Of the non-motor symptoms that can occur with Parkinson’s, thinking or cognitive changes are some of the most concerning for people with the disease and their care partners. Not everyone experiences cognitive problems, and in those who do, they vary. Parkinson’s disease (PD) cognitive changes range from those that are bothersome but don’t interrupt everyday life — such as difficulty multi-tasking — to troubles that greatly affect daily activities.

But patients and doctors lack adequate therapies to prevent and treat cognitive problems. There is only one U.S. Food and Drug Administration-approved medication for Parkinson’s disease dementia: Exelon, or rivastigmine.

Given these unmet needs, a group of Parkinson’s doctors, researchers, and patients and their care partners met to discuss non-pharmacological ways to maintain cognition and treat cognitive problems. They also discussed the current understanding of cognitive problems in Parkinson’s and issues in research. Their findings, published in Nature Partner Journals Parkinson’s Disease, suggest ways to help people with Parkinson’s be proactive about their brain health, wherever they are in the disease course.

Early to Mid-stage Parkinson’s

• Exercise
  More and more studies are examining the effect of exercise on cognition in PD, and results are promising. While small studies of some exercise (aerobics and dance, for example) have shown benefit, researchers are working to define the best types and intensity of exercise for cognition in Parkinson’s. For now, the best exercise is probably the one you enjoy and feel safe doing.

• Eat a healthy diet
  Good nutrition is essential for living well. Few studies have evaluated diet and cognition in Parkinson’s, but studies in people without PD suggest that foods such as blueberries, dark chocolate, tea and wine may protect against cognitive decline. Also in people without PD, certain diets (Mediterranean, DASH and MIND diets) and supplements (folate and vitamin B12) may be beneficial for cognition.

• Get or stay socially active
  Spend time with friends and family or join a support group. Interacting with others not only engages your mind but also keeps you from isolating yourself, which can worsen symptoms.

• Do brain exercises
  Brain exercises can strengthen areas of cognition, such as memory or attention, and a few trials of cognitive training in PD have shown benefit. You can do cognitive training on a computer or in person, alone or in a group. For best results, work with a therapist to find the best program for you.

• Learn coping strategies
  Work with an occupational therapist or neuropsychologist to find techniques to help you remember things, pay attention or do your everyday tasks more easily.

• Take your time with tasks
  If you experience cognitive changes, certain tasks such as dressing or bathing may take longer. Rushing may make them more difficult. Give yourself extra time.

• Tell your family and close friends
  You aren’t alone. Build a support system around you. If you’re having trouble, let your family and friends know instead of trying to hide your symptoms.

• Seek help for depression or anxiety
  For many people, mood problems are part of Parkinson’s. These can interfere with cognition. Treating mood problems can improve cognition in some people.

Advancing Parkinson’s (In addition to all of the above)

• Follow a structured daily routine
  Maintain a regular sleep and wake schedule, eat meals around the same time, and incorporate activities (exercise and visits with friends, for example) each day. When there are cognitive changes, a predictable routine can help keep balance and avoid upset.

• Consider medication for cognitive impairment
  If cognitive changes interfere with daily activities, talk with your doctor about the potential benefits and risks of medication. Exelon (rivastigmine) is approved for PD dementia, and other medications can help with mood or behaviour problems that may go along with cognitive changes.

• Put advance directives in place
  A living will is a legal document that tells your family and physicians what care you’d want (a breathing machine, resuscitation if your heart stopped, etc.) if you couldn’t express your wishes. A health care proxy appoints someone to make medical decisions on your behalf if you are unable. No one enjoys having these conversations, but talking to your family and putting these documents in your medical record can be comforting and reassuring. (You can prepare these directives at any time in your Parkinson’s journey.)

• For care partners, take care of yourself
  You can’t take care of someone else if you aren’t taking care of yourself. Maintain your own identity through hobbies and social activities. Take breaks when you need them, and get support either online or in person. Make your own health a priority — eat a healthy diet, exercise regularly and keep doctors’ appointments. Know your own limitations and monitor for caregiver burnout.

Some of these recommendations are backed by strong evidence, while others are more anecdotal. In general, more rigorous research is needed. But with your physician’s guidance and the help of other specialists (physical therapists, nutritionists, neuropsychologists, etc.), many of these interventions can be individualized and incorporated into your care.