Taxing Cognitive Changes

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Cognitive Changes From PD Can Be TaxingNick Kenrick. via Foter.com / CC BY-NC-SA

We are now leaving tax season and this can be quite a blessing for many families struggling with PD. There is nothing that raises anxiety for a person with PD more than a tax form and April 15 deadline. This situation becomes a Sword of Damocles that causes hours of needless agitation. It also provides some insight as to how brain trauma arising from the progression of the disease can appear in some seemingly unrelated places.

I have selected the tax dilemma because it is a common manifestation of significant change in executive function. Men and women who have managed the family taxes for many years suddenly find themselves increasingly at sea over how to proceed with this process. There is a disruption of reliable problem solving ability.

To start any task, it is necessary for a person to develop a strategy for attacking the problem. One must establish a starting point then break the task into any number of smaller steps which need to be placed in some cohesive order. If circumstances or a new insight change the order of these steps, it is necessary for a person to possess some cognitive flexibility to shift the steps in the solution appropriately. It is then necessary to move through the steps in some coordinated fashion until they reach a satisfactory conclusion. Although this is a somewhat oversimplified overview of problem-solving, it provides a handy illustration of how this process can go awry for someone with advancing PD.

As in years past, documentation is sorted into piles that should allow for systematic and entry into the tax forms. However, growing changes in executive function often cause a person to have difficulty organizing the information and figuring how to proceed. Often, they gather up their documentation only when Tax Day is looming, rather than as they go along through the year. In some cases, the documentation is scattered or misplaced, a sign of growing disorganization. Assuming the information has been gathered, many with PD find that they are unable to break the task into meaningful subroutines and even if they do, may find it impossible to prioritize these routines. And should the priorities prove unwieldy, a person with Parkinson’s may be experiencing such rigid thinking that they simply do the same task over and over (called perseveration by the medical community).

Most significantly, the recognition that the task is much too large to manage can result in a grinding anxiety. No amount of reassurance from friends, family or tax accountants can save them from their absolute certainty the IRS will have them targeted.

In an April 28 Washington Post article, Nicole Anzia wrote, “No one likes tax time, which is why most of us do our best to forget about it until we absolutely have to think about it. But with just a little bit of organization and maintenance during the year, next April will be less taxing.”

Perhaps. Unless one’s Parkinson is making the organization and maintenance difficult, if not impossible.

Beating Parkinson's One Family at a Time