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Parkinson’s Symptoms

Well known symptoms of Parkinson's are tremor, stiffness and slowness of movement. Other symptoms include pain, problems with sleep, depression, anxiety or apathy.   Not everyone will experience the same symptoms and the condition affects everyone differently.

Motor Symptoms of Parkinson’s

Some people Initially develop a tremor (shaking). Others notice mild clumsiness of a limb, handwriting can become small. Others develop a stooped posture or a reduction in arm-swing when they are walking.

Constipation

Constipation is very common in Parkinson's and can precede the diagnosis by years. Parkinson’s constipation is caused by a reduction in the ability of the bowel to contract. While eating bran to increase the bulk of the bowel motion is important for most causes of constipation, in Parkinson's this must be done cautiously as the bowel may not have the strength to move the extra bulk along. Often people need to treat themselves with exercise and extra fluid along with stimulating agents such as fruit extracts. Sometimes a special laxative such as lactulose is necessary.

Constipation

Sleep Disturbance

Most people develop some form of sleep disturbance. This can include interruption of sleep by tremor, pain or difficulty rolling in bed. A very common pattern is marked tiredness in the evening and falling asleep soon after going to bed. This is followed by waking up around midnight and frequent awakenings through the rest of the night. This pattern is often associated with sleepiness in the early afternoon. It is reminiscent of jetlag, and in fact it may be due to disturbances of the biological clock.

Other people develop a more distinctive sleep disturbance. The most striking of these is Rapid Eye Movement (REM) sleep behaviour disorder. In this situation, the person talks or acts out vivid dreams.

Sleep Disturbance

Anxiety

Anxiety is thought to affect up to 40% of people with Parkinson’s to some degree, ranging from mild to severe. Anxiety is often present at the same time as depression although one can be present without the other.

Anxiety

Depression

Approximately one third of people develop depression at some time during their Parkinson’s. Depression can sometimes precede the diagnosis of Parkinson's. 

The frequency of depression in Parkinson's is greater than would be expected in people with other chronic conditions; there is much less depression in people with heart disease. The increase in depression in Parkinson's is likely related to chemical changes in the brain, similar to the chemical changes that produce Parkinson's itself. Depressionin people with Parkinson's has traps for both patients and doctors. Many of the symptoms of Parkinson's: namely the slow movement, poor energy and disrupted sleep, are very similar to those of depression and can mask the true diagnosis of depression.

A number of symptoms can point to the development of depression. These include a disturbance of sleep, a lack of energy, a feeling of hopelessness or lack of optimism, poor concentration and forgetfulness, a change in appetite and feelings of sadness.  

 The depression associated with Parkinson's responds to standard anti-depressant treatment. The important point is to recognise the possibility of depression and bring it to the attention of your doctor.

Depression

Apathy

A closely related symptom is a lack of motivation or apathy. Apathy is a reduction in motivation related to not caring enough about things, either because we can’t feel strongly enough about something to act, or because we don’t think that it is important enough. This can be particularly frustrating for family members. So it is important to understand that apathy is a characteristic of Parkinson’s - not the person being lazy or difficult. It is also sometimes mistaken for depression.

Apathy

Fatigue

Fatigue, daytime sleepiness and a loss of motivation can be common symptoms for people with Parkinson’s. Some find the tiredness can be improved with regular exercise and rest. When tiredness is prominent, people often have to be careful not to take on too many responsibilities or tasks that they cannot complete.

Fatigue

Non-Motor Symptoms of Parkinson’s

Sometimes the first development of Parkinson’s  is a sense of increased fatigue, making tasks take longer and seem more of an effort, but there are many other non-motor symptoms such as apathy, anxiety, sleep disturbance and depression.

Loss of Balance & Freezing

This tends to occur later in Parkinson's. Sometimes there is some difficulty getting out of a deep chair or a low car seat. As the condition progresses, the person becomes less able to compensate for a mild loss of balance when walking on rough ground and may tend to fall forwards. Sometimes to compensate for this the feet move forward quickly to produce a peculiar running walk.

Some people can develop a problem of ‘freezing’ in which the feet seem to stick to the floor during walking. The person comes to a temporary stop before getting going again.

Loss of Balance & Freezing

Slowness of Movement

This is also known as bradykinesia. It can affect various parts of the body.  One of the early signs of Parkinson's is a flat or expressionless face. This can sometimes give the person the appearance of lacking emotion, not being interested in other people, or looking serious and not smiling. When the bradykinesia affects body movements the person has difficulty rolling over in bed or sometimes getting out of a chair. 

Bradykinesia in the limbs affects rapid movements. This is particularly noticeable with alternating movements such as cleaning teeth, combing hair or shaving. People with bradykinesia of the hands develop a distinctive change in handwriting where the letters get progressively smaller and less legible as the writing proceeds across the page.

Slowness of Movement

Stiffness or Rigidity

Stiffness or rigidity is often detected by the examining doctor. These symptoms can contribute to deep aching sensations felt in the limbs.

Stiffness or Rigidity

Tremor

About three quarters of people develop a tremor at the onset of their illness. However, a number of people never develop tremor throughout the course of their Parkinson's. The tremor is usually more on one side, at least at first. A feature of the tremor is that it tends to occur when the limb is relaxed. 

The tremor tends to disappear while performing tasks such as writing or drinking from a cup; although like all things about Parkinson’s, this is not always the case. Because the tremor usually disappears with movement, it is frequently not disabling, although it can be embarrassing.

Tremor

Resources

From managing fatigue, medication or learning Parkinson’s specific exercises, there is a variety of information and education on how to live with Parkinson’s.

Living with Parkinson’s: the Stories