More than 200,000 people in the United States are diagnosed with Parkinson's disease (PD) each year. Despite how common this condition is, though, most people don't really know much about it.
What exactly is Parkinson's disease?
Parkinson's is a progressive disorder of the nervous system that mainly affects movement. However, it also causes non-motor (non-movement) neurological symptoms like trouble with cognition, personality changes, psychosis, depression, and trouble sleeping.
How long can someone live with Parkinson's disease?
People with Parkinson's have a slightly shorter lifespan than those who do not. On average, people live 10 to 20 years after diagnosis. It is important to remember though that most are diagnosed around age 60, meaning people with PD regularly live to be 70 or even 80.
What are the complications of Parkinson's disease?
Parkinson's disease can result in many complications, some of which can be life-threatening. For example, in late stages of the disease, someone can have difficulty swallowing. The result? Someone is at greater risk of inhaling foods and liquids into their lungs, which can lead to pneumonia. In fact, pneumonia is the leading cause of death for those with PD.
Early diagnosis is key to improving quality of life.
Unfortunately, there is no cure for Parkinson's disease. However, early diagnosis and treatment can slow the disease's progression and offer relief from symptoms.
What are common symptoms of Parkinson's?
So, just what signs should someone be on the lookout for? The first is a classic symptom of PD that many people associate with this disease...
Tremors are one of the five main motor-related symptoms of Parkinson's disease. There are a number of different neurological and musculoskeletal (muscles, bones, ligaments, tendons, and nerves) issues that can lead to tremors.
What are these tremors like?
A hallmark of Parkinson's disease? Tremors that occur when a person is at rest. PD tremors are particularly slow and rhythmic rather than rapid and shaking.
Where do the tremors begin?
For most Parkinson's patients, tremors begin in one leg, foot, or hand. As time goes on, they spread to the other side of the body as well. Additionally, some people experience a resting tremor in their chin, jaw, tongue, or mouth.
What about internal shaking?
There are also patients who describe tremors as being "internal," or feeling muscle shaking that aren't necessarily visible to those around them.
The following common sign of PD is something of the opposite issue of tremors...
12. Rigidity and Postural Instability
Rigidity and postural instability go hand-in-hand with Parkinson's. The rigidity comes first, and the stiffness then leads to warping of the posture. People with Parkinson's often experience a reduced range of motion and rigidness in their torso or limbs.
Misdiagnosis is common.
When the disease is in its early stages, it's common for rigidity problems to be misdiagnosed as an orthopedic or arthritic issue. Some Parkinson's patients are treated for a shoulder rotator cuff injury before they receive their actual diagnosis.
Further complicating the matter is the fact that postural instability might not be apparent at all times. In other words, some patients have balance issues most strongly when engaged in certain movements. Specifically, people are more likely to lose their balance when getting out of bed, getting up from a chair, turning around too quickly, or standing upright in a non-moving position—all of which might be more readily attributed to loss of motor function from just old age.
How does this symptom progress?
Some people might present with postural instability when they're first diagnosed, but rigidity is more common. It's not until the disease progresses that serious balance issues come into play.
Why is that, though? Well, as the muscles stiffen, people are unable to maintain their posture and balance. That is why it's common for Parkinson's patients to experience falls.
What types of falls are common with PD?
The most common falls are backward, and some patients can be pushed over by a simple light touch because they are unable to catch their balance.
When someone is able to move, they might notice that they aren't as nimble as they once were...
What is bradykinesia?
Bradykinesia is a Greek word that means "slow movement." In addition to being a symptom of Parkinson's disease, bradykinesia is also seen in other movement disorders and neurological illnesses related to Parkinson's.
What is bradykinesia like?
The symptom is characterized by both a slowness of the body's movement and a mask-like facial expression with a reduced ability to emote (facial masking, or hypomimia). The eyes also tend to blink less often than an average person's. In other words, not only will someone's body movements be slower, but they will be more likely to have a blank, expressionless face.
What are the complications of bradykinesia?
People with bradykinesia typically experience issues with their fine motor coordination. Now, fine motor skills are necessary for engaging in complex and detailed muscular movements, which means this symptom can negatively impact day-to-day functioning.
How does this symptom manifest?
People with Parkinson's might have trouble executing everyday tasks because the movements of their fingers are slow and imprecise. Some ways this symptom manifest include:
- Difficulty buttoning shirts
- Being unable to knit after a lifetime of doing so
- Tiny handwriting (micrographia)
- Struggling to roll over in bed
Symptoms can worsen each other.
