Topics of interest · Movement disorders
Parkinson's, movement disorders and deep brain stimulation.
How thinking can change in Parkinson's and related conditions, why an assessment helps, and how a neuropsychologist contributes to a deep brain stimulation team.
Parkinson's disease is often thought of as a movement condition, but it can affect thinking, mood and sleep as well. Understanding that fuller picture helps people plan and make decisions with confidence.
This page explains how thinking can change in Parkinson's disease and related movement disorders, why a careful assessment is worthwhile, and the part a neuropsychologist plays when someone is considering deep brain stimulation surgery. Our role is assessment, baseline and monitoring, and support. We are not a surgical service; surgery and medical treatment are provided by neurologists and neurosurgeons.
Thinking and movement
How thinking can change
Many people with Parkinson's notice no change in their thinking at all. For others, certain thinking skills can become slower or less reliable. Knowing which, if any, are affected is useful information.
- Planning and mental flexibility (sometimes called executive skills, the brain's planning and self-management system) can become slower or take more effort
- Attention and processing speed can vary, so that thinking and reacting take a little longer
- Memory may be affected, though often it is the retrieving of information rather than the storing of it
- Visuospatial skills, such as judging space and distance, can change
- Mood, motivation and sleep often shift alongside the condition, and these in turn affect thinking
- Some people develop mild cognitive impairment, and a proportion go on to develop a dementia associated with Parkinson's; an assessment helps tell these apart from ordinary variation
Internationally agreed criteria (the Movement Disorder Society) describe how cognitive change in Parkinson's is recognised, including a brief screening level and a more detailed neuropsychological level. A detailed assessment fits the more thorough of these.
Why assess
Why an assessment helps
A careful look at thinking answers practical questions and gives the treating team objective information to work with.
- It describes which thinking skills are affected, and which remain strong, so support can be matched to the person
- It separates the effects of mood, sleep, fatigue or medication from a settled change in thinking
- It sets a baseline so that change can be measured over time rather than guessed at
- It informs decisions about work, driving and the supports a person needs
- It contributes to planning for deep brain stimulation, where thinking is an important part of the assessment
- It supports related conditions too, including atypical parkinsonian conditions, essential tremor, dystonia and other movement disorders, where a thinking profile aids diagnosis and planning
For cognition in other neurological conditions, such as multiple sclerosis, epilepsy, stroke or brain tumour, see our neurological conditions page.
“Understanding thinking, not just movement, helps people plan with confidence.”
Deep brain stimulation
The neuropsychologist's role in a DBS team
Deep brain stimulation (DBS) is a surgical treatment that can help selected people with Parkinson's disease and some other movement disorders, mainly by improving movement symptoms. It is not a cure, and it is not right for everyone. Deciding whether it is suitable is the work of a multidisciplinary team.
A DBS team typically brings together a neurologist, a neurosurgeon, specialist nursing, and a neuropsychologist, with psychiatry and other specialists as needed. The team weighs up the likely benefits and risks for each person, and the final decision is a shared one. Thinking and mood are an important part of that picture, which is where neuropsychological assessment contributes.
We regularly provide neuropsychological assessment for the deep brain stimulation service at Gold Coast Private Hospital, working alongside the treating team.
Before surgery
Assessment before surgery
Before DBS, a neuropsychological assessment helps the team understand a person's thinking and mood as part of deciding whether surgery is likely to help and is safe to proceed with. It provides a careful baseline against which any later change can be measured. Because thinking and mood can influence both the decision and the outcome, this part of the assessment is given real weight by DBS teams.
After surgery
Assessment after surgery
After DBS, a follow-up assessment compares thinking against the baseline taken beforehand. Most people are stable, while a smaller number show some change, particularly in attention and planning. Comparing like with like lets the team see clearly what has changed and what has not, and helps guide support afterwards.
We do not perform surgery or program the device. Our contribution is the assessment, the baseline, and the follow-up comparison, provided to the treating team to inform their decisions.
What is involved
A calm, unhurried assessment
A typical assessment includes a clinical interview, a testing session, and time for scoring, interpretation and a written report. Plan for a morning or an afternoon, sometimes split across two visits. Where possible, and with consent, we like to speak with a family member or someone who knows the person well. Being rested helps; it is useful to bring glasses and hearing aids if used, a list of medications, and any previous reports or scans. For people with Parkinson's, it is worth noting when medications are due, as timing can affect how a person feels during testing.
The written report sets out the cognitive profile in plain language, answers the referral question, and gives practical recommendations. With your consent, we share it with your neurologist, surgical team or other treating clinicians.
Cost & funding
Clear on cost before we begin
Neuropsychological assessment is not rebated under Medicare's Better Access program. Assessments are commonly funded privately, or through the NDIS, DVA, WorkCover Queensland or insurers. Where an assessment is arranged as part of a hospital DBS pathway, the funding arrangement is confirmed in advance. We confirm the funding pathway before booking. See our Fees and Policies page.
Take the next step
If you or someone you care for has Parkinson's disease or another movement disorder and a question about thinking, request an appointment or call 0452 452 262. Neurologists and other specialists can refer through our referrer page. You do not need a referral for a private appointment.
Request an appointmentSources: Litvan I, Goldman JG, Tröster AI, et al., Diagnostic criteria for mild cognitive impairment in Parkinson's disease: Movement Disorder Society Task Force guidelines, Movement Disorders, 2012 (Level I and Level II assessment). Emre M, Aarsland D, Brown R, et al., Clinical diagnostic criteria for dementia associated with Parkinson's disease, Movement Disorders, 2007. Lang AE, Houeto JL, Krack P, et al., Deep brain stimulation: preoperative issues, Movement Disorders (CAPSIT-PD recommendations on multidisciplinary assessment, including neuropsychology). Rossi M, Bruno V, Arena J, et al., comprehensive multidisciplinary DBS screening, and reviews of cognitive outcomes after subthalamic DBS in Parkinson's disease. This page is general information, not medical advice.