Non motor symptoms

Parkinson’s is no longer thought to affect only the neurons (nerve cells) in the brain. Researchers believe that several other neuronal systems in the body which control sleep, smell, bowel and bladder movement etc. are also affected in Parkinson’s.

Non motor symptoms are now an increasingly recognized entity in Parkinson’s and are thought to precede the onset of motor symptoms by at least a few years. It is important to note that not everyone with Parkinson’s will present with all the symptoms as enlisted.

Sleep Disturbances
Sleep disturbances are the most frequent non motor problems seen in Parkinson’s. These often go unnoticed and are now thought to arise even before the motor symptoms of Parkinson’s set in. Sleep disturbances include difficulty falling asleep, frequent awakenings, excessive sleepiness, restlessness in bed or a lack of sleep (insomnia). Such disturbances may be a result of one of the symptoms that make it difficult to feel restful, e.g., pain due to dystonia, stiffness, rigidity or anxiety.

Alternatively, a PwP’s sleep may be affected by a Parkinson’s medication as well. It is important that you regularize your sleep cycles and maintain good sleep hygiene. Please consult your doctor for a medication review, if you have problems with sleep.

Tiredness or Fatigue
Fatigue is physical and/ or mental exhaustion that is very common in Parkinson’s. It may be one of the first symptoms to appear.

This can be improved with a regularized exercise and rest schedule. If fatigue is associated with a secondary cause like depression or sleep problems then these problems should be assessed by a doctor and treated first.

Excessive sweating
This is an important symptom which may go unnoticed at times. If you feel you’re sweating more than usual with no precipitating factors like hot weather, anxiety or stress etc please consult your doctor. Parkinson’s may cause oily skin and dandruff. The autonomic nervous system when affected in Parkinson’s loses its ability to regulate body functions like sweating, glandular function etc.

Changes in taste and smell

Do you remember of any instances wherein you couldn’t smell a particular dish or a perfume? Have you felt that you don’t enjoy food as much as before because you can’t taste it that well? Loss of smell is one of the earliest and least noticed symptoms of Parkinson’s. And because the sensation of taste is linked to smell, most people also tend to have a loss of appetite.

Change in cognitive functioning

Cognitive changes start happening in early Parkinson’s and slowly progress thereafter. These include a reduced attention span, changes in memory (especially memory for recent events ), problems with visuo-spatial functioning (eg. direction finding), personality changes and psychosis/hallucinations.
Dementia also occurs in a small percentage of patients with Parkinson’s.

Constipation
This is caused by the muscles of the bowel moving more slowly than usual, together with the effects of reduced physical activity and/or a poor diet.

This particular symptom can be treated – either through the sensible use of diet and exercise, or by receiving medication from the doctor.

Problems with urination
Urinary problems manifest as increased urgency and frequency to visit the washroom, (particularly in the night), incomplete bladder emptying and incontinence. It is generally thought to occur later during the course of Parkinson’s.

It is important that you regulate your water intake, restricting it especially nearing bedtime, and avoid caffeine based beverages as far as possible as these cause dehydration. Other causal factors of similar symptoms like prostate enlargement should also be evaluated particularly in elderly males. Your doctor may refer you to an urologist/gynecologist for further tests and evaluation.

Orthostatic Hypotension
Some patients tend to feel light headed on assuming an upright posture. (i.e. standing up from sitting or lying down). This is also accompanied by a drop in blood pressure. It is thought that a reduction in dopamine levels disturbs the normal functioning of the neurons (nerve cells) that regulate blood pressure.

Please consult your doctor if you feel that this happens to you. Also it is advisable to go from a lying to a sitting posture, spending around 2-3 minutes in the same position and then assuming a standing posture. This will help in stabilizing your blood pressure and reduce the feeling of light-headedness.

Speech & Swallowing Difficulties
Changes to the function of facial/throat muscles can also affect the voice in some people with Parkinson’s, 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.

Changes in mood

Depression
This is commonly experienced in Parkinson’s, 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 urges); poor sleep and memory; and a decreased appetite.

Age – Anxiety
Features of anxiety and panic attacks are frequently seen in Parkinson’s and are known to affect a person’s emotional well being and sleep wake cycles.

If you are experiencing any of these symptoms, you should discuss it with your doctor.

Sexual Problems
Sexual dysfunction is often seen in Parkinson’s but goes unreported most of the time. It manifests as erectile dysfunction and reduced libido or sexual drive. It is thought that a reduction in dopamine levels may be a causative factor for underlying sexual dysfunction.

Patients with Parkinson’s who have sexual dysfunction should discuss the same with their neurologist or physician. Often the neurologist may refer you to a specialist like an urologist or a gynecologist for further evaluation.

Co-existing factors like depression if present should be treated first. Also other factors like cigarette smoking, alcohol, and the intake of certain medications which alter sexual function need to be evaluated.

Skin Sensations and Pain
Patients may experience cramps, aches and feeling of numbness, tingling sensation, coldness, or burning. This most frequently occurs in the legs, although lower back pain and headaches are also common.

It would be advisable to consult your doctor if the symptoms persist.