The lesser known symptoms of Parkinson's
published in Reader's Digest,
15 April 2016
Knowing about a disease and living with it are two very different things. Most people know about the tremor, rigidity and slowed movement that can characterise Parkinson’s. Few know about these other very common symptoms.
Ralph’s story
Having worked as a chef for many years, Ralph was troubled by a loss of smell. At first, he assumed he just had a cold, but his smell never returned.
Ralph also started to forget his food orders, blaming it on a recent bout of insomnia. And why was he so constipated? He knew all about healthy eating.
It was only when Ralph visited a doctor for a suspected frozen shoulder, that he was diagnosed Parkinson’s and realised that these earlier problems could well have been the warning signs.
In fact, almost 30 symptoms of Parkinson’s exist that have nothing to do with movement, often occurring as a result of Parkinson’s itself or as a side effect of the drugs prescribed. Here are just a few.
Depression and anxiety
Thought to occur as a result of changes in brain chemicals including dopamine and serotonin, up to 30% of people with Parkinson’s have depression, often before diagnosis—suggesting it is not just a reaction to the doctor’s news.
Other brain effects include poor memory, hallucinations and even impulsive behaviours such as gambling—particularly when patients take pramipexole, a dopamine-like drug.
Fatigue and insomnia
Though this can have many causes, sleep disturbances are up to 4 times more common in those with Parkinson’s disease and can include excessive daytime sleepiness, which presents itself as either a constant feeling or through sudden ‘sleep attacks’ and insomnia.
Changes in the brain’s hypothalamus and brain stem areas might be responsible, but sleep can also be affected by depression, Parkinson’s drugs, incontinence and pain.
Incontinence and constipation
In one survey of Parkinson’s patients, 56% answered positively to the question: “have you experienced a sense of urgency to pass urine which makes you rush to the toilet?”
Several studies have shown a link between progression of Parkinson’s and increasing bladder problems, while deep brain stimulation (a surgery that may help symptoms) may sometimes improve bladder function.
Constipation is very common in Parkinson’s, possibly due to effects on nerves and muscles in the gut.
Smell
Loss of smell can occur up to six years before the movement symptoms of Parkinson’s and presents itself in more than 90% of patients.
According to Professor Doty at the Smell and Taste Centre, University of Pennsylvania, “The basis for the dysfunction is presently enigmatic, although decrements in several neurotransmitter systems may be involved.”
Interestingly, a patient's sense of smell can also be reduced in Alzheimer’s, Huntington’s disease and myasthenia gravis and the same brain chemicals might be involved.
Of course, several other factors can affect smell including having a cold, ageing, cigarette smoking and head injury.
Handwriting
Many people with Parkinson’s notice changes in their handwriting, which often becomes smaller. The good news is that scientists may be able to use this as an early predictor of Parkinson’s, starting treatment sooner to prevent further damage.
The ‘non-motor symptoms’ are often very debilitating, yet they can be a useful diagnostic tool.
The 100 for Parkinson’s project aims to collect worldwide patient data on non-motor and motor symptoms to better understand how they affect their quality of life and to establish whether they show a particular pattern of occurrence that may aid diagnosis and treatment.