PIP Review and Cognitive Impairments

Since his initial PIP assessment in 2019, my husband has been diagnosed with cognitive impairment. This is in addition to Parkinson’s.

He’s on medication that treats mild to moderate dementia although that diagnosis has not yet been made. (His ACE 111 score is within the mild dementia range).

Clearly this has a global impact on his function. There doesn’t seem to be much in the guides in terms of dealing with such a condition.

The Decision Maker in 2019 noted he had mild impairment in cognition but deemed his insights to be adequate and not requiring prompting. Three years on and he no longer reads, uses the internet, gets utterly confused by the tv remote, cannot follow plot lines etc. He would have no chance at all of planning and following a route; he gets very confused and disoriented. He also experiences hallucinations.

Is there any advice I’ve missed in the guides about this? Or any you can offer?

Or is the diagnosis of Cognitive Impairment and the medication sufficient? (Of course I shall be documenting the changes for each activity. I’m wondering if the diagnosis carries much impact).

Thank you.

Dear Magdalena

Sorry to hear about your husband’s cognitive impairments.

Please give as much information as you can when answering the descriptors as I’m sure your husband will be really struggling with his activities of daily living. Here’s a few example to think about …. can he wash himself without prompting or maybe he washes but forgets to use shower gel. Can he dress himself without any help or does he put his clothes on in the wrong order eg trousers first then underwear over them. Can he make a cup of tea or does he forget to use boiling water or forgets to put the teabag in the drink?

Over the next few days take a step back and try not to prompt your husband on everything he does. Then you make some notes on all the things that aren’t right as this then can be used to evidence some of the descriptors. Also, add all the things he can no longer participate in and state why he can’t do them.

Good luck with it

Thank you so much for your answer. Could you share your thoughts on this next question too please.

With Parkinson’s, cognitive impairment and dementia are viewed as being different from Alzheimer’s and other forms of dementia because it’s seen as a progression of Parkinson’s rather than two separate diagnosis (ie. Parkinson’s AND dementia).

Parkinson’s dementia is also different in that both cognitive and motor functioning are impacted rather than just the cognitive, and the range of cognitive abilities affected are wider.

Since we’re in the early days of this (and pray it won’t get worse and progress to a full dementia diagnosis), my husband’s cognitive impairment is being managed by his consultant neurologist and the specialist team who care for him.

I was reading the PA4 form from his face to face assessment from three years ago and noticed that the health professional mentioned a couple of times that my husband hadn’t been referred to the memory clinic.

As an aside I’m very familiar with this as my mum (who passed recently) had a mixed dementia diagnosis.

This isn’t necessarily what happens with Parkinson’s as getting the balance right in terms of medications can be tricky. My husband is on the standard medication for Parkinson’s dementia already so I’m not sure what, if anything, a referral to the memory clinic would serve.

Long story short, I’m worried that the absence of such a referral would go against him. Should I explain the situation in the Additional Information Section?

Many thanks for your reply. You are helping me untangle all of this. May I prevail upon you to answer one more question?

On the original PIP2 form I told them that my husband had Parkinson’s Disease and Dysexecutive Syndrome (DSE) which is how the general cognitive problems in Parkinson’s are described.

While reading the PA4 form in the justification for descriptor choice the health professional repeatedly states:

“FME supports condition, IOs/CSE showed mild impairment to cognition however he showed good insight and cognition overall”

Sometimes she adds a few other comments.

When explaining her decision, the DM states “You had a mild impairment with cognition, insight, intellect and memory however you were able to understand the assessment process well.”

He didn’t receive any points regarding this.

I’m slightly concerned that these references to mild impairment in cognition (all small case) may be somehow lead a diagnosis of Mild Cognitive Impairment (MCI) to be played down. MCI is an actual diagnosis in its own right and in my husband’s case, a progression of Parkinson’s.

I just to want to ensure there’s no confusion here because the poor man has deteriorated.