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Parkinson’s is officially classified as a movement disorder because it involves damage to the areas of the brain, nerves and muscles that influence the speed, quality, fluency and ease of movement.

Motor (or movement-related) symptoms are usually the most visible elements of Parkinson’s. Motor symptoms of Parkinson’s also respond well to Parkinson’s medications.Although motor symptoms of Parkinson’s often get the most attention and treatment, researchers estimate motor symptoms don’t actually appear in most people until around 60−80% of the nerve cells in the brain that make dopamine have stopped working because of Parkinso

We will help you identify and learn about the various motor symptoms of Parkinson’s so you can be proactive in the management of your symptoms.The impacts of Parkinson’s on movement are called motor symptoms.

• Tremor: a rhythmic shaking in your arms, legs or chin. Most people with Parkinson’s who experience tremor that is worse when relaxing and resting have rest tremor. Others experience active tremor, which means their shaking worsens when trying to do something, like drinking out of a cup of coffee or eating with a spoon.
• Rigidity: painful stiffness, often in the arms, legs, neck or back muscles.
• Akinesia, Bradykinesia, Hypokinesia: Akinesia and bradykinesia refer to the reduction of movement, slowness of movement, and sometimes even complete lack of movement that can be caused by Parkinson’s. Hypokinesia refers to a loss of momentum or force in movement that can come with Parkinson’s, usually in connection with akinesia, bradykinesia, or both. The small, cramped handwriting (called micrographia) that some people with Parkinson’s experience is thought to be some combination of akinesia and hypokinesia.
• Postural Instability: balance problems caused by a loss of reflexes that help you stay upright. This can cause challenges with general balance as well as walking (especially making a turn). Sometimes postural instability brings the tendency to fall backward, called retropulsion.

Early motor symptoms can also include a mask-like face or loss of facial expression, small, cramped handwriting (micrographia), and decreased natural arm swing.People often complain of a heaviness feeling, dragging of one side, or cramping in certain muscles. Speech can become softer and more difficult as Parkinson’s progresses and swallowing can also be affected.As Parkinson’s progresses, walking can change from shuffling steps to festination, or a tendency toward smaller and faster steps that can tip you forward. Sometimes people with Parkinson’s will experience freezing of gait, feeling like your feet are glued to the floor, and trouble starting to walk again once this happens. Freezing often occurs when you first begin to walk, make a turn, or are in a tight and crowded space.

• Reduced manual dexterity, making everyday tasks like buttoning a shirt difficult
• Severe muscle cramping
• Pain without an obvious cause 

(Dizon, 2020)

Parkinson’s is officially classified as a movement disorder because it involves damage to the areas of the brain, nerves and muscles that influence the speed, quality, fluency and ease of movement. While the effects of Parkinson’s on movement are often the most visible symptoms, like tremor, non-motor symptoms of Parkinson’s, like emotional and cognitive challenges, can sometimes have an even greater effect on your quality of life.

The effects of Parkinson’s not related to movement are called non-motor symptoms. 

Non-motor symptoms of Parkinson’s may actually outnumber motor symptoms and can appear years before motor symptoms.

We will help you identify and learn about the various non-motor symptoms of Parkinson’s so you can take the first steps to living well.

Non-motor symptoms of Parkinson’s are effects not related to movement.

There is a wide variety of possible non-motor symptoms of Parkinson’s, ranging from physiological effects like trouble swallowing, pain and fatigue, to mental and emotional impacts, such as mood changes, cognitive challenges and anxiety.

Just as Parkinson’s affects everyone differently, the type, frequency and severity of non-motor symptoms each person experiences vary. 

Remember, just because something is listed as a non-motor symptom of Parkinson’s does not mean you will experience it.

Non-motor symptoms of Parkinson’s have traditionally been harder to identify because they are not as obvious as many of the physical symptoms. However, non-motor symptoms of Parkinson’s often begin before the more visible physical symptoms. These are called “pre-motor symptoms.” 

Symptoms such as loss of smell, depression and constipation may appear years before your actual diagnosis.

Non-motor symptoms also tend to cause more stress and frustration in everyday life than the motor symptoms of Parkinson’s. Recognizing and discovering how you can best manage your non-motor symptoms are critical for learning to live well with Parkinson’s.

It’s a lot harder to explain the Parkinson’s that people don’t see. 

• Cognitive challenges
• Memory problems
• Feeling tongue-tied
• Fatigue 
• Sleep problems
• Anxiety 
• Depression
• Apathy
• Loss of smell
• Numbness or tingling
• Pain

Some of the non-motor symptoms of Parkinson’s are connected to the effects Parkinson’s has on the autonomic nervous system, which controls functions your body “automatically” does, like blood pressure, sweating, digestion and heart rate.

