In Parkinson’s, the most basic symptoms are; tremor (trembling or shaking), stiffness, and slowness of movement. These are called the Motor symptoms.
Other symptoms like; difficulties in maintaining posture and balance, soft speech, problems with urinating, slow bowel movements and sleep disturbances may also be experienced. These are the Non-motor symptoms.
As a result of these symptoms the smooth carrying out of daily activities and everyday routines may be affected. A characteristic of Parkinson’s is that symptoms can change from day to day and sometimes even from hour to hour.
The Motor Symptoms in Parkinson’s
The three chief motor symptoms that characterize the diagnosis of Parkinson’s are called the Triad of symptoms.
- Tremors; a trembling of the limbs that usually affects the hands and feet but may sometimes also affects the lips, tongue, jaw, abdomen and chest.
Characteristically, the tremors occur in the affected area when it is at rest and disappear during a movement. Therefore, these tremors are called Resting Tremors
- Rigidity; or muscular stiffness, wherein the affected muscle seems in a state of tension or contraction and is unable to relax even while at rest. This is responsible for the aches and pains in the body. Such rigidity is called Plastic or Passive rigidity - there is a constant uniform resistance to passive movement or manipulation of the limbs and muscles.
- The slowness of bodily movements is called Bradykinesia. This involves not only slowness in carrying out a movement, but also hesitancy in initiating a new movement and fatiguing easily.
There appears to be a decrease in the performance of automatic movements like; eye blinking, swing of the arms while walking, hand gestures while talking, expressive facial movements etc. Bradykinesia can also cause;
- Difficulties with rolling over in bed or getting out of a chair.
- A distinctive change in the handwriting: progressively, moving across the page, letters get smaller and less legible.
Change in posture and difficulties in balance are other important motor related symptoms associated with PD.
With time changes maybe seen in ones gait or walking like; steps become small, shuffling of feet, difficulties with turning (in fear of loosing balance) etc.
Medications help bring some of the symptoms under control. And exercise enhances the effects of the medication and works to maintain muscle agility.
Exercises can reduce stiffness and improve mobility, posture, balance and help overcome problems related to balance and walking. It greatly improves the quality of ones daily life with its direct impact on certain symptoms like stiffness and slowness.
The Non-Motor Symptoms of PD
In addition to the motor symptoms, PD can result in other symptoms in varying degrees. Some of the frequent non-motor symptoms are;
- Constipation - caused by the muscles of the bowel moving more slowly than usual, together with the effects of less physical activity and/or a poor diet. This particular symptom is relatively easy to treat- either through the sensible use of diet and exercise, or by receiving medication from the doctor.
- Skin Sensations and Pain - Patients may experience cramps, aches and feeling of numbness, tingling sensation, coldness, or burning. This most frequently occurs in legs, although lower back pain and head aches are also common.
- Speech & Swallowing Difficulties - Changes to the function of facial/throat muscles can also affect the voice in some people with Pd, producing speech that may be quiet, hoarse, hurried or hesitant. Difficulties in chewing, swallowing, drooling and dryness of the mouth may also be experienced. Guidance from a speech and language therapist should be sought for these difficulties..
- Tiredness or Fatigue - Fatigue is physical and/ or mental exhaustion that is very common in PD. It maybe one of the first symptoms to appear. This can be improved with regularized exercise and rest schedule. If the fatigue is associated with a secondary cause like depression or sleep problems then they should be assessed and treated first.
- Sleep Disturbances - such as excessive sleepiness or a lack of restful sleep maybe experienced. Such disturbances maybe a result of one of the symptoms that make it difficult to feel restful, e.g., pain, stiffness or anxiety. Alternatively, sleep may be affected by a PD medication aswell.
- Depression - is commonly experienced in PD, sometimes in response to the diagnosis and sometimes it is caused by the condition itself. Signs of depression include a negative view of oneself, the environment and the future; loss of motivation, energy, and interest (including social and sexual); poor sleep and memory; and a decreased appetite. Depression is treatable and must be discussed with ones doctor.
* We would like you to Note - This is not an exhaustive list, just a mention of the more frequently seen features.
Motor Fluctuations in PD
In PD, there are times when symptom control is good and the medication seems to be working well- this is called the "ON" time. At other times, symptom control may be poor- this is called the "OFF" time. Motor fluctuations refer to a state where a person with PD changes frequently between ON time and OFF time. Understanding the shifts between ones ON and OFF time is important and can help one manage ones medication better and understand its efficacy.
Another change in symptom control is seen at the peak of levodopa absorption, when a person may experience restless movements known as dyskinesias- almost as if there was ‘too much’ movement.
Wearing - off is a phrase commonly used to describe the period of time between the end of the effect of one dose, and the beginning of the next one. That is, the beneficial effects of the previous dose appear to be wearing off. The time when the ‘on’ time is over and the ‘off’ time has become apparent.
A doctor maybe able to reduce the effects of wearing off by recommending;
- Smaller, but more frequent, levodopa doses.
- A different form of levodopa that releases the drug more gradually.
- Chewing the levodopa tablets or taking them with carbonated drinks to increase the speed of their effect.
- Not taking levodopa with meals.
- Treating constipation.
Another alternate is to add another drug (MAO-B inhibitor/dopamine agonist/COMT inhibitor) to minimize the wearing off symptoms. Such an addition of another drug is called combination therapy.
Treating motor fluctuations is a complicated process and needs to be tailored to each individual’s symptoms & dosages. Thus it should be done with the advice of your doctor.
You can help your doctor understand the fluctuations you experience by recording your wearing off period in the course of the day for a period of time.