allows us to interact with the world by: Evaluating circumstances inside and outside of us Evaluating circumstances inside and outside of us Planning, executing, and modifying purposeful activities Planning, executing, and modifying purposeful activities Maintaining attention and directing mental processes Maintaining attention and directing mental processes Effectively processing information so it can be recalled Effectively processing information so it can be recalled

9. www.davisphinneyfoundation.org What Can I Do About “Clognition” Redefine Executive Function: Redefine Executive Function: – “Higher Order Cognitive Function” involving: The frontal lobes, particularly the prefrontal cortex The frontal lobes, particularly the prefrontal cortex Other areas of the cortex Other areas of the cortex The basal ganglia and other deep brain structures The basal ganglia and other deep brain structures All those nerve tracts connecting these areas All those nerve tracts connecting these areas

10. www.davisphinneyfoundation.org What Can I Do About “Clognition” Common Executive Function Problems Common Executive Function Problems – Motivation 1. Make your plan a day or two before 1. Make your plan a day or two before 2. Don’t think, DO IT 2. Don’t think, DO IT 3. Repeat Step 1 3. Repeat Step 1

11. www.davisphinneyfoundation.org What Can I Do About “Clognition” Common Executive Function Problems Common Executive Function Problems – Perseveration (“sticky behavior”) 1. If your solution isn’t working stop and take stock 1. If your solution isn’t working stop and take stock 2. Ask someone you trust to check your reasoning/approach 2. Ask someone you trust to check your reasoning/approach 3. Form a new plan 3. Form a new plan

12. www.davisphinneyfoundation.org What Can I Do About “Clognition” Common Executive Function Problems Common Executive Function Problems – Metacognition (Thinking about your thinking) 1 Take your time, this isn’t a race 1 Take your time, this isn’t a race 2. Ask someone you trust guide you when you are stuck or lost 2. Ask someone you trust guide you when you are stuck or lost 3. Don’t get flustered 3. Don’t get flustered

13. www.davisphinneyfoundation.org What Can I Do About “Clognition” Common Executive Function Problems Common Executive Function Problems – Prospective Memory (Remembering to do something in the future 1 Use checklists, calenders, and timers 1 Use checklists, calenders, and timers 2. Set aside a regular time to reflect upon what you need to do 2. Set aside a regular time to reflect upon what you need to do

14. www.davisphinneyfoundation.org What Can I Do About “Clognition” Remember- Remember- – Cognitive change is common with PD but it is not the same thing as dementia!