40+ symptoms

The 8th-14th of April is Parkinson’s Awareness Week. Our tagline for the week is Different for Everyone, to represent and recognise the many symptoms that come with Parkinson’s Disease and how everyone’s experience with it is different.

The theme of the campaign stemmed from the awareness priorities identified by people with Parkinson’s, their families and care partners in our recent survey.

Parkinson’s Disease (PD) is a progressive neurological disorder, and is classified as a Movement Disorder, as it primarily affects movement. It is variable in its progression, meaning some people progress more slowly than others and the symptoms can be effectively controlled with medication for many years.

PD is caused by a loss of a chemical called dopamine. We all lose some of this chemical as we get older, however, it is only when we have lost about 80% of our dopamine we start to have symptoms. This means that people with Parkinson’s have lost this chemical at a faster rate than others.

When most people think of Parkinson’s Disease, they think of tremors, stiffness or slowness of movement.

However, PD can also affect thinking, behavior and mood. These changes can bring their own challenges and frustrations as they often impact the quality of life. Each person with PD is different, and many people do not develop each symptom.

We have summarized some of the many symptoms of PD in this article to help bring awareness and to educate as many people as we can about how complex PD can be.

Tremors

When people think of PD, the first symptom they often associate with it are tremors.

However, only about 70% of people with PD will experience tremors.

According to Parkinson’s Foundation, tremors tend to occur in the hands but they can also appear in other parts of the body, including the lower lip, jaw or leg. These tremors can interfere with routine activities such as shaving, dressing, writing, typing and many other tasks that require motor coordination.

Some people report an internal tremor, a shaking sensation inside the chest, abdomen or limbs that cannot be seen.

Fatigue and stress can often make tremors worse. Levodopa is the medication most commonly given to control the movement symptoms of PD, including tremors. To read more, click here.

Balance

Slow movement, freezing and other motor symptoms can often impact how someone with PD walks. Therefore, this can cause a greater risk of falling.

The best way to improve your balance and to avoid freezing and falling is to engage in as much exercise as possible. This can include walking, yoga, physiotherapy and more.

To read more on balance, please read here.

Blurred Vision

Parkinson’s Disease can bring many kinds of vision changes.

According to Parkinson’s Foundation, these can include:

• Double vision: As a result of the eye muscles having trouble working together. This can be aided by wearing special prism glasses.
• Dry eye and blurred vision: As a result of decreased blinking, this can then lead to blurred vision. Blurred vision can also be caused by PD medication.
• Trouble reading: This can occur as the eye movements that usually follow the lines of a page are slowed, and can have trouble starting. It is recommended to change eye position and try blinking more. Levodopa can often help.

To read more about blurred vision and vision changes with PD, please click here.

Hallucinations

When a person hallucinates, they may see, hear, feel, smell or taste something that, in reality, does not exist.

While the hallucinations may comprise quite complex scenes, they typically involve the person seeing small animals, insects or other people in the room with them. These images do not usually speak or make sounds and they can either disappear quickly or last for some time.

Occasionally, the hallucinations are auditory (where the person hears a voice or sound without seeing anything), or tactile (the person feels something touching them), but for people with Parkinson’s, these are less common than visual hallucinations.

To read more about Hallucinations and PD and how they are treated, please read here.

Anxiety

Anxiety can be an entirely normal feeling and is often an appropriate response to a dangerous or threatening situation. What is often understood as anxiety can range from worry and stress to the bodily symptoms associated with fear or panic. The bodily symptoms of such anxiety may include sweating, pounding of the heart, shortness of breath, tightness in the chest and unpleasant feelings in the stomach.

In Parkinson’s, anxiety may be based on the very real fear of functioning with a disability. However, at times, it can take on a life of its own and be unrelated to the physical state of the person with Parkinson’s.

Some people with Parkinson’s have anxiety related to the ‘on/off’ state of their motor symptoms. When ‘off’ and less able to move well, they may develop significant anxiety symptoms and, at times, may even have panic attacks.

For those who experience mild and intermittent anxiety, conservative measures such as avoiding stimulants, including caffeinated drinks, tea/ coffee, alcohol and cigarettes, along with identifying and avoiding triggers of anxious episodes can be helpful. Some people find other methods, such as relaxation tapes, yoga, massage, acupuncture, mindfulness and complimentary therapies beneficial.

To read more about anxiety and PD, please read here.

Freezing

Many people with mid-stage to advanced Parkinson’s disease (PD) experience “freezing.” Freezing is the temporary, involuntary inability to move. Not all people with PD experience freezing episodes, but those who do have a greater risk of falling.

People feel as though their feet are stuck to the ground. It also commonly occurs when trying to turn in small spaces or when walking through doorways.

