Non-Motor Symptoms of Parkinson’s Disease

Samantha Holden, MD University of Colorado Movement Disorders

MOTOR SYMPTOMS Bradykinesia Tremor Rigidity Gait Imbalance

NON-MOTOR SYMPTOMS Urinary frequency

Dementia Depression/Anxiety

Psychosis Apathy Drooling Sexual dysfunction Runny nose Fatigue

Constipation Orthostatic hypotension Pain Insomnia Decreased Restless Leg Syndrome Nausea/Vomiting sense of smell Non-Motor Symptoms of PD

 Under-recognized and under-treated  Can be more disabling than motor symptoms  Not every person gets every possible symptom Smell & Taste Dysfunction

 Hyposmia or anosmia: decreased or loss of sense of smell  Can be one of the first symptoms of PD  Can lead to decreased appetite  No treatment Drooling

 Not due to overproduction of saliva, instead due to impaired mouth movements and swallowing  If mild, occurs during sleep or with meals  Can progress to be nearly constant  Embarrassing, can cause choking or aspiration

Rhinorrhea

 Runny nose  Can be like a “leaky faucet” for some people  Embarrassing, annoying  Can treat with Atrovent nasal spray

Choking and Swallowing Difficulty

 Slowness of movement of the mouth and throat muscles  Can lead to malnutrition, aspiration pneumonia  CAN BE LIFE-THREATENING – LET YOUR DOCTOR KNOW ASAP  Can be tested with a Swallowing Evaluation Nausea & Vomiting

 Common side effect of PD medications  Usually improves over time  Can also occur without medications  Slowed stomach emptying Constipation

 Extremely common  Fewer than 3 BMs per week or straining to pass stools  Can be one of the first signs of PD  Slowed transit in the bowels

Bladder Dysfunction

 Urinary urgency, frequency, incontinence, nocturia  In men, can be confused for prostate issues

Pain

 Can be directly due to PD  Stiffness, cramping, spasms  Commonly in neck, back and calves  Can occur during “off” periods  Early morning dystonia – toe cramping and curling before first levodopa dose in AM

Dementia

 Up to 80% of people with PD will have some cognitive trouble during their life  Slowness of thought, impaired attention and memory, visuospatial dysfunction  Should be screened at least once a year by doctor Psychosis

 Hallucinations, illusions, delusions  More common if dementia present  Can be side effect of medications or due to medical illness  Especially if sudden onset

Depression

 Very common – related to underlying disease, not just reaction to getting/having the diagnosis  Can be a very early sign of PD  Sadness, lack of pleasure in things you used to enjoy, hopelessness

Anxiety

 Frequently occurs with depression  Panic attacks, phobias, generalized anxiety  Can be a very early symptom of PD  Can occur with “wearing off” Apathy

 Lack of interest, initiative, motivation and emotion  Indifferent, no goals for the future  No longer enjoy activities Impulse Control Disorders

 Increase in compulsive or impulsive behaviors  Shopping, gambling, binge eating, cleaning, hypersexuality  Punding – repetition of useless tasks, like organizing objects  Dopamine dysregulation syndrome – addiction to Sinemet, taking more and more pills

Sexual Dysfunction

 Erectile dysfunction, decreased libido, decreased sensitivity, trouble reaching orgasm  Hypersexuality, or increased sex drive or inappropriate sexual behavior  Can be due to dopamine agonists  More common in men than women Orthostatic Hypotension

 Drop in blood pressure when changing positions  Especially lying to standing  Can also occur after large meals  Symptoms: Lightheadedness, fatigue, malaise, headache, shoulder ache, cognitive slowing, passing out

Fatigue

 Nearly universal symptom in PD  Lack of energy, lethargy, feeling “drained”  Not necessarily sleepiness or needing a nap

Excessive Daytime Sleepiness

 Different from fatigue  Falling asleep in the middle of the day  During meals or conversations, in public places, while driving  “Sleep attacks” with dopamine agonists  Not necessarily due to poor sleep at night  Overactive sleep drive Insomnia

 Two types:  Trouble getting to sleep  Trouble staying asleep – more frequent in PD  Waking up too early (3-4am)  Disrupted circadian rhythm and sleep-wake cycle

REM Behavior Disorder

 Acting out dreams – talking, screaming, kicking, punching  Can fall out of bed, injure yourself or your bed partner  Can be the very first sign of PD (even 20-30 years prior)

Take-Home Points

 Parkinson’s disease affects much more than just movement  Being aware of possible symptoms makes them easier to recognize and to obtain appropriate treatment  Every person with PD is different

Questions?