Wiki Parkinson

Non-Motor Symptoms of Parkinson’s Disease

Parkinson’s disease (PD) is typically defined by motor symptoms like tremors, rigidity, and bradykinesia, but non-motor symptoms (NMS) are just as prevalent and can significantly impact quality of life. The symptoms may precede or accompany motor difficulties, and they often must be treated with specific management plans. Here’s the list of common non-motor symptoms of PD:

???? Cognitive Symptoms
1. Cognitive Impairment
Mild cognitive impairment (MCI): Often develops in early stages, influencing attention, memory, and executive functions (e.g., decision-making, planning).

Parkinson’s disease dementia (PDD): Later on, cognitive worsening may be more pronounced, interfering with daily activities and independence.

2. Memory Difficulty
Difficulty with short-term memory, particularly remembering newly learned information or names.

3. Executive Dysfunction
Difficulty with organizing ideas, solving problems, and performing tasks, leading to frustration and lower quality of life.

???? Mood and Psychological Symptoms
1. Depression
Major depressive disorder is a prominent characteristic in most patients with PD, with characteristics of chronic sadness, fatigue, and lack of interest in activities.

Depression in PD may be due to neurochemical changes or may be secondary to adaptation to the disease.

2. Anxiety
Anxiety is prevalent among patients with PD with generalized anxiety, social anxiety, or certain phobias (e.g., fear of falling, fear of disease progression).

Anxiety can worsen motor symptoms and interfere with daily living.

3. Apathy
Apathy or loss of motivation is a common non-motor symptom, which has a tendency to lead to decreased social interaction and avoidance of personal care.

4. Hallucinations and Psychosis
Visual hallucinations and delusions (paranoia) are more frequent later in PD, particularly in patients with dementia or on dopaminergic treatment.

???? Autonomic Symptoms
1. Orthostatic Hypotension
Low blood pressure when standing, causing dizziness, lightheadedness, and falls.

2. Constipation
Gastrointestinal tract slowing of motility is common in PD as an effect of the disease’s action on the enteric nervous system.

3. Excessive Sweating
Increased sweating, especially nocturnal sweating, is found in PD patients.

4. Urinary Issues
Urinary frequency, urgency, and incontinence are common. Nocturia (waking during the night multiple times to empty the bladder) is also noticed.

????‍⚕️ Sleep Disorders
1. Insomnia
Difficulty sleeping or staying asleep due to restless legs, pain, or repeated nighttime awakenings.

2. REM Sleep Behavior Disorder (RBD)
A disorder where patients physically act out their dreams, putting them at risk of injury. It is most often an early sign of PD.

3. Daytime Sleepiness
Daytime sleepiness is an issue for people with PD, affecting daytime functioning and leading to an increased risk of accidents.

???? Sensory and Motor-Related Non-Motor Symptoms
1. Pain
Chronic pain, including musculoskeletal pain and neuropathic pain, is common in PD. Muscle rigidity and dystonia (involuntary muscle contractions) may cause this.

2. Loss of Sense of Smell (Anosmia)
Loss of the sense of smell or anosmia typically appears in the initial stages of PD and can precede motor symptoms by years.

3. Speech and Swallowing Difficulty
Hypophonia (soft speech) and dysphagia (difficulty swallowing) are discomforting symptoms that impair communication and nutrition.

????‍♂️ Motor Complications Disrupting Daily Function
1. Freezing of Gait (FOG)
Patients with PD may experience sudden, fleeting moments when feet are “glued” to the floor, and it becomes difficult to move.

2. Postural Instability
Patients with PD can experience balance problems, which expose them to falls.

????️ Vision Difficulty
1. Double Vision (Diplopia)
Double vision can be due to poor coordination of eye muscles.

2. Reduced Blink Rate
Reduced blink rate, which can lead to dry eyes and eye irritation.

???? Impact on Daily Life
The buildup of non-motor symptoms has a tendency to affect not just the patient but also caregivers and family members. Multidisciplinary management (neurologists, psychologists, dietitians, and physical therapists) is needed to manage the whole spectrum of PD symptoms.

Would you like to hear more about how to deal with these non-motor symptoms or any treatment for them at all?

Tremor is most apparent symptom of Parkinson’s disease (PD), typically starting on one side of the body and often being most notable in the hands, though it can appear elsewhere in the head, legs, and jaw.

Following is a more detailed look at tremor in Parkinson’s disease:

✅ 1. Parkinson’s Tremor Features
Resting Tremor: The most distinguishing feature of Parkinson’s-related tremor is that it predominantly occurs when the muscles are at rest and disappears when the affected body part is in motion.

“Pill-Rolling” Tremor: The characteristic tremor movement, in which the thumb and forefinger appear to be moving as if rolling a pill between them.

Frequency: The Parkinson’s tremor is typically 4-6 Hz (per second), which is very slow compared to other disease tremors.

Asymmetry: The tremor will often start on one side of the body and is worse on that side. Over time, it migrates to the second side.

✅ 2. Sites of Tremor
Hands: The most common site, often seen in a resting position (e.g., when hands rest on the thighs or lap).

Fingers: A common presentation, especially in the “pill-rolling” movement.

Head or Jaw: Tremor can also affect the head, resulting in a mild nodding or shaking, and sometimes it can affect the jaw, resulting in clenching or spontaneous jaw movements.

Legs: Tremor of the legs occurs less often but may also be observed, especially in later stages of the disease.

✅ 3. Impact on Daily Life
Functional Disability: Tremor may affect fine motor capacity, so writing, handling utensils, buttoning clothes, and other tasks of this kind may be difficult for Parkinson’s patients.

Social Stigma: Visible tremors may lead to embarrassment or concern about appearance in public.

Sleep Disturbances: Tremors can persist during sleep, but they usually diminish during the period of deep sleep.

✅ 4. Tremor-Influencing Factors
Medication: Dopamine replacement therapy (e.g., levodopa) can reduce tremors, but the effect can be transient.

Stress: Increased anxiety or stress can exacerbate tremors.

Fatigue: Overwork or fatigue can make tremors worse.

Temperature: Cold weather or abrupt changes in temperature may sometimes worsen tremor severity.

✅ 5. Treatment
Medications:

Levodopa: The primary medication for Parkinson’s that has been demonstrated to reduce tremors by raising levels of dopamine in the brain.

Dopamine Agonists: They also reduce tremors.

Anticholinergics: In some cases, to reduce tremor, especially in early Parkinson’s.

Deep Brain Stimulation (DBS): For intractable tremors that are not helped by medications, DBS surgery may be an option. Electrodes implanted in the brain can help regulate abnormal brain activity that leads to tremor.

Physical Therapy: Can be useful in enhancing movement as a whole and reducing the functional impact of tremors.

Botox Injections: Sometimes used for head or jaw tremor, as it can reduce involuntary muscle movement.

✅ 6. Difference Between Parkinson’s Tremor and Other Tremors
Resting vs. Action Tremor: Parkinson’s tremor occurs during resting muscles, whereas other tremors, including those from essential tremor, occur more during movement.

Asymmetry: Parkinson’s tremor tends to begin on one side of the body and remain more severe there, whereas essential tremor can affect both sides of the body.

Summary:
Parkinson’s tremor is a hallmark symptom, specifically the resting tremor that can affect activities of daily living and cause social challenges. Tremor is generally responsive to medications like levodopa, but may become more difficult to manage as the disease progresses.

Would you like more on treatment advances or tips on living with tremor in Parkinson’s?

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