It is useful to have ways to overcome “Freezing” when it happens. Every person needs to discover their own way of coping with “Freezing”. Stress and anxiety make you more likely to “Freeze”.

If you experience “Freezing”, make sure those who care for you know about this symptom, as there may be things they can do to help you when it happens. Likewise, it is important that if you are walking with someone and you “Freeze”, that the other person does not try to drag you along to get you going – this will almost certainly result in a fall.

To read more about Freezing and PD, please read here.

Sleep problems

A recent survey suggested that up to 90% of people with the Parkinson’s experience problems with sleeping at night. There are a variety of possible causes and therefore a variety of possible treatments. It is therefore important to discuss difficulties related to sleeping with a nurse or your GP.

Insomnia and other sleep disorders are more common in people with Parkinson’s who have depression and their doctor may therefore also suggest specific treatment for depression.

Some people with PD may also experience Excessive Daytime Sleepiness (EDS). This may cause frequent dozing during normal waking hours. This can then have several impacts, including poor sleep at night.

In some situations, medicines which promote wakefulness may be used to alleviate the issue. However, anyone experiencing sleepiness should use caution when carrying out activities such as driving.

It is important a person with Parkinson’s to let their medical team know if they have experienced sudden onset of sleep, as they may change the anti-Parkinson’s medications. To read more, click here.

Muscle Cramps & Dystonia

People with PD often find that they are prone to a variety of aches and pains. For example, muscular rigidity and a reduction in, or absence of, movement (akinesia) can lead to cramps, which are often quite distressing and which may not be relieved by ordinary painkillers.

Occasionally, people with PD may experience severe muscle spasms or dystonia that are different from ordinary muscle cramps and have different causes and treatments.

Dystonia is a movement disorder characterised by a sustained involuntary contraction of the muscles causing the affected part of the body to go into spasm.

Although more common in young-onset PD, dystonia can affect anyone and can be prolonged and very painful. The contractions and spasms that are the primary symptoms may lead a person to mistake dystonia for muscle cramps caused by the rigidity found in PD. However, dystonia and cramping are very different; both make the muscles hard, but in cramping, muscles become ‘less elastic’ while in dystonia the hardness comes from the muscles contracting without relaxing.

To find out more about dystonia and muscle cramping, please read here.

Facial Masking

The same stiffness and slowness that can impact your walking and other activities can also reduce facial expressions.

Facial masking can affect how we communicate. When the facial muscles are stiff or take longer to move, it can be hard to smile, frown, raise your eyebrows or others.

Medications can help with this, but if miscommunication becomes prominent, try to explain the difficulty with muscle control and expression you are facing as it could help others understand.

Please go to Parkinson’s Foundation for more information on facial masking.

Low Blood Pressure

Parkinson’s and almost all the drugs used to treat the condition (levodopa and dopamine agonists) can cause low blood pressure.

Clinically significant low blood pressure describes a situation where the blood pressure is low enough to produce one or a number of the following symptoms:

• Dizziness/light-headedness (in the extreme this can result in a fall);
• Changes in vision, such as blurred, tunnel, greying or blacking vision;
• Angina-like pain in the chest;
• Weakness and/or Fatigue;
• Feeling muddled or confused.

If medication is being taken to lower blood pressure, it is advisable to have it checked as this, combined with the effects of Parkinson’s, may be making blood pressure too low.

To fund out more, please read here.

Bladder & Bowel Issues

People with Parkinson’s disease are more likely to suffer from bowel and bladder issues, particularly constipation.

Constipation is the number one reason why a person’s Parkinson’s has become suddenly worse – the levodopa medications used to treat Parkinson’s (Sinemet, Stalevo and Madopar) are absorbed by the bowel, so if it is filled to capacity, you are unlikely to get the full benefit from these drugs.

As with Parkinson’s generally, the more healthy your lifestyle, and the more active and mobile you can keep yourself, the better.

With bowel problems, it is important to make sure that you drink enough and eat a diet with plenty of fibre, such as fruit, vegetables and whole meal bread and cereals. Drink plenty of fluids throughout the day to help the fibre work.

There are two main problems that can occur with the bladder in Parkinson’s– an overactive bladder, and difficulty in emptying.

It is important not to cut down too much on the amount of fluid you drink as this will not help and may lead to bladder infections. It may help to cut out caffeine, fizzy drinks and some types of alcohol. This is very individual, so it is worth experimenting to see what helps you.

You should tell your GP, Consultant or Parkinson’s Disease Nurse Specialist (PDNS) about your problems and they will be able to provide advice on any additional support available to you.

To read more about bladder and bowel issues with PD, please see our website here.

“The content and views expressed are those of Parkinson’s Ireland and not of the sponsors.”