Understanding Parkinson’s Disease Symptoms: Motor and Non-motor
What is Parkinson’s Disease (PD)?
· PD is a progressive neurodegenerative disease caused by 60-80% loss of or damage to neuron brain cells in the part of the brain known as the substantia nigra.
· These neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As dopamine is depleted, messages are not sent correctly, causing shaking, stiffness, difficulty with walking, balance, coordination, voice, digestion, and many other symptoms.
What are the Symptoms of Parkinson’s Disease (PD)?
There are primary (motor), and secondary (non-motor) symptoms of PD. Not everyone with the disease experiences all of the symptoms associated with PD. The progression and symptoms of the disease vary for each person.
Primary Symptoms of PD (Motor):
• Slow movement (Bradykinesia) – Slowness in standing up, walking, sitting down, and speaking is quite frustrating, both for people with Parkinson’s (pwps) and their caregivers. Slowness can manifest as “freezing” episodes when someone becomes stuck in the same spot until they can initiate movement. This often happens as the person steps into a doorway or gets up from a chair.
• Tremors – When the body is at rest, tremors can occur in the hands, fingers, arms, legs, feet, mouth, or chin. Tremors can be rhythmic and sometimes cause an action with the thumb and fingers called “pill rolling”.
• Rigidity – (Akinesia) Muscle rigidity or stiff joints can cause pain and feel and look like temporary paralysis. The face appears “masked”, almost expressionless. A person may look as though they’ve had a stroke because there is almost no movement. Dexterity issues also can occur, leading to small, cramped writing.
• Poor balance–Balance issues are one of the major dangers in PD. Many pwps fall several times a day or tip over because they lean and don’t realize they are not balanced. There is a disconnect between what the brain tells the body to do and what actually is relayed to the body part. Gait problems and/or blood pressure issues often precipitate falls.
Secondary Symptoms of PD (Non-motor):
• Decreased sense of smell
• Weight loss
• Loss of bowel and/or bladder control
• Constipation and/or bowel impaction
• Difficulty swallowing, dysphagia
• Choking, coughing, or drooling
• Fatigue
• Hypotension or Orthostatic hypotension
• Excessive sweating
• Swelling in the extremities
• Oily or scaling, dry skin
• Loss of intellectual capacity, such as decreased executive functions
• Anxiety, depression, apathy, anger
• Psychosis: paranoia, hallucinations
• Slower response to questions, usually due to word-finding difficulty
• Soft, low, voice with diminished articulation where words run together or words are repeated several times
• Vision problems: double vision, blurry vision
• Sexual intimacy problems, erectile dysfunction
Additionally, pwps may also experience dystonia. A dystonia is an involuntary movement that is characterized by prolonged muscle contraction that can involve the entire body or one area of the body. Often dystonias can be very painful and manifest with pain similar to cramps and a feeling that their body is being pulled or twisted in an unnatural position.
What are Examples of Precursors to a PD Diagnosis?
PD symptoms can take anywhere from 20-30 years to manifest. Any of the following symptoms could possibly lead to a PD diagnosis:
• Arms don’t swing when walking
• A twitch or tremor in a finger or extremity
• Diminished or changed sense of smell
• REM sleep disorder – acting out dreams
• Word-finding difficulty
• Joint pain or stiffness
• The face shows little movement or emotion
• Constipation
• Depression, anxiety or apathy. The voice is soft and lower; people often ask a person to repeat what he or she said.