On the heels of brain awareness week, it seems only natural to discuss the cognitive changes that can accompany Parkinson’s disease (PD). As a speech-language pathologist, my lens is tailored to my scope of practice, which includes assessment and treatment of the executive functions of the brain. What are the executive functions? I thought you’d never ask.

Executive functions of the brain play a key role in the inner workings of daily routine. Here are a few of the executive functions I address regularly in my sessions:

This list only scratches the surface of the functions our brains complete on a daily basis. For now, we will take a shallow dive into memory, attention, and self-monitoring to find out how to balance brain skills when they begin to change. Part 2 will cover the other three areas. Stay tuned for more.

The executive functions of the brain impact complex tasks in daily life. A few examples are:

• managing finances
• planning and organizing the logistics of a social event
• multitasking with your personal planner
• managing the pressure of work deadlines

 
Executive functions also show up in mundane tasks including:

• washing the dishes
• getting dressed
• driving to the pharmacy
• making a phone call

 
Memory

This is a skill that is most commonly recognized when it begins to fade. Additionally, memory is the skill that people with PD and their family members most commonly report to me as problematic. There tends to be a lot of fear associated with memory loss. It is vital to remember that some changes in memory are considered part of the normal aging process. “Normal” might include misplacing your keys, finding your lost glasses on your head, or forgetting the exact location of where you parked after a shopping spree. Memory is an integral part and required skill of daily communication. If you find that memory is becoming more difficult for you, consider the next executive function as a tool to assist recalling and retaining information.

Attention

When describing attention to a patient, I always link my pointer fingers together and say, “Memory and Attention are best friends. You rarely see one without the other.” The statement you won’t remember what you weren’t paying attention to, borrowed from The Source for Executive Function Disorders by Susanne Phillips Keeley, also supports the same concept. If you find yourself struggling to focus, consider your environment and how you can adapt it to increase the likelihood of sustaining your attention. Think about the various “plates” you may be balancing and consider putting one or two down. Take the tie to identify someone reliable in your life who can help with tasks you are willing to distribute. Allowing someone to assist with your care also helps create an environment of trust, which is helpful for the next executive function.

Self-Monitoring

How often do you correct yourself? This skill is an easy one to lose track of, which is why it is helpful to have someone else serve as your “checks and balances”. Self-monitoring means that you can identify when you are behaving or thinking incorrectly or inappropriately and, as a result, change course. This skill is used when you are working on a project and have to redirect yourself when your attention is waning. This skill is used when you notice an erroneous calculation in the budget and go back to adjust the numbers. This skill is used when you are feeling really low and decide to grab a water and go for a walk outside. Each of these examples includes 1) noticing an error or undesirable behavior/thought and subsequently 2) addressing it by selecting a better option without being prompted.

Now you can thank your brain for doing all those amazing things without your command on a day to day basis! If you are struggling to complete cognitive tasks due to possible changes in your memory, inability to focus, or trouble with self-monitoring, it is important to speak with your neurologist. This healthcare provider will be able to make individualized referrals and recommendations around re-building your cognitive skillset and developing strategies to make living with cognitive changes more manageable.

In anticipation of Parkinson’s disease awareness month in April, there will be an intermission to focus on a few other topics. Come back May 1st for “Brain Change: When Cognition Blurs the View (Part 2)!