SYMPTOMS OF PARKINSON’S
(पार्किंसंस में देखे गए संकेत और लक्षण)
When symptoms of Parkinson’s start manifesting, they may be very mild initially and many a times they go unnoticed. Parkinson’s tends to affect each person in a different way. Not every symptom affects every person with Parkinson’s (PwP) and the rate of progression and intensity of symptoms varies across individuals.
MOTOR SYMPTOMS IN PARKINSON’S
(चाल संबंधी लक्षण)
Motor symptoms in Parkinson’s are related to issues with body movements. They are easily observable. Here are some examples:
SHAKING OR TREMOR AT REST (कंपन)
A tremor involves shaking or quivering movements that happen without one’s control.
They can occur in the hands, fingers, tongue, lips, jaw, and legs. In Parkinson’s, “resting tremor” occurs wherein tremor in a body part happens when it is at rest. Not everyone with Parkinson’s may present with tremor as a symptom. Tremor is also a symptom of other conditions besides Parkinson’s.
RIGIDITY OR STIFFNESS OF THE MUSCLES (कडकपन)
Rigidity or stiffness in Parkinson’s occurs in the muscles of the body, especially in the limbs and trunk.
It becomes difficult to relax the muscles, causing heaviness, aches and pains. In Parkinson’s, this can also lead to a fixed facial expression or “masked face”, rigidity in vocal muscles causing problems with speech and swallowing, stiffness when you wake up in the morning, difficulty turning over in bed, swinging arms, etc.
SLOWNESS OF MOVEMENT OR BRADYKINESIA (धीमा चाल चलन)
The term ‘Bradykinesia’ denotes slowness of movement (“brady”- slow, “kinesia”- movement).
In Parkinson’s, slowness is seen in everyday activities like eating, grooming, bathing and toileting, dressing and walking with short shuffling steps. There can also be a reduction of automatic movements like blinking, facial expressions, arm swinging while walking, gesturing while talking and a hesitancy in initiating a new movement. As a result, PwPs might get easily fatigued.
PROBLEMS WITH BALANCE OR POSTURAL INSTABILITY (असंतुलन)
Postural instability involves a loss of protective reflex reactions to sudden perturbations along with rigidity and weakness in the muscles
This is the leading cause of falls. A stooped or bent posture (झुका हुआ), changes in walking style, fluctuations in blood pressure, problems with vision etc. that occur in Parkinson’s can contribute to imbalance. PwPs may find it difficult to maintain balance while arising from and while going to sit down on a chair or bed, when negotiating a turn while walking, when multi-tasking, etc.
OTHER MOTOR SYMPTOMS IN PARKINSON’S
(अन्य चाल संबंधी लक्षण)
Gait is the walking style or walking pattern that people have. We see different types of gait in Parkinson’s.
PROBLEMS WITH WALKING OR GAIT (चलने की समस्या)
Gait is the walking style or walking pattern that people have. We see different types of gait in Parkinson’s.
SHUFFLING (छोटे कदम)
Some people with Parkinson’s (PwPs) take very short and quick steps while walking, making a dragging sound. This is referred to as “shuffling” of the feet.
FREEZING (पैर ज़मीन पे जम जानेका अहसास)
Freezing while walking is when PwPs are unable to take a step forward to initiate walking or may stop abruptly when they are walking. It feels like your feet are ‘glued to the ground’ or are ‘frozen’ or feel ‘stuck’. This ‘freezing episode’ can last for a few seconds up to a few minutes. It occurs because of a “motor block” wherein signals from the brain to the body are interrupted. The episode often worsens because of anxiety.
Freezing can also occur when you walk in narrow spaces like narrow doorways and corridors, when you want to turn or change direction, when you are in a crowded place, when approaching or getting out of your bed or chair, when you are in a hurry to go somewhere, when you are multitasking or distracted, etc.
FESTINATION (बिन काबू तेज़ कदम)
Festination involves sudden, uncontrolled acceleration in speed while walking making it difficult to slow down or stop easily and to maintain balance, leading to falls in the forward direction. Festination often occurs along with shuffling of the feet.
PROBLEMS WITH SPEECH (बोलने की समस्या)
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.
PROBLEMS WITH SWALLOWING (निगलने की समस्या)
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.
PROBLEMS WITH FINE MOTOR MOVEMENTS (छोटे चालनकी समस्याएं)
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.
Small, crowded handwriting (लिखावट की समस्याएं) (micrographia)
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).
MASKED FACE (मुखौटे जैसा चेहरा)
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.