• Constipation
• Frequent need to urinate that can develop into incontinence
• Lightheadedness, especially when getting up in the morning or rising from a chair or couch
• Sexual dysfunction, especially erectile dysfunction
• Excess salivation (drooling)
• Excessive perspiration
• 
  

While most popular Parkinson’s medications do not treat non-motor symptoms, some do find specific medications can be effective for certain non-motor symptoms.

There are also several lifestyle changes that can help manage and even reduce non-motor symptoms, such as exercising regularly, reducing stress and getting more sleep.

Many non-motor symptoms may seem unrelated to Parkinson’s or even an intentional choice on the part of the person living with Parkinson’s, like apathy or cognitive challenges.

Since non-motor symptoms can have such a profound impact on how you and your family live, it is important to mention what you are experiencing with your healthcare provider. Your healthcare provider can then discuss various medical and lifestyle management strategies and refer you to the appropriate specialist(s) when helpful.

Although changes in cognition or thinking abilities can happen at any time, they typically tend to come as we age. Statistics show that as many as 95% of people with Parkinson’s will experience some kind of cognitive change throughout the course of their time with Parkinson’s, ranging from very mild to acute.

One way Parkinson’s can affect your mind is called bradyphrenia, meaning “slow brain.” A common complaint among people with Parkinson’s and their families, bradyphrenia often shows up as a slowing of processing speed in the brain and trouble switching from one task to another.

While everyone experiences subtle changes and declines in how they think and process with age, people with Parkinson’s who have more trouble with cognition than what is considered normal for their age have mild cognitive impairment (MCI).

• Executive functioning: including multitasking, reasoning, problem-solving, concentration and complex planning.
• Language: including difficulty finding the right word in your mind or feeling tongue-tied.
• Memory: trouble retrieving memories that have already been encoded. This is different than Alzheimer’s, where memories are not able to be encoded.
• 
  

In many situations, these challenges do not significantly impact daily life. For some people living with Parkinson’s, these changes will never progress beyond mild cognitive impairment. Others experience a very slow cognitive decline over time.

If cognitive challenges start to have a significant impact on quality of life, such as making it difficult to drive or consistently forgetting important things like where you parked, if you paid a bill or even what you ate, mild cognitive impairment may be better described as dementia. Dementia brings up a lot of fear and can be difficult to discuss, even with your physician. However, physicians can perform objective tests to measure your thinking and memory to help identify when and cognitive impairment should be addressed. Keep in mind that the progression of dementia that can come for some people in the later stages of Parkinson’s can be influenced when caught early and managed proactively.

If you or your care partner and family members notice changes in your cognition, have frequent conversations with your physician. There can be several different influences on problems you are having with thinking, processing and memory.

An evaluation by a neuropsychologist, a specialist trained in measuring thinking and behavioral functions, can help identify cognitive difficulty or dementia. Neuropsychological testing measures thinking abilities such as concentration, attention, memory, language abilities, abstract thinking, spatial skills and executive functions and can help your physician determine what could be causing thinking problems.

Some people experience improvements in cognitive function when they take certain medications or even change their current medications. Talk with your physician about which medications might work for you.

Physical exercise has also been proven to help not just the body, but the brain. Exercise can improve cognitive function as well as reduce the long-term risk of dementia.

In the same way physical exercise improves movement and strength, brain exercise can help improve your cognitive functioning. There are many games and puzzles designed to boost the brain’s fitness, from traditional crossword puzzles to interactive brain teasers modeled after video games. It is important to continually challenge your brain, trying new things creates new pathways in the brain and help keep your brain active and healthier. Try new ways to exercise, different types of brain teasers or even find a new path for your daily walk.

Creativity can also enhance cognition and many people with Parkinson’s discover a newfound enjoyment in various art and music projects. Art and music projects may also enhance cognition.

Parkinson’s impact on emotions and mood are often overlooked because they are complicated and harder to talk objectively about than physical symptoms. While a Parkinson’s diagnosis itself can bring feelings of grief and anxiousness for the future, there are also biological changes caused by Parkinson’s that can result in mood changes such as anxiety, apathy and depression.

Anxiety is experienced as nervousness, worrying, feeling jittery, having an unsettled mind or the inability to stop racing thoughts. It is more common in people with Parkinson’s and can occur with or without other mood changes like depression. Anxiety can stem from decreased dopamine levels that come because of Parkinson’s, as well as from the realities of living with Parkinson’s, such as fearing the experience of off-times from medications when you are in public. If anxiety routinely interferes with your sleep or daily activities, be sure to discuss it with your healthcare professional. Anxiety in Parkinson’s can be treated effectively.

