During our November Live Well Today webinar, Dr. Jori Fleisher shared practical advice for care partners and people with Parkinson’s about navigating advanced Parkinson’s.

Dr. Fleisher discussed tips and tools that can help you manage challenges you may face as Parkinson’s advances, including cognitive decline, apathy and fatigue, difficulties with sleep, speech and swallowing disruption, and urinary and digestive issues.

You can watch or listen to the webinar below. Subscribe to our YouTube page to be notified whenever we upload new content. 

SHOW NOTES

Regardless of how long you’ve been living with Parkinson’s, your experience is complex and personalized. As you age and your Parkinson’s advances, you will experience changes in your symptoms. Your medications, dosing schedules, and other therapies will be updated. Your home environment may be adapted. But one thing remains constant–the importance of seeking out the care you need and taking action to live well.

As Parkinson’s advances, remember too that Parkinson’s is not just a movement disorder. Many people report that the non-motor symptoms actually have a greater impact. The most important thing to know about non-motor symptoms is that for every non-motor symptom you experience, there is likely someone who can help you manage it.

With this in mind, be sure you speak up about the symptoms that are most impactful in your life, and ask for referrals if your primary provider isn’t able to offer the particular kind of care you need.

Cognitive Challenges as Parkinson’s Advances

Parkinson’s can slow down your ability to think and process information. It alters many regions of the brain and this can lead to impairments in executive function, language, and memory. Parkinson’s can also cause visuospatial changes and neuropsychiatric symptoms, like delusions and hallucinations.

Executive Function Changes

Challenges related to executive function often increase as Parkinson’s progresses, though the changes are typically gradual. You may find your decision-making skills and problem solving abilities may seem less sharp. Multi-step or complex tasks may become more difficult, and you may find it challenging to follow directions or remember names.

Visuospatial Changes

Visuospatial changes can increase as Parkinson’s progresses. These changes relate to how people see and and understand the world around them with regard to spatial relationships. Visuospatial changes may mean you lose your sense of direction more easily. It can also affect your gait and can increase your risk of falls by worsening your depth perception.

Neuropsychiatric Changes

Neuropsychiatric symptoms also grow more common as Parkinson’s progresses. These are often lumped into a term called Parkinson’s Disease Psychosis (PDD), a non-motor symptom that causes people to experience hallucinations and/or delusions. Approximately 50% of all people living with Parkinson’s will experience some form of hallucinations or delusions, and the longer someone lives with Parkinson’s, the greater the likelihood they’ll experience them.

• A hallucination is something someone sees, hears, smells, tastes or feels that’s not actually there. Essentially, they’re tricks that the brain plays on the senses.


• Delusions, which are less common than hallucinations in Parkinson’s, are fixed beliefs about things that aren’t true; they often manifest as paranoia or suspicion.

It is important to remember that in Parkinson’s cognitive changes–like other changing symptoms–are subtle. If you or your loved one experiences a cognitive episode that comes on suddenly, you should reach out immediately to your physician. For example, if you’ve never had hallucinations and all of the sudden have one, it’s unlikely that the hallucination was caused by Parkinson’s. It could, however, be caused by a serious medical condition like an infection, so it’s essential that you notify your physician right away.

How to Manage Advancing Cognitive Changes

Although changes in cognition are common as Parkinson’s progresses, there are several strategies you can employ to help manage these symptoms and continue living well. Dr. Fleisher broke these strategies down into two categories: non-medication-related and medication-focused.

Non-medication strategies

• Exercise, exercise, exercise. Any type of aerobic exercise may help slow down your Parkinson’s progression and help manage symptoms. Find a mode of ex