Unfortunately, postural instability and bradykinesia can combine to create the following sign of PD...
10. Gait and Walking Difficulties
How does PD cause walking difficulties?
Postural instability and bradykinesia both combine to make walking difficult. For people who don't notice the initial balance issues and fine motor impairment, the difficulties with walking may be the first symptoms that lead them to seek treatment.
What specific walking difficulties arise with PD?
- When a person walks, their arms tend to have a natural swing. The amount of swinging involved varies from person to person. An early sign of Parkinson's is a reduction in your average arm swing as you walk.
- As the disease progresses, you might find that you can only take small and slow steps.
- Shuffling gaits are common due to a combination of balance problems and motor control issues.
- Another gait problem that commonly occurs is propulsion, which causes people to propel themselves forward with short and rapid steps. This may be due to a feeling of imbalance.
- Advanced Parkinson's can also present with "freezing" episodes, which cause a person to be unable to move their feet from the floor.
Mobility aids are sometimes necessary.
As Parkinson's progresses, it's common for walking to become more and more difficult. Mobility aids can improve a person's quality of life, and some people may transition to full-time use of a wheelchair in the later stages. Unfortunately, the following symptom can make using mobility aids difficult...
What is dystonia?
Dystonia is a type of movement disorder that causes the muscles to involuntarily move in ways that can be unnatural or painful.
Parkinson's or something else?
Not everyone with Parkinson's develops dystonia, and it's very possible to receive a Parkinson's diagnosis even if you don't have dystonia. In the same vein, dystonia can be caused by brain lesions, medication side effects, other neurological diseases, and genetic disorders. All in all, this symptom alone is not always a definitive guarantee that a person has Parkinson's.
Where does dystonia commonly happen?
When a person has dystonia, parts of their body repetitively move and twist in uncontrollable ways. There are a number of different body parts and muscle groups that Parkinson's-related dystonia can affect. The most common are the:
Dystonia is often painful and distressing, particularly when it impedes a person from moving in the way they want.
How does dystonia commonly manifest?
Dystonia affecting the eyes and neck can appear particularly troubling.
- Dystonia affecting the eyes often looks like rapid or increased blinking. However, it's actually a repeated involuntary closing of the eyes.
- When the neck is involved, the condition is called cervical dystonia. Parkinson's patients might find that their neck turns, bends forward and backwards, tilts at awkward angles, or assumes an unnatural posture. Most commonly, the neck muscles will be flexed, and the neck will be unnaturally hunched or bent forward instead of held straight.
Of course, PD can change the way someone talks, too...
8. Vocal Changes
It's very common for individuals with Parkinson's to experience changes to their voice.
How does PD affect voice?
These changes are typically caused by other motor symptoms, rather than being a whole new phenomenon of their own. For example:
- Bradykinesia can cause the vocal cords to move more slowly, and it might impede their ability to rattle.
- If the vocal cords have a limited range of movement, a person's voice might come out softly even if they're trying to speak at full volume.
What are the vocal changes like?
Ways PD can change someone's voice include:
- Volume changes. Some people find that their voice is more soft and quiet whenever they speak. Others have strong volume at the beginning of a sentence and then find that the loudness dies off toward the end.
- Inflection difficulties. People might also have limitations on their ability to express emotion and differentiation through their vocal tone. Because of this, it's common for words to come out in a monotone even if the speaker intends to use inflection.
- Speech speed. When Parkinson's advances to later stages, people might begin speaking much more rapidly than they used to. The words may crowd or slur together and be difficult to understand.
- Stuttering. Stuttering is also common, sometimes occurring alongside the rapid fire speech.
PD isn't just an emotionally and mentally painful condition; it's physically painful, too...
7. Pain and Fatigue
How common is pain in those with PD?
Many people are unaware of how common pain is in Parkinson's disease, but it's actually one of the single-most common symptoms. In fact, anywhere from 40%-80% of Parkinson's patients report that they have pain.
Why does PD cause pain?
Researchers believe that certain painful sensations and experiences might be felt only by individuals with Parkinson's. Additionally, if there's a comorbid condition causing pain, the motor symptoms of Parkinson's can increase existing pain levels.
In some cases, pain might be an early warning sign of the disease. One of the most common occurrences is for painful shoulder symptoms to be misdiagnosed as frozen shoulder or a rotator cuff injury. In actuality, the pain wasn't caused by a muscle injury, but rather by the rigidity and stiffness caused by Parkinson's.
What kinds of pain does PD cause?
There are four types of PD pain.
- Musculoskeletal pain occurs when there are issues with the joints, bones, and muscles.
