As promised, we will continue the cognition conversation today with Part 2 of executive functions that can change with Parkinson’s disease (PD). In review, the executive functions of the brain play a key role in the inner workings of daily routine. Individuals with PD may experience various changes in cognition and I have selected six cognitive skills that I treat most frequently in therapy sessions as a speech-language pathologist. The first post on cognition covered brain functions including memory, attention, and self-monitoring. Today we will take a look at three more: problem-solving, planning, and organization.

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

• driving to a new location
• balancing the family budget
• facilitating a team meeting at work
• managing medications and medical appointments

 
Executive functions also show up in everyday tasks such as:

• sorting the laundry
• recalling information from a visit with a physician
• listening to a conversation with background noise
• getting out the door on time for events or appointments

 
Problem-Solving

Problem-solving is one of my favorite skills to address in therapy because there are many effective strategies. If negative cognitive changes become apparent, problem-solving is often one of the first responsibilities taken over by a designated loved one, which can be a difficult transition. If you are looking to improve or maintain your skills in problem-solving, consider these questions: Can you identify the problem? Are you able to pinpoint viable solutions independently? How often do you carry out the solutions effectively? Focus on answering and carrying out these questions for day-to-day responsibilities in order to strengthen your independence.

Planning

Take a moment to list three tasks that require planning. Here are some examples from my life: social gatherings, time for self, time for others, work projects, walking the dog, finances, groceries and meal preparation. You may believe that most of these tasks occur by default, requiring little thought. However, if you experience obstacles with planning, managing time and identifying critical steps does not come naturally. Susanne Phillips Keeley, in The Source for Executive Function Disorders, suggests a strategy called “Plan-Execute-Repair.” The strategy focuses on the following:

1. Make a plan

2. Identify the steps of executing the plan

3. Establish a back-up plan; a way to repair things if the logistics don’t pan out

Try integrating this strategy when you anticipate being successful. As you master the small tasks, graduate to the more complex ones.

Organization

You could argue that organization and planning are analogous skills in some contexts. Organization and planning are solidly linked by the involvement of time management. A key difference in the two is that planning requires you to identify the steps involved and organization requires the comprehension and accurate sequencing of those steps. Sequencing allows you to complete tasks such as forming a cohesive thought, making dinner, or balancing the checkbook. All of these require cognitive organization in order to complete it successfully. If you discover your thoughts are scattered or you start an activity only to forget what you were doing in the first place, take the time to prioritize your responsibilities for the day. Don’t rush to make everything organized, just tackle one corner of your brain, one topic of conversation, or one room in the house at a time. And go easy on yourself!

Your brain works to balance all the plates of responsibility on a day to day basis. However, if you are struggling to complete cognitive tasks due to possible changes in your ability to problem-solve, plan appropriately, or organize your thoughts and responsibilities, speak with your neurologist. Your healthcare provider can make individualized referrals and recommendations around re-building your cognitive skillset and developing strategies to make living with cognitive changes more manageable.