DYSKINESIA (बडी नाच जैसी हरकतें/ अपगर्त)
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.
DYSTONIA (शरीर के अंगों की अप्राकृतिक मुद्रा/ दुस्तानता)
In dystonia, PwPs may experience muscular contractions orspasms which force one or multiple parts of the body into unnatural postures. These movements are slower than dyskinetic movements, and may be painful. It is commonly experienced in the feet or legs with toes curling inwards, or tightening of calf muscles. Dystonia may be either due to Parkinson’s itself or due to a side effect of Levodopa.
Many PwPs experience cramps- a pulling sensation in their muscles (particularly in the calf/ toes). Cramps in Parkinson’s are very different from dystonia and are caused by muscular rigidity and bradykinesia (slowed movements). They are painful and can also interrupt a full night’s sleep.
NON-MOTOR SYMPTOMS IN PARKINSON’S
(चाल के लक्षणों से असंबंधित लक्षण)
Parkinson’s is not only a movement- related condition. In addition to motor symptoms, Parkinson’s can result in other types of symptoms that are not related to body movements, and are more difficult to observe. These are known as non-motor symptoms.
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 enlisted.
Non- motor symptoms may appear because in Parkinson’s, other areas of the brain, other neuronal systems and neurotransmitters besides dopamine which are responsible for other functions might be affected.
PSYCHOLOGICAL CHANGES (मनोवैज्ञानिक परिवर्तन)
Psychological changes are changes that occur in thoughts, beliefs, mood and behavior. People with Parkinson’s (PwPs) may experience mood fluctuations and also significant changes in mood. They may also experience increased levels of stress and anxiety.
It is important to remember that
- Such changes involve a combination of physiological (bodily) changes, cognitive changes and behavioural changes. All these are important to identify as possible indicators.
- Besides a neurologist, these changes should be reported to a psychologist, psychiatrist or mental health professional that is trained in dealing with psychological issues. It is possible to manage these symptoms with medication, psychotherapy and counselling.
- It is important to remember that having these issues is nothing to be ashamed of and is often not in one’s control. It is also important to learn more about these conditions.
DEPRESSION AND MOOD CHANGES (डिप्रेशन, मनोदशा में बदलाव और उतार-चढ़ाव)
Depression is a mood symptom, wherein a person reports ‘feeling low or sad’, a loss of interest, energy and motivation, negative view of oneself and one’s circumstances, decreased appetite, poor sleep and memory, for a prolonged period of time.
In Parkinson’s, depression can occur in response to the diagnosis, dealing with the chronic condition and sometimes as a symptom of the condition itself. PwPs may also experience extreme fluctuations in mood which can be a result of Parkinson’s medication or due to living with the condition itself. Reduced dopamine production is linked to depression in Parkinson’s.
ANXIETY AND STRESS (चिंता और तनाव)
Anxiety involves intense, excessive and persistent worry and fear about situations that are unwanted and unrealistic and whihc affect our decisions and behaviours. It can be experienced with fast heart rate, rapid breathing, sweating, and feeling tired. These reactions are also stress reactions.
In Parkinson’s, one can have features of anxiety and panic attacks related to aging, living with a chronic condition, and interacting with others or in public. They are known to affect a person’s emotional well-being and sleep- wake cycles.
Various motor symptoms like tremors, freezing and rigidity are connected to anxiety and stress, and often, techniques that relax the mind and body have been effective in reducing the severity of symptoms immediately and also over time.
Hallucinations and delusions (मतिभ्रम और भ्रम)
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 (नींद संबंधी परेशानियां)
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.
CHANGE IN COGNITIVE FUNCTIONING (संज्ञानात्मक कार्य में परिवर्तन)
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.
PROBLEMS WITH URINATION (मूत्र संबंधी समस्याएं)
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.
TIREDNESS OR FATIGUE (थकान)
Fatigue is physical and/ or mental exhaustion. It may be one of the first symptoms to appear in Parkinson’s. Fatigue is often associated with a secondary cause like depression or sleep problems. It can be improved with a regularized exercise and rest schedule.
EXCESSIVE SWEATING (बहुत ज़्यादा पसीना आना)
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.
CHANGES IN TASTE AND SMELL (स्वाद और गंध में परिवर्तन)
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.
ORTHOSTATIC HYPOTENSION (आसन बदलते समय चक्कर आना)
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 PROBLEMS (यौन समस्याएं)
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.
SKIN SENSATIONS AND PAIN (त्वचा की संवेदनाएं और दर्द)
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.