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Symptoms of Established Parkinson’s Disease

Symptoms of established Parkinson’s Disease

As described here, Parkinson’s Disease (PD) has symptoms which involve altered movement, called motor symptoms; and other behaviours, called non-motor symptoms. Listed below are common motor and non-motor symptoms.

Motor Symptoms:

Sleep

Motor symptoms can make it difficult to sleep. Poor sleep has a negative impact on the quality of the day ahead and for general wellbeing, so getting this sorted out is very important. Some sleep issues relate to the dopamine level dropping too low overnight when there is a long gap between medication doses. If the doctor knows there is a problem with sleep, he/she will try and analyse whether an alteration in the drug regime might be helpful.

Other symptoms which cause sleep issues include:

  • tremor, stiffness, impaired bed mobility, cramping and pain.
  • Psychological symptoms can also disturb sleep – depression, anxiety, panic, feelings of agitation

Aggression

This type of aggression is a feature of Parkinson’s disease, rather than marital conflict. It can be a symptom of dream enactment associated with Rapid Eye Movement (REM) sleep behaviour disorder. (You can read more about dream enactment in this post.)

There is a mechanism in the brain to paralyse the arms and legs and the vocal cords during REM sleep. That paralysing mechanism is not working properly for a substantial proportion of people with Parkinson’s disease. So, bed partners may be at risk. Sufferers may also be at risk, because they might punch the wall, or the bedside table, or fall out of bed.

Restless Leg Syndrome

There are many reasons for poor sleep in Parkinson’s disease. Sometimes it relates to a problem like restlessness. There is a condition called Restless Leg Syndrome (RLS) that’s hard to describe unless you’ve had it. RLS can be quite disturbing. It can feel there is something about your legs that isn’t quite like pain. It’s an uneasy, uncomfortable feeling in that makes sufferers get up and walk around for relief. Restlessness of the legs is generally associated with low dopamine levels. It makes it very difficult to get off to sleep.

Speech

Speech can be affected as it becomes more difficult to maintain mouth control.

Swallowing

Swallowing can also be a problem. Speech therapists have many tips and tricks to help those with PD conquer both speech and swallowing difficulties.

Slowness

Moving slowly is a classic symptom of PD which is evident as an early symptom and can increase in severity as it progresses.

Loss of smell

One of the pre-motor symptoms which can be evident some years before the onset of motor symptoms, loss of smell is described more fully in this post. 

Dream enactment

Because there is an alteration in the ability of the brain to control movements, the usual system to stop movements while asleep is not working. Those with PD will sometimes play out their dreams, moving limbs and enacting the dream in their sleep.

Micrographia

Smaller than usual writing, or writing beginning normally and gradually getting smaller is explained more fully in this post.

Implications for Driving

With symptoms of PD including those as described above, it is understandable that the affected person may not be able to drive safely. This also has an impact on confidence and independence.

Postural Hypotension

Postural hypotension is a feeling of lightheadedness which can occur when standing up suddenly. It is a common symptom of PD, and is a result of a sudden drop in blood pressure. This can be either a symptom of the disease itself, or a consequence of the drugs used to control other symptoms.

 

Non-motor symptoms:

The range of non-motor symptoms is something that has become increasingly recognised in the last 10 to 15 years. Previously Parkinson’s disease was thought of very much as a motor problem. Now it is recognised that there are psychological and sometimes cognitive (reasoning) problems as well.

Slow thinking

People with Parkinson’s disease might report that their speed of thinking is a bit slowed, their ability to retrieve a memory or a name, or recognition of a face may be a little slower.

Internal controls

Bowel, bladder and sexual function may be affected and it is important to mention these as part of the assessment in the medical interview. (See this article for more information). 

Unintentional aggression

While it is possible for married couples ot feel that they are having marital issues, in fact often the person with PD may be exhibiting a common symptom.

Depression

Psychological issues such as depression and anxiety often begin as early signs of PD, and continue as the disease progresses.

Assessment and treatment of the symptoms is an important aspect of caring for a person with PD. Read this to find out what to expect at the GP assessment.

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