Parkinson’s Cognitive Treatments & Assessments

Most people with Parkinson’s disease will experience cognitive decline. In fact, impaired cognition is the most common non-motor symptom of Parkinson’s disease (Alzahrani & Venneri, 2018).

While challenging for patients and their loved ones, speech therapy can help improve daily participation and safety. In this article, you’ll learn the ins and outs of Parkinson’s cognitive treatments, including:

• Best cognitive assessments for Parkinson’s disease
• Evidence-based cognitive treatments and strategies

Common Cognitive Changes In Parkinson’s Disease

Around 60% to 80% of people with Parkinson’s disease experience cognitive decline (Orgeta et al., 2020). In fact, cognitive deficits are often detected before the onset of motor symptoms.

While Parkinson’s disease can impact all areas of cognition, the greatest deficits are typically seen in:

• Executive functioning (problem solving, planning, task completion)
• Attention (sustaining focus, divided attention, etc.)
• Memory, particularly working memory
• Visuospatial skills (Rosca & Simu, 2020)

Cognitive Assessments for Parkinson’s Disease

A 2025 literature review by Severiano e Sousa et al. recommended the following cognitive assessment for people with Parkinson’s disease, particularly in the later stages of the disease. 

These assessments cover all relevant cognitive areas while minimizing motor demand:

• The Montreal Cognitive Assessment (MoCA) for global cognition and visuospatial function. 
• The Digit Span Backwards subtest of the Wechsler Adult Intelligence Scales (WAIS) for executive function and attention. 
• The Trail Making Test (TMT) for executive function and attention
• A semantic fluency task for attention, executive function, and language. 
• The Boston Naming Test (BNT) Short Version for language.
• The Judgement of Line Orientation (JoLO) for visuospatial function. 
• The Clock Drawing Test (CDT) for attention, executive function, and visuospatial function. 
• The Brief Visuospatial Memory Test-Revised (BVMT-R) for visual episodic memory. 
• The Rey Auditory Verbal Learning Test (RAVLT) for memory.

Why Parkinson’s Cognitive Treatment?

Cognitive deficits can impact all aspects of life, from following a conversation to staying safe to doing daily activities.

By assessing and treating cognitive deficits early, speech therapy can help patients improve their functional independence and quality of life.

Next, let’s dive into functional and effective cognitive treatments for people with Parkinson’s disease.

6 Parkinson’s Cognitive Treatments

Cognitive rehabilitation is a proven treatment for people with Parkinson’s disease who have mild cognitive deficits (Calleo et al., 2012; Gattoni et al., 2025). These treatments use targeted cognitive activities to restore or compensate for cognitive impairments caused by a brain injury.

Depending on their deficit, you may treat attention, problem-solving, memory, and/or executive functioning. 

Here are 6 evidence-based treatment ideas for your patients with Parkinson’s disease:

1. Functional Memory Tasks 

Target the memory deficits that are impacting your patient’s daily independence and safety, such as forgetting to take medications or forgetting appointments.

Here are example functional memory tasks:

• Practice filling a pill box
• Set alarms to remember to take medications
• Use a calendar to record and remember appointments
• Write down notes to remember what was said over the phone or during appointments

Read Memory Activities for Adults for more ideas.

2. Teach Memory Strategies

Teach patients with Parkinson’s disease how to use memory strategies to improve recall:

1. Pay Attention. Listen, look, and focus
2. Take a Mental Picture. Take a mental picture and store it in your brain. For example, visualize where you left your keys and take a mental picture.
3. Repeat and Rehearse. Repeat over and over what you have just learned, such as a new name or phone number.
4. Chunk and Organize Information. Sort information into categories. For example, organize your grocery list into groups, such as produce and canned foods.
5. Create Associations. Make connections between what you want to remember and what you already know. For example, remember a new name by connecting it to someone with the same name.
6. Use External Reminders. Use written, visual, and other external reminders to help you remember, such as an alarm, a checklist, or a sticky note.

3. External Memory Aids 

Teach people with Parkinson’s disease to use memory aids such as setting alarms, posting a large calendar, using a memory clock, and setting medication reminders.

Read 11 External Memory Aids For Dementia And TBI for more ideas.

4. Executive Functioning Strategies

TEACH-M is a proven strategy for improving executive functioning, attention, and memory deficits (Calleo et al., 2012).

TEACH-M is an acronym for Task analysis, Errorless learning, Assessment, Cumulative review, High number of practice trials, and Metacognition.

Follow these steps:

• Task analysis. Help patients learn new skills by breaking down a task into smaller steps. Teach each smaller step, then ‘chain’ them together.
• Errorless learning. The goal is for your patient to make as few errors as possible as they learn a new skill or a step of a skill.
  • First, model the skill
  • Focus on accuracy
  • Emphasize not guessing by giving as many cues as needed
  • If they make an error, give enough cues to elicit the correct response. For example, model the skill again
• Assessment. Monitor patient progress. For milder impairments, teach the patient to assess and monitor their own performance.
• Cumulative review. The patient regularly reviews all the steps they have learned at least once before attempting the task.
• High number of practice trials. The patient completes the entire task many times. But, prioritize doing the task correctly (errorless learning) over more repetitions.
• Metacognition. For cognitive treatment to be the most effective, patients must be aware of their cognitive deficits.
  • Before the task, ask the patient to predict how they’ll do
  • After the task, ask the patient to assess how they did
  • After the task, discuss how their prediction compared to how they actually did
• Meaningful. We added an extra M! Tasks that are meaningful to the patient lead to better results.

