How Parkinson's Impacts Communication
Part 3: Seven Things I've Learned from Working with People with Parkinson's Disease. A Speech Pathologist's Perspective.
By Sophie Walsh, Senior Speech Pathologist
6. Cognitive changes and the rhythm of conversation
Parkinson’s doesn’t just impact movement, it can also impact cognitive functions like attention, memory, problem-solving, and word-finding. Many people notice they lose track of their thoughts mid-sentence, struggle to find the right word, or need longer to respond.
In conversation, this might look like:
Delayed responses (pauses between questions and answers)
Repetition or drifting off-topic
Difficulty keeping up in group conversations
Trouble shifting between topics
These changes can be subtle at first, but they impact confidence and communication flow. The key is patience and support. Giving someone more time to speak, limiting distractions, and using cues or visuals can go a long way in making communication smoother and less stressful.
And just like movement, swallowing or speech, cognition can be supported with the right strategies, to varying degrees depending on how long a person has been living with PD. This might include cognitive rehab, mindfulness, structured routines, and gentle reassurance and encouragement.
7. Flat affect and social connection
One of the more subtle and emotionally challenging aspects of Parkinson’s is flat affect - a reduced ability to show facial expressions. It can look like someone is disengaged, when in reality, they may be feeling a lot internally. This has left me questioning how well (or not) my jokes have landed on a number of occasions in therapy sessions!
Combined with slightly slower processing speed and cognitive changes outlined above, this can really impact relationships. Conversations can feel one-sided or awkward, not because of disinterest, but because the person with Parkinson’s is simply taking longer to respond, or struggling to initiate speech.
These changes can impact self-esteem and lead to withdrawal from social settings, but they’re not signs of changes to personality or intellect. Often when given time to respond and the right tools to get their message across, personality, humour and perspectives about the topic at hand can be communicated effectively.
Helping friends and family understand what’s happening “behind the scenes” can rebuild connection and reduce frustration.
Final Thoughts
Parkinson’s disease is complex, but it’s not a one-way street. With knowledge, effort, and the right supports, people can and do find new rhythms. Whether it’s getting your voice back, navigating mealtimes more safely, or staying connected in conversations - these challenges are manageable, especially when addressed in early stages.