- Dystonic pain is related to dystonia.
- Radicular pain is pain in the nerves.
- Central pain isn't well understood and requires more research. Current research indicates that central pain is caused by brain abnormalities rather than issues originating elsewhere in the body.
What about fatigue?
Fatigue often goes hand-in-hand with pain, but it can also occur on its own. Now, fatigue isn't just feeling tired; it is intense exhaustion that persists even after adequate amounts of rest.
Why does PD cause fatigue?
Some fatigue may be related to how draining the pain and motor issues are. Consistent sleep issues also contribute to feelings of fatigue and exhaustion in Parkinson's patients.
PD can be more than just physical; in fact, cognitive issues are also common...
6. Psychological Issues
Parkinson's causes a number of neurological symptoms that disrupt cognitive functioning, emotional processing, and overall mental health.
What type of psychological issues are common with PD patients?
Three of the most common psychological issues experienced by Parkinson's patients are depression, anxiety, and psychosis.
What are PD-induced depression and anxiety like?
Depression and anxiety may occur comorbidly (together) or individually, and their severity varies by individual. Fortunately, some people find that their symptoms improve when they treat their other Parkinson's symptoms. Antidepressants, psychotherapy, and cognitive behavioral therapy may be particularly helpful for relieving these symptoms.
What is PD-induced psychosis like?
Psychosis is a more severe psychological symptom, and it's also widely misunderstood by the general population. A psychotic person is someone who is experiencing delusions, hallucinations, or any other kind of break with reality. They are not inherently violent, and most psychotic people are actually more likely to be victims of violence than perpetrators.
How can psychosis be managed?
Over half of the patients diagnosed with PD will eventually begin to experience psychotic symptoms. Getting an accurate diagnosis and treatment of this symptom can be difficult. Since the condition is related to both neurological and psychological factors, it may be helpful for a patient's psychiatrist and neurologist to consult with each other when creating a treatment plan.
Unfortunately, the following PD symptom can worsen the entire condition...
5. Sleep Problems
Many people with Parkinson's experience sleep disturbances like insomnia and vivid dreams. According to one study, the average person with Parkinson's is only able to get five hours of sleep every night, which is far less than the CDC-recommended 7-9 hours.
What is insomnia?
Insomnia means someone experiences poor sleep quality and has issues with falling and/or staying asleep. Most commonly, people with PD are likely to experience issues staying asleep. In fact, people with PD are about twice as likely to wake up throughout the night as someone without the condition.
How else can PD interrupt sleep?
Some of the other reasons for a decrease in restful sleep include:
- Obstructive sleep apnea that intermittently stops the person's breathing
- A frequent need to urinate in the night
- Confusion in the night
- Psychosis in the advanced stages of the disease
What about vivid dreams?
It's also common for people with PD to have extremely vivid dreams. However, these dreams tend to be medication side effects rather than a symptom of the disease itself.
Someone with PD can expect changes to their smell and vision as well as their sleep...
4. Changes to Sense of Smell and Vision
Sensory changes are a common neurological component of Parkinson's. People may experience a combination of changes to their senses of smell and sight. Eye problems due to diminished blinking are also common and can lead to vision loss.
How does PD cause vision problems?
The average person blinks anywhere from sixteen to eighteen times per minute. With the reduced movements in Parkinson's disease, that can slow to one to two times per minute.
Reduced blinking may lead to permanent vision problem.
Blinking is necessary to keep the eyes moisturized. Not treating the dryness means that light-sensing cells may begin to die off, causing permanent vision impairment.
How does PD cause issues with smelling?
One common early symptom of Parkinson's is that a person's sense of smell is either reduced or eliminated entirely. A reduced ability to detect and differentiate between odors is called hyposmia, while a total loss of the sense of smell is called anosmia.
Issues with sense of smell can create other issues.
Sense of smell is closely tied to sense of taste, so those with a reduced sense of smell typically have a reduced sense of taste. When this occurs, someone may not be as motivated to eat, which can lead to nutritional deficiencies and even weight loss.
Don't ignore these symptoms.
It's important to pay attention to these symptoms if they appear, as they can often be the first sign that anything is amiss. Unfortunately, many people don't notice the loss of smell since it happens gradually, and since smell is a sense that isn't often focused on.
But with Parkinson's disease, sense of smell might be affected months or years prior to the onset of motor symptoms. Remember: Early diagnosis could make a huge difference in prognosis.
More unpleasant symptoms can occur.
Those with inner muscular side effects of PD will unfortunately likely develop the following frustrating issues...