Learn more about TEACH-M For Memory & Executive Functioning

5. Other Functional Cognitive Activities

Target attention, problem solving, sequencing, visuospatial skills, and other cognitive skills with targeted functional cognitive activities. Again, focus on deficits that are relevant and important to your patient.

Here are example activities.

• For attention, practice reading with background noise
• For problem solving, ask patients to generate solutions to common issues, like what to do if they run low on prescription medications
• For sequencing, practice multiple-step tasks, like making a meal
• For visuospatial skills, practice scanning functional material, such as their own reading material, or by scanning the person’s environment to navigate the space

Read 21 Effective Cognitive Rehabilitation Exercises for more ideas.

6. Care Partner & Family Training

Speech therapy can teach care partners how to better support their loved one’s cognition, communication, and swallowing safety.

You may teach strategies, such as having a routine and using visual aids. Or share tips for improving the environment by decluttering and choosing the right chair for better posture.

We put together 17 Parkinson’s Care Partner Support Tips for more actionable ways that speech therapy can support care partners.

Dementia & Parkinson’s Disease?

Unfortunately, patients with Parkinson’s disease are also at a higher risk of developing dementia.

A 2024 study by Gallagher et al. found that 9-27% of patients with Parkinson’s disease were at risk of dementia 10 years into the disease, 50% at 15 years, and 74% at 20 years.

If your patient with Parkinson’s disease has been diagnosed with dementia, it may help your treatment planning to start by staging their level of dementia. Examples of dementia staging tools are the Clinical Dementia Rating Scale (CDR®), Global Deterioration Scale, and FAST Dementia Staging.

With these patients, focus your Parkinson’s cognitive treatment on external aids, environmental modifications, and care partner education.

References

• Alzahrani, H., & Venneri, A. (2018). Cognitive Rehabilitation in Parkinson’s Disease: A Systematic Review. Journal of Parkinson’s disease, 8(2), 233–245. https://doi.org/10.3233/JPD-171250
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Calleo, J., Burrows, C., Levin, H., Marsh, L., Lai, E., & York, M. K. (2012). Cognitive Rehabilitation for Executive Dysfunction in Parkinson′s Disease: Application and Current Directions. Parkinson’s Disease, 2012(1), 512892. https://doi.org/10.1155/2012/512892
• Ehlhardt, L. A., Sohlberg, M. M., Glang, A., & Albin, R. (2005). TEACH-M: A pilot study evaluating an instructional sequence for persons with impaired memory and executive functions. Brain injury, 19(8), 569–583. https://doi.org/10.1080/002699050400013550
• Gallagher, J., Gochanour, C., Caspell-Garcia, C., Dobkin, R. D., Aarsland, D., Alcalay, R. N., Barrett, M. J., Chahine, L., Chen-Plotkin, A. S., Coffey, C. S., Dahodwala, N., Eberling, J. L., Espay, A. J., Leverenz, J. B., Litvan, I., Mamikonyan, E., Morley, J., Richard, I. H., Rosenthal, L., Siderowf, A. D., … Parkinson’s Progression Markers Initiative (2024). Long-Term Dementia Risk in Parkinson Disease. Neurology, 103(5), e209699. https://doi.org/10.1212/WNL.0000000000209699
• Gattoni, M. F., Gobbo, S., Feroldi, S., Salvatore, A., Navarro, J., Sorbi, S., & Saibene, F. L. (2025). Identification of Cognitive Training for Individuals with Parkinson’s Disease: A Systematic Review. Brain Sciences, 15(1), 61. https://doi.org/10.3390/brainsci15010061
• Orgeta, V., McDonald, K. R., Poliakoff, E., Hindle, J. V., Clare, L., & Leroi, I. (2020). Cognitive training interventions for dementia and mild cognitive impairment in Parkinson’s disease. The Cochrane database of systematic reviews, 2(2), CD011961. https://doi.org/10.1002/14651858.CD011961.pub2
• Rosca, E. C., & Simu, M. (2020). Parkinson’s Disease-Cognitive Rating Scale for Evaluating Cognitive Impairment in Parkinson’s Disease: A Systematic Review. Brain Sciences, 10(9), 588. https://doi.org/10.3390/brainsci10090588
• Severiano E Sousa, C., Alarcão, J., Pavão Martins, I., & Ferreira, J. J. (2024). Cognitive testing in late-stage Parkinson’s disease: A critical appraisal of available instruments. Applied neuropsychology. Adult, 31(2), 191–202. https://doi.org/10.1080/23279095.2022.2114355