In Parkinson’s, the volume of the voice becomes soft/ low, clarity of speech reduces, and the tone of the voice becomes monotonous/ “expressionless” (without variations). Speech problems are a combination of motor symptoms like rigidity, slowness and lack of co-ordination in the muscles of the face, mouth and throat, issues with posture and breathing, and non- motor symptoms like anxiety, embarrassment and language issues.
These difficulties, along with the symptom of a ‘masked’/‘expressionless’ face makes it difficult for PwPs to communicate and express emotions. People may frequently ask them to repeat what they have said and can result in PwPs isolating themselves and reducing communication.

Many PwPs have difficulty in chewing and swallowing their food and/or water. This is experienced because the mouth and throat muscles become weak due to Parkinson’s. It could lead to choking, coughing and clearing the throat due to loss of control when eating and drinking.

Fine motor movements involve using the small muscles in our fingers, hands, wrists, forearms, feet and toes. In Parkinson’s, motor symptoms affect these muscles and their co-ordination, causing difficulties in activities like writing, buttoning up a shirt, pleating a saree, counting money, eating food with your fingers, holding small objects, etc.

occurs progressively and as one moves across the page, letters get smaller and less legible. Difficulties are mostly noticed in the form of a change in signature. This can also be a result of ‘hypokinesia’ (reduced scale/amplitude of movements).

Parkinson’s may lead to rigidity and restriction of movements in facial muscles causing face- masking or ‘hypomimia’. It becomes difficult for PwPs to form expressions and blink regularly. This, along with problems in speech in Parkinson’s, creates problems in communication for PwPs.

In dyskinesia, there are excessive, generally fast movements like twitching, jerking, twisting or restlessness in different parts of the body, beyond the person’s control. It is different from tremor and is more often thought to be a side effect of Levodopa (a Parkinson’s medication). It is often painless and may or may not interfere with daily activities.

In hallucinations, people experience seeing, hearing, touching, tasting or smelling something that isn’t actually present in reality and is not experienced by others in that space. In delusions, people have and hold on to thoughts and beliefs that have no evidence, or have evidence that contradicts them in reality. In Parkinson’s, these may be induced as a side effect of medications like levodopa which increases the level of dopamine in the brain.

Problems with sleep happen frequently in Parkinson’s. These may occur before the motor symptoms in Parkinson’s set in and include difficulty falling asleep, frequent awakenings, excessive sleepiness, restlessness in bed or a lack of sleep (insomnia). They may be a result of other Parkinson’s symptoms like pain due to dystonia, stiffness, rigidity or anxiety that makes it difficult to feel restful; or due to Parkinson’s medication.

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 (like direction- finding, judging depth and distance), etc. Dementia also occurs in a small percentage of people with Parkinson’s, usually in the advanced stage.

Constipation in Parkinson’s is caused by the muscles of the bowel moving more slowly than usual along with the effects of reduced physical activity and/or a poor diet. Changes in diet and exercise and prescribed medication from the neurologist are effective in treating this.

Urinary problems include increased urgency and frequency to visit the washroom, (particularly at night), incomplete bladder emptying and incontinence. It is generally thought to occur in later stages of Parkinson’s. Other causal factors like prostate enlargement particularly in men and muscles degeneration due to child birth in women should be evaluated.

This symptom may go unnoticed at times. It occurs without factors like hot weather, anxiety or stress, etc. The autonomic nervous system is often affected in Parkinson’s and loses its ability to regulate body functions like sweating, glandular function etc. For women, excessive sweating can also happen during menopause. Parkinson’s may also cause oily skin and dandruff.

In Parkinson’s, PwPs are sometimes unable to smell a particular scent, and unable to taste and enjoy food as much. The sensation of taste is linked to smell, so most PwPs also tend to have a loss of appetite. Loss of smell is one of the earliest and least noticed symptoms of Parkinson’s.

Some patients tend to feel light headed or dizzy on assuming an upright posture (like standing up from sitting or lying down). This is also accompanied by a drop in blood pressure. In Parkinson’s, it is thought that a reduction in dopamine levels disturbs the normal functioning of the neurons (nerve cells) that regulate blood pressure.

Sexual dysfunction in Parkinson’s includes erectile dysfunction in men and reduced libido or sexual drive in women. A reduction in dopamine levels may be a causal factor. Co-existing factors can include depression, cigarette smoking, alcohol, and intake of certain medications which alter sexual function.

Patients may experience cramps, aches and feeling of numbness, tingling sensation, coldness, or burning. This most frequently occurs in the legs, lower back and head.