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Brain Fog/Cognitive Problems

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To start with, I am newly DX(Sept 2013) with atypical PD with dopamine receptive tremors(he said mine is aggressive for some reason), dystonia and I also have SLE with all the stuff that goes with that.  So sorry if this is kind of long.


 I have been having severe problems with cognitive function. My wife says I constantly repeat myself and I have a problem remembering words so it sounds like I'm stuttering.(I have to pause to remember the words or I will completely redo a sentence to avoid the word) I also forget where I put things, when to take meds, my short term memory is terrible and ANY kind of stress makes everything much worse. And my voice sometimes fades in an out. (This is new)  


 I did see a speech therapist at UCSF(when I was DX in Sept) and she did a memory test on me and I didn't do that well I forget what she called the test but it was where I had to count forward then backward also had to repeat a series of words/phrases also the months of the year forward then back, looking at pictures and doing word association. I did OK on the forward stuff but going backward she said I missed a few numbers and 3 of the 12 months, and on the remembering words and numbers series I did miss a few as well. She also did a swallow study and that was OK, she said that my swallowing was slow but no dysphasia yet. And my voice at the time was OK.


 Are these related to PD or are they SLE or maybe a little of both?  Also should I start seeing a speech therapist?


 Thanks for your help




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Without seeing you in person it is not possible for me to tell you whether the symptoms you are experiencing are the result of PD or SLE.  I can tell you that slowness of thinking and changes in cognition do occur in people with PD along with motor changes.  The experience of having difficulty with memory or making the words come out is very common for people with Parkinson's disease.  It can have a negative impact on quality of life and I am glad that you wrote to learn more about it.


The difficulties initiating speech and slower thinking are similar to difficulties in limb movements with delayed initiation and slowness of movement.  Bradykinesia is the term typically used to describe this slowed initiation of movement.


Speech problems have been reported to occur in as many as 89% of people with PD.  The most common difficulties reported are reduced vocal loudness, monotone, mumbled articulation and a hoarse or breathy sounding voice in addition to difficulty with your voice fading in and out that you wrote about.   The underlying cause of speech and voice difficulties has multiple sources:

  • Reduced vocal fold adduction
  • Reduced mouth opening
  • Decreased dynamic modulation of muscles of articulation
  • Mismatch between the person’s perception of their loudness during communication and actual levels of loudness

Many times there is also a mismatch between the person’s perception of their loudness during communication and actual level of loudness and understandability.  For example, someone with PD may think people in their family need hearing aids when in fact it is the person with PD who is speaking too softly to be easily understood.


Unfortunately, the medications that can be so helpful for improving limb movement don’t always have a positive impact on bradykinesia for movement of speech muscles.  That is why people who have communication difficulties as a result of PD need behavioral speech treatment.


The good news is that speech treatment may help you.  I recommend that you speak to your physician and get a referral to a speech-language pathologist (SLP).  Find an SLP who is experienced in treating communication deficits associated with PD.  That person will do an evaluation to determine how much of your difficulty is due to changes in speech motor control and how much may be caused by changes in cognitive/linguistic abilities.  I hope this information helps and that you will seek an evaluation soon to get started on improving your communication skills.  Please write again if you have any additional questions.


Dr. Mahler

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Thanks so much for your help. My PCP and I are really trying to find one in my local area that will take me.

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The LSVT LOUD website has a list of certified clinicians listed geographically.  You could go to the LSVT Global website at www.lsvtglobal.com and select "Find a Clinician" to find a therapist in your area.


LSVT LOUD is a specific speech and voice treatment for people with PD so if a therapist is certified then they are more likely to have a special interest or experience in the communication deficits specifically associated with PD.


I wish you the best in finding the help you need.


Dr. Mahler

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