Cognitive deficit can impede conversation for Parkinson's patients

By Lorraine L. Janeczko

NEW YORK (Reuters Health)  Cognitive impairment, more than physical speech problems, may make it difficult for people with Parkinson's disease (PD) to carry on a conversation, according to new research from the UK.

"When you think about a patient with Parkinson's who is struggling to communicate, it is the poor speech quality that you initially notice. However, on speaking with people with Parkinson's, you rapidly realize that the issue is more complex, and problems like struggling to find the right word, keeping up with changes of conversation topic, or responding fast enough to keep in the conversation hugely impact their confidence and willingness to communicate in everyday life," Dr. Katherine Deane, of the University of East Anglia in Norwich, told Reuters Health by email.

"Cognitive impairment can negatively impact how health professionals work with people with Parkinson's. It can give an impression of dementia, or reduce the accuracy of assessments," Dr. Deane said.

"Many people with Parkinson's have problems with communication. Clear communication is critical to ensure good clinical care, but it also has a huge impact on the quality of life of people with Parkinson's. Explaining to patients how cognitive impairments impact communication could substantially improve their well-being," she advised.

Dr. Deane and colleagues conducted a systematic review to assess whether cognitive or physical speech problems create the main obstacles to communication. They reviewed 4,832 studies, found 12 relevant studies, and reported their results in online March 16 in the Journal of Parkinson's Disease.

Nine of the ten studies that assessed the role of cognitive status found evidence for an association, whereas the contribution of physical deficits to everyday communication difficulties "appeared of modest magnitude," the authors report.

"The first key conclusion of this systematic review is that we found evidence to suggest that both cognitive status and (physical difficulties) may be associated with everyday communicative outcomes in PD," they wrote. "The second key conclusion is that the contribution of (physical impairments) to everyday communication, while statistically significant, appears to explain a relatively small proportion of the variance in everyday communication outcomes. This, in turn, suggests that other factors beyond predominantly motor-driven impairment . . . may play an important role in everyday communication difficulties in PD."

Dr. Deane suggested a few strategies for health care professionals who interact with patients with PD, to reduce frustration and improve interactions:

- "Wait one minute for answers. Don't jump in and explain or rephrase, but give your patient enough time to respond.

- "Reduce distractions. Face your patient away from windows and turn off radios, TVs, and other media to help focus your patient's cognitive capacities on answering your questions.

- "Theme and title your questions. Group your questions in logical order and introduce each change of subject. For example: 'I need to ask you about things you do in the bathroom. Do you have any problems getting on and off the toilet?' (Wait for answer). 'Do you have any problems brushing your teeth?' (Wait for answer). 'Thank you for talking to me about things you do in the bathroom. Now I want to talk about things you do in the kitchen.'

- "Accept help. For someone with Parkinson's, communicating can be very effortful and tiring. If the patient gives you permission, ask the carer to answer more general questions and ask the patient to answer critical questions. For example, get a list of medications from the carer, then ask the person with Parkinson's whether they have difficulty swallowing their pills."

The authors wrote that limitations to their analysis included the cross-sectional design of most studies, high risk of bias, and low sample size, and they advised caution in generalizing beyond their sample.

Dr. Deane suggested further research to develop strategies to help people with Parkinson's work around their cognitive impairment and maximize their capacity to communicate, with the involvement of family and friends to ensure that everyone involved is considered in a cohesive strategy.

The authors reported no external funding or disclosures.

SOURCE: http://bit.ly/1o0YwoR

J Parkinsons Dis 2016.

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