3. Gastrointestinal and Urinary Issues
People with Parkinson's often experience issues with inner muscular structures as well. These issues tend to present as gastrointestinal distress and urinary dysfunction.
How does PD cause gastrointestinal issues?
The digestive system is made up of automatic muscles that move without conscious focus. Now, these muscles are necessary to push food and waste through the system. Since Parkinson's slows muscle movement, many people experience gastrointestinal distress related to slowed digestion.
What is the most common gastrointestinal issue in those with PD?
The most common symptom is therefore constipation, which may occur because the slowed digestive process causes feces to become impacted and/or harder to pass. Constipation may also arise as a side effect of PD medication.
What about urinary problems?
When the bladder is involved, common symptoms include:
- Increased urgency. Some people feel as if they cannot resist the urge to urinate even when the bladder isn't full.
- Increased frequency. Some people report that they have increased urinary issues at night, which may be due to lying flat.
- Slowness. A person with PD might urinate slowly.
- Overfull bladder. Some people experience overfilling of their bladders, which may lead to urinary incontinence (involuntary urination).
- Difficulty urinating at all. Some people struggle to even start a urine stream.
These issues are certainly difficult to deal with for the individual. Unfortunately, the following sign of PD can also be difficult not just on the sufferer, but also their loved ones...
2. Changes in Cognition and Personality
In addition to psychological issues, neurological symptoms including cognitive changes and personality alterations are common.
Parkinson's or something else?
Now, these changes aren't necessarily symptoms of mental illness, but they are significant neurological markers. Though many underlying causes can lead to these kinds of changes, they should be evaluated by a doctor, since prompt diagnosis and treatment of potential neurological problems is vital.
When cognitive issues present in the disease's early stages, it may be a sign of a related disease that isn't Parkinson's, but something like Lewy body dementia.
Who is more likely to develop these symptoms?
Cognitive changes tend to be more pronounced in elderly individuals with Parkinson's or in people with advanced Parkinson's disease.
How do cognitive changes manifest?
It may be difficult for PD sufferers to:
- Find words
- Think critically
- Make logical judgment calls
- Complete trains of thought
- Stay organized
These cognitive changes may be the result of PD itself or PD medications. After all, there are some medications that cause confusion and "brain fog" as side effects.
What are the personality changes like?
Personality changes occur gradually over time rather than being sudden and startling. This slow progression is due to the fact that these changes are related to the ongoing effects of the disease on the brain.
Can medication affect personality?
In rarer cases, personality changes might be a side effect of Parkinson's medication. Certain medications can lead to the development of impulse control disorders, which may present with symptoms like:
- Pathological gambling
- Reckless endangerment
- Other impulsive decisions
One of the most common yet least talked-about symptoms of PD?...
The following is one of the most common symptoms of PD. It's also one of the least talked-about signs of the disease...
1. Sexual Concerns
Sexual concerns are common for those with Parkinson's and their partners.
The symptom everyone is "mum" about.
Though sexual dysfunction and other sexual issues are extremely widespread among the Parkinson's population, this symptom isn't often talked about. In fact, many people are unaware that their issues may be related to their PD and may hesitate to bring these feelings up with their doctor.
What are the most common concerns?
- Drop in libido. The biggest concern for most people is a reduction in overall libido and sexual desire.
- Sharp uptick in libido. Conversely, many people report that beginning medication to treat Parkinson's symptoms also leads to an increase in their sexual desire. This increase may be so severe that that the libido becomes uncomfortable or troublesome.
- Impotence. Some might find that they are unable to maintain or achieve an erection, a common condition known as impotence. Now, impotence is often related to natural aging, though, and isn't a sign of a serious underlying condition by itself.
So, what should someone who suspects that they or a loved one has this disease know?...
Early Diagnosis is Key to Improving Prognosis
Parkinson's disease is a progressive neurological illness that presents with a range of motor and non-motor symptoms. By understanding how different symptoms present, people can seek treatment for themselves or a loved one who may have the condition.
Early diagnosis and treatment is key to retaining motor function and improving the overall prognosis.
What is diagnosis like?
There isn't a specific diagnostic test available to confirm Parkinson's. Instead, Parkinson's is typically diagnosed by a neurologist following a physical and neurological examination, a review of symptom progression, and a review of both personal and family medical history.
Those with multiple symptoms of Parkinson's disease, particularly the unusual neurological or motor symptoms, should speak to a doctor. Even if the underlying cause isn't PD, neurological and musculoskeletal issues should be diagnosed as soon as possible, as they can be related to other serious conditions.