All the PD books on the market talk about changes in cognition. However, as most are written by either patient or neurologist, cognition is not often an area either is well-versed in. As a neuropsychologist, I am frequently called upon to articulate the problem to help the patient’s care team make decisions about medical management, vocation, and treatments, including DBS. This subject is too complex for a single blog, but it is possible to provide at least an overview.
Not everyone with early-onset PD experiences cognitive change but it is likely that a majority do. The term “clognition” is frequently thrown around by people with Parkinson’s to describe this condition. Although there is a tendency to conflate psychiatric concerns like anxiety and depression with it, I think the metaphor of a sluggish, clogged thought process is pretty good.
Early-onset PD typically strikes people who are still working, so work is frequently the place that “clognition” is first noticed. Even before the motor symptoms manifest, many individuals find that they are taking longer to complete routine job requirements. An eight-hour workday begins to take ten or twelve hours and this is sometimes not enough for the task at hand. Or it may be that a person has a list of tasks that need to be completed but inexplicably cannot figure out how to get started. It might even be a little bit hard to prioritize the things that need to be done.
Even though most who use the term “clognition” don’t typically say so, the problem is a change in executive function. This is a complex area of discussion but I will risk oversimplifying it by calling it the mental interface for successful function in the world. PD often causes people to be less able to think on the fly, to process information rapidly and precisely in order to produce a productive action. It is almost as if there is a delay in how quickly the information becomes available for a person’s use. He or she may be involved in a conversation but find that tracking the flow can be challenging. But formulating a timely response to what one is hearing can be an even greater challenge.
There are a host of other challenging aspects to “clognition” that I hope to discuss more in future blogs here. Would you describe yourself as having "clognition"? If so, consider sharing your experience here. It could help others better understand and manage it.