Apathy is a loss of motivation to participate in regular activities, socialize or express emotions. Apathy can lead to isolation and avoidance, taking a toll on you and your family and friends. Be careful to not confuse apathy with decreased facial expression (also called “facial masking”), which is another symptom of Parkinson’s and often inhibits your ability to show your emotions.

Depression is ongoing feelings of hopelessness, overwhelming sadness or loss of motivation. It may manifest as depressed mood, memory problems, fatigue, sleepiness and insomnia. Other symptoms of depression include irritability, poor concentration, loss of enjoyment in social activities and hobbies, loss of appetite or increased appetite. Apathy and anxiety may also occur alongside depression.

Depression is one of the most common non-motor symptoms in people with Parkinson’s

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Some people experience depression throughout their lives, while others find it is a symptom that comes as dopamine decreases because of Parkinson’s. Feelings of depression may also coincide with the wearing off of Parkinson’s medications because of the same reason.

Depression, anxiety and apathy can have a significant impact on you and your family’s quality of life.

• Taking medications (antidepressants, antianxiety medications)
• Changing medications that have mood-related side effects
• Exercising regularly
• Reducing stress
• Improving sleep
• Improving diet
• Talking to a counselor
• Meditating
• 
  

Be sure to include depression and any other mood changes you are experiencing in conversations with your healthcare providers. If you experience suicidal thoughts at any point, alert your care team and healthcare providers immediately.

Identify mood triggers, add positive energy into your daily life and provide a way to talk with your doctor and healthcare team about treating depression. 

Parkinson’s can have many different effects on your sleep, including trouble falling or staying asleep, vivid dreams, waking up frequently during the night and excessive sleepiness during the day. Like other non-motor symptoms, sleep problems can appear before the motor symptoms.

An estimated 30% of people with Parkinson’s experience some combination of insomnia (trouble falling asleep) and sleep fragmentation (waking up frequently during the night). Studies have shown people with Parkinson’s have different sleep patterns and that their deepest periods of sleep during the night are shorter and interrupted more often than people without Parkinson’s. Often this is made worse by medications that may wear off in the night, causing tremor, painful stiffness or other symptoms to return and disrupt your sleep.

Anxiety, depression nighttime sweating and trouble moving in bed are other non-motor symptoms of Parkinson’s that can make getting a good sleep difficult. Fragmented sleep is also exacerbated by how often some people with Parkinson’s find themselves waking up often during the night to use the toilet because of the changes in the bladder that come with Parkinson’s.

Occasionally medications used for Parkinson’s, including dopaminergic medications like carbidopa-levodopa (Sinemet®) and select antidepressants and sleep aids, can cause vivid dreams or nightmares and disrupt your sleep. As unsettling as these can be in and of themselves, this can present serious concerns when combined with another possible effect of Parkinson’s on sleep called Rapid Eye Movement Sleep Behavior Disorder (RBD), when the natural processes that prevent you from acting out your dreams with movement stop working. As a result, a person with RBD might yell, scream, kick or get out of bed to “act out their dreams.”

Typically, individuals with RBD report that these dreams are very vivid and that they do not feel rested in the morning.  The bed partner often reports violent responses by the person with RBD, which involved being punched, bitten or kicked, while the person acting out the dream is unaware of this behavior. If you or your loved one is experiencing RBD, discuss with your doctor. There are possible medications that can help as well as adaptations and modifications to beds and bedrooms to enhance the safety for the person with Parkinson’s as well as their partner. Some couples living with Parkinson’s discover the safest and most effective way to ensure both partners sleep safely and as soundly as possible is to sleep in separate beds.

Restless legs syndrome (RLS) is common in people with Parkinson’s and can present another interruption to a good night’s sleep. RLS is characterized by unpleasant feelings in the legs when they are at rest that is usually relieved with movement. RLS can result from medications and medical conditions other than Parkinson’s, so definitely discuss with your doctor if you are experiencing RLS.

Other non-Parkinson’s-related issues such as sleep apnea, pauses in breathing or shallow breaths during sleep, can make sleep problems worse. While sleep apnea is not more common in people living with Parkinson’s, it does occur more frequently in adults as they age.

Many people with Parkinson’s also experience excessive daytime sleepiness, which can be caused by the various effects of Parkinson’s that interrupt sleep at night as well as from side effects of some Parkinson’s medications.  (Dizon, 2021)