While many patients do not experience all these symptoms initially, most have at least two of these during diagnosis:
- Slow Movement (Bradykinesia): Trouble with buttons, using utensils, less arm swing when walking, trouble getting out of a chair and stooped posture
- Stiffness in Movement (Rigidness): Arms or legs may feel tight, heavy, or frozen
- Resting Tremor: Usually noticed when the arm is relaxed or holding an object for a prolonged period
- Instability when standing or walking
Patients also experience a variety of secondary motor symptoms that include the following:
- A change in facial expression (lack of blinking or smiling)
- A frozen and painful shoulder
- Limping or dragging of one leg
- Numbness, tingling, aching, or discomfort in the neck or limbs
- The softness of the voice
- The subjective sensation of internal trembling
Although tremor is the most known and visual symptom (e.g. shaking in one or both hands when relaxed), as many as 30% percent of patients never develop tremors. The shaking usually reduces when the hand is used. Tremors can also occur in the leg or the jaw.
Parkinson’s symptoms tend to first appear on one side of the body and can be mistaken for stroke symptoms. Ultimately, however, most patients will go on to develop symptoms on both sides of the body.
Please contact your physician if you are experiencing any of these symptoms to determine the cause and to discuss treatment plans.
- Depression: Biochemical changes in the brain may cause depression. Most patients usually respond well to a combination of antidepressant medications and psychologic counseling.
- Anxiety: Like depression, biochemical changes in the brain may cause anxiety. For some people, it may either be a normal reaction or due to changes in dopamine medications. If you have anxiety, please talk to your physician. Anti-anxiety medications can be very effective as well as counseling/cognitive behavioral therapy
- Apathy: Trouble with motivation can make it difficult to fully participate in activities including exercise, physical and occupational therapy, and the overall treatment plans. This may be noticed more by family or caregivers and is important to discuss with your physician.
- Loss of smell or taste: Often experienced many years before the onset of motor symptoms.
- Constipation: Gut muscles may also be slow to push stool along. The most effective way to manage constipation is to prevent it by:
- Exercising regularly
- Drinking plenty of fluids
- Increasing the fiber content of your diet
- Using stool softeners
- Sleep Disorders:
- Excessive daytime sleepiness and fatigue may be caused by poor sleep at night, painful muscle cramping, medications, or by the disease itself. To help with sleep, your physician may add a dose of levodopa at night. Since depression can also contribute to insomnia and early morning awakening, the treatment of depression may also be useful.
- Rapid Eye Movement Behavior Disorder (RBD): Common in Parkinson’s disease, RBD may begin years before motor symptoms appear. Symptoms include nightmares or violent dreams (often of fighting or being chased), yelling, hitting, fighting, kicking, or thrashing during sleep. This can lead to injury for patients and bed partners. Fortunately, treatment can help.
- Restless Leg Syndrome (RLS): Restless legs syndrome involves an abnormal feeling in the limbs along with a compulsion to move that limb. It tends to occur at night and many patients have difficulty falling asleep. We often prescribe nighttime doses of medications such as dopamine agonists to reduce symptoms.
- Urinary Symptoms: Frequent urination is a common problem. Discuss this symptom with your physician so that they can assess the cause and rule out a urinary tract infection. Several medications and exercises are available that can also help.
- Sexual Dysfunction: Sexual dysfunction and erectile dysfunction is a common symptom.
- Cognitive and Memory Problems: Difficulty producing words.
- Impulse Control Disorder: Patients may have difficulty controlling impulsive behaviors, such as gambling, shopping, accessing pornography, or displaying inappropriate sexual behavior. This is usually related to medications used to treat Parkinson’s disease, particularly dopamine agonists. It is important to tell your physician if you experience any relationship, financial, or legal problems. Often, adjusting medications can help.
- Hallucinations: Visual hallucinations can occur in Parkinson’s disease, typically in more advanced stages, and can be increased by some of the medications used to treat Parkinson’s disease. Sometimes, medication is used to treat hallucinations, usually Quetiapine.
- Orthostatic Hypotension: Orthostatic hypotension is the sudden drop of blood pressure that sometimes occurs when you stand up. Symptoms include dizziness, graying of vision, fatigue, fainting, weakness, and frequent falls. This can also be a side effect of some medications. Your medications may need to be adjusted if this occurs, and your physician may recommend that you increase your fluid and salt intake.