How mood and cognition affect Parkinson’s – Webinar notes

In early March 2020, Parkinson Canada offered a webinar on mood and cognition in Parkinson’s disease (PD), featuring social worker Adriana Shnall, PhD.  She provided an overview of mood and cognition symptoms, including depression, anxiety, social avoidance, disinhibition, increased emotion, decreased emotion (which can be a sign of apathy), and cognitive impairment.  Then Dr. Shnall discussed strategies for improving communication and working around these issues.

Though this webinar focused on Parkinson’s disease, all of the discussion of mood issues is relevant to disorders in the Brain Support Network community, which include Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration.

There was a good question-and-answer about apathy:

Q: Dealing with apathy is a great source of frustration for caregivers. At what point does encouragement on the part of the caregiver turn into nagging?

A: It can be a hard distinction. It is important to push a bit, since changes in the brain make it difficult for the person to take initiative anymore. Pick your battles. If going to see the grandchildren today is really important, but the person doesn’t feel motivated, push for that. If it’s something less important, maybe let it slide sometimes. Giving alternatives so that the person can make a choice is sometimes helpful.

While I didn’t think the discussion of cognition and psychosis was very helpful, I thought the discussion of communication issues was very good and applies to all of us in the BSN community.  Here’s a short excerpt:

What causes difficulties in communicating with someone who has PD?

  • Quieter voice: It can be harder to hear the person
  • Masked face: It can be harder to read their facial expression
  • Mood and cognitive issues: It can be harder for them to engage and express themselves

Strategies for better communication:

  • One-on-one conversations or smaller groups are best.
  • Reduce or eliminate distractions such as TV or music.
  • Sit close, make eye contact, and speak at eye level.
  • Encourage the person to take a deep breath when they start to speak, to help with speech volume. 
  • Give the person time to respond – it can take longer for a person with PD to express themselves.
  • Don’t make assumptions. 
  • Remain calm; smile.
  • Avoid using sarcasm, which can be misinterpreted.
  • Ask one question at a time, to avoid overloading.
  • Ask close-ended (yes or no) questions, which can be easier to answer than open-ended questions.
  • Give hints if the person is having word-finding difficulties.
  • Try to speak in short, simple phrases.

Watch the webinar recording on YouTube here:

Lauren Stroshane at Stanford Parkinson’s Community Outreach listened to the webinar and has shared her notes here: