New research into the non-motor symptoms of Parkinson’s is revealing that people with Parkinson’s disease experience subtle changes in thinking ability and language right from the start. In fact, for approximately 5% of people, cognitive changes precede the onset of motor symptoms. These changes may affect all areas of language, including comprehension and expression in both verbal and nonverbal communications.
Affected areas include:
- Attention. Because people have difficulty filtering out non-salient information, they may have trouble communicating when there are multiple distractions or multiple speakers. This may affect the ability to understand information and take in a large volume of information.
- Language structure. The difficulty of processing and producing complex syntax both written and auditory and difficulty with drawing inferences can affect conversation and reading. As a result, people with Parkinson’s may use simplified sentence structures and less “rich” communication.
- Memory. Retrieving information can be more of a problem than storing information, so people with Parkinson’s can benefit from strategies that make it easier to retrieve information and break it into smaller units.
- Emotional processing. There is evidence that the masked facial expression in Parkinson’s is not just a matter of rigidity and stiffness in the facial muscles; it has a cognitive component, as well. People have difficulty both expressing and understanding emotions, particularly negative emotions such as sadness and anger, in a variety of ways, including facial expression, changes in tone of voice, inflection and volume, and words relating to emotional concepts.
- Executive function. Problems in this area exist from the early stages and may appear as a delayed ability to organize language, integrate information, and identify and modify language strategies.
- Word finding. People have problems with generating words. They may also have more difficulty with verbs than nouns. As a result, a person’s language may sound vague or rambling. One person with Parkinson’s said, “I find I have to use a lot of words to convey what I’m thinking.”
- Social communication skills. In conversation, people may have difficulty with turn-taking, initiating topics, maintaining topics and drawing references.
- Mood. Depression and apathy are common in Parkinson’s and they can reduce cognitive performance. However, “If someone is slow to communicate and has emotional processing impairments, this may be perceived as depression when it may, in fact, be a function of communication changes related to cognition and language skills,” says Angela South, a speech-language pathologist and PhD Student at the University of Western Ontario in London, Ontario. South’s research on cognitive-linguistic deficits in Parkinson’s and the impact on the communication dynamic between individuals and their family care partners is funded, in part, by a Graduate Student Award from Parkinson Society Canada. This work may assist speech-language pathologists in improving communication outcomes for people with Parkinson’s from the early stages of the disease and as the disease progresses.
Read Effective Communication Cognitive Impairment in Parkinson’s for more information and helpful tips for people with Parkinson’s and care partners.