Parkinson's Disease

Parkinson’s disease has two types of symptoms: 

• Motor symptoms: affect movement
• Non-motor symptoms: affect cognition and other functions

Motor Symptoms

Motor symptoms are the most common in Parkinson’s disease. Early in the disease process, movement problems usually affect only one side of the body. Over time, problems may affect the other side of the body, with these symptoms being milder.

The four main motor symptoms are:

1. Tremor (Shaking). Tremors affect most people with Parkinson’s disease. Early in the disease the tremor may not be noticeable. It usually starts in one hand and spreads to the other side of the body. It stays worse on the side where it started. The tremor happens when people are resting and goes away when the person moves the part of the body that is shaking. Tremors may get worse with stress or anxiety.
2. Bradykinesia (Slowed Movements). Bradykinesia is slowness of movement. Everyone with Parkinson’s will get this symptom eventually. It may cause fatigue and weakness. People take longer to start and complete movements. This symptom can:
   
   • Make simple activities, like dressing and typing, slow and hard to do.
   • Cause speaking to be slower and harder.
   • Make people take short, shuffling steps and find it hard to stay balanced or stop walking. Falls risk increases.
3. Rigidity (Muscle Stiffness). Rigidity causes muscles in the arms, legs, or torso to be stiff. It usually starts on the same side of the body as the other symptoms, and gradually affects the other side, too. So people find it:
   • Find it hard to move.
   • Have limited range of motion: For example, this can affect how far someone can extend their arm.  
4. Postural instability (Difficulty with Balance). Parkinson’s disease causes poor balance so standing and sitting become harder. People tend to sway backward or forward and are at increased risk of falling. Loss of balance and falling usually happens later in the disease. Some people may need assistance or a wheelchair to move around.

Other Motor Symptoms

• Short, shuffling steps
• Freezing (suddenly stopping while walking or making other movements)
• Festination (short shuffling steps that become faster)
• Speech problems (soft, flat-sounding speech, slurred speech, stammering)
• Swallowing problems (difficulty chewing or swallowing food, excessive saliva or drooling)
• Micrographia (gradual shrinking in the size of handwriting, making it cramped and difficult to read)
• Visual changes (decreased eye blinking, blurred vision)
• Hypomimia (loss of facial expression, sometimes called “masked facies”)

Non-Motor Symptoms

Parkinson’s disease can also cause symptoms that are not related to movement but can be bothersome. Common non-motor symptoms include the following.

Cognitive (Memory and Thinking) Problems

About 40 percent of people with Parkinson’s disease have problems with decision making, short-term memory, and multi-tasking. These problems may be mild or severe.

People with Parkinson’s disease are likely to get dementia over time. Dementia occurs when cognitive problems are serious enough to affect activities of daily living.

Sometimes, people may hallucinate or develop delusions with paranoia. These can take the form of believing someone is stealing from them, their spouse is cheating on them, or someone is trying to harm them.

Changes in Mood

People with Parkinson’s disease may have:

• Depression
• Anxiety
• Irritability
• Apathy (loss of motivation), which can cause decreases in speech, emotion, and activity

Sleep Problems

People with Parkinson’s disease may have difficulty falling and staying asleep. Sleep problems may include:

• Difficulty turning over in bed and getting comfortable
• Vivid dreams
• Need to urinate frequently
• A sleep disorder that causes them to act out their dreams. 

Fatigue

Daytime sleepiness is common in people with Parkinson’s disease. Some people experience sudden “sleep attacks.” 

These symptoms are important to tell your doctor about, as they can affect your safety with activities such as driving.

Autonomic Dysfunction

Autonomic dysfunction occurs when nerves that control non-voluntary body functions, such as heart rate, blood pressure, and sweating, are affected. People with Parkinson’s disease can experience:

• A drop in blood pressure when standing up (leading to dizziness or lightheadedness, called orthostatic hypotension)
• Constipation
• Urinary leakage or difficulty urinating
• Sexual dysfunction, which may include an abnormal decreased or increase in interest in sex. Men may not be able to have erections.

Loss of the Sense of Smell

Many people with Parkinson’s disease lose the ability to smell or identify odors. This often happens early in the disease.

Pain

People with Parkinson’s disease may experience pain in several places or only in specific areas, often in the same parts of the body affected by the motor symptoms. The pain can be sharp, stabbing, burning, or tingling.