What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
How Does Parkinson Affect The Nervous System
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Adapting Behavior To Deal With Uncertainty
This theme is composed of the subthemes balance in life being forced into a new role, and fluctuations cause insecurity. The theme incorporates the participants multifaceted lived experiences of balance impairment. The concept of balance was not solely seen as a physical function but was also discussed in relation to mental well-being and the interplay between body and mind.
Im thinking about a weighing scales, like that youare in balancein every way. That things do not weigh too much on 1 side, and in a spiritual way as well.
Even though this mind-body interplay was not always explicitly expressed, all participants conveyed a direct or indirect emotional impact of reduced balance capacity. Having an impaired balance capacity often meant having to refrain from, or adapt, ones activities. No longer being able to perform things one previously could led to a reduced sense of freedom and independence. As a consequence of this, participants were forced into new roles in their management of disease restrictions.
You lose the freedom to move in the way that you would like to. That must be the biggest freedom that you have, to be able to go where you like.
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What Changes Can Occur
There are several ways PD may affect speech:
- The voice may get softer, breathy, or hoarse, causing others difficulty hearing what is said.
- Speech may be slurred.
- Speech may be mumbled or expressed rapidly.
- The tone of the voice may become monotone, lacking the normal ups and downs.
- The person may have difficulty finding the right words, causing speech to be slower.
- The person may have difficulty participating in fast-paced conversations.1
Some of the medical terms that describe the speech changes that can occur with PD include:
- Dysarthria, which is a motor speech disorder or impairment in speaking due to PD affecting the muscles required for speech
- Hypophonia, which means soft speech, is an abnormally weak voice caused by the weakening muscles
- Tachyphemia, also known as cluttering, is characterized by an excessively fast speed of talking and a rapid stammering that makes it difficult to understand the person speaking2,3
Icipants And Baseline Characteristics
Initially, we identified 322 patients in our dataset who met all the inclusion criteria. After a detailed checking of data and medical records based on exclusion criteria, 61 patients were excluded. Consequently, 261 patients were included in the explorative dataset. Among them, 78 patients did not reach the scheduled 12-month follow-up point by the time of data collection, 37 patients assessment data contained missing information, and 35 patients were lost to follow-up, resulting in a total of 111 patients being included in the validation datasets. The detailed workflow of participants identification is shown in Fig. . For the 261 and 111 patients in the explorative and the validation set, 122 and 65 patients were assessed using UPDRS, and 139 and 46 patients were assessed using Movement Disorder Society-unified Parkinsons disease rating scale , respectively. After score conversions, a comparison of baseline characteristics and motor improvement between the 2 datasets are shown in Table . There was no significant difference between the 2 sets, except that the patients in the validation set had better on-medication balance performance in Berg balance scale at baseline .
Fig. 1: The workflow of participants identification in the explorative and the validation datasets.
PD, Parkinsons disease STN-DBS, subthalamic nucleus deep brain stimulation.
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Exercise Beliefs And Reservations
This theme contains the subthemes sense of well-being and normality, symptom management, and doubts. The first 2 subthemes deal with the varying motivating factors towards being physically active. Some participants described physical activity as something that enabled them to temporarily take their mind off the disease. Continuing with activities they had previously performed also seemed to reinforce a sense of normality.
Tennis and jogging and ball sports work pretty well, I mean I dont think about the fact that I have the disease.
An array of activities were described as ways of managing different symptoms such as impaired gait, balance, and posture. Certain participants expressed thoughts on how physical activity could affect the brain and held positive beliefs towards activities that they considered as challenging.
Its really good for your brain, its like you get reflexes, yes, so its greatyou have to think like, you have to think strategically when you play table tennis you need to be 1 step ahead in your thoughts when you get the ball, how you are going to place it. It means that you have to think. Think table tennis, and not just hit the ball back, there needs to be thought behind it. And everything needs to happen really fast as well.
Bradykinesia And Freezing Impair Gait
Dynamic balance control involves controlling the body CoM with respect to, but not necessarily over a moving base of support. Walking becomes less automatic in PD so it requires more attention, particularly for challenging tasks such as turning, walking between obstacles, and dual-tasking. Newly diagnosed patients with PD show signs of bradykinetic gait features, such as reduced trunk rotation, decreased arm swing, and slow turns, even when walking speed is normal . Extent of arm swing on the most involved side may, in fact, be the most sensitive early sign of gait affected by the disease. Bradykinesia results in slow gait velocity and shuffling of the feet that progresses with the disease. Freezing of gait is not usually only lack of stepping but often includes high frequency trembling of the legs as the patients attempt to get their feet moving. These quick motions may represent repeated, multiple APAs that get larger and larger until a step is finally triggered .
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What Are The Causes
In Parkinsons disease, nerve cells in a part of the brain called the basal ganglia start to die and produce less of a neurotransmitter called dopamine. The basal ganglia use dopamine to form connections between neurons. This means when theres less dopamine, there are fewer connections.
The basal ganglia are responsible for making sure your body movements are smooth. When there arent as many connections in this area of the brain, it cant do that job as well. This leads to Parkinsonian gait and the other movement symptoms of Parkinsons disease.
Other Symptoms Of Parkinsons
The primary motor symptoms of PD are tremor, rigidity, postural instability , and bradykinesia .
PD also causes many secondary motor symptoms, including micrographia , changes in gait , stooped posture, dystonia , cramping, difficulty swallowing, sexual dysfunction, impaired fine motor dexterity, and akathisia .
In addition to these motor symptoms, PD can cause non-motor symptoms such as depression, difficulty swallowing or chewing, urinary problems, constipation, skin problems, sleep problems, pain, and cognitive problems, such as memory problems or slow thinking.1,7
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Tips For Coping With Speech Difficulties
- Exercise your voice by reading out loud or singing every day.
- Drink enough water, avoiding shouting and rest your voice when it is tired.
- Train your voice like an actorsit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
- Get feedback from friends and family members about how others perceive your speech develop a cue or code word you can use in public to make you focus on speaking clearly.
- If you have soft speech, use tools such as a voice amplifier , placed on your shirt, and on the telephone . Ask an occupational therapist about other tools.
- Make eye contact with the person to whom you are speaking.
- Reduce background noise.
- Socialize in small groups or one-on-one.
- If you experience a facial masking, use feeling words to communicate your emotions . Use practice physical gestures to help convey emotions.
- Determine which times of day your speech is best. Plan social engagements around those times.
Even in the early stages of PD, many report that their voices are too soft, causing others to ask them to repeat themselves. Other people with PD may have a gruff or hoarse quality to their voice. Try these strategies:
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
For more insights on this topic, listen to our podcast episodeImportance of Early Detection of Swallowing Disturbances or download our Speech and Swallowing book.
Equipment And Walking Aids
You might find that equipment can help you to walk, such as a walking stick or a rollator .
Before you start using a walking aid, it’s very important to get advice from a physiotherapist. Some walking aids aren’t recommended for people with Parkinsons as they can affect your walking pattern and make you more likely to fall. But, the correct walking aid can increase your confidence and help you to lift your feet better.
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Medications And Other Causes
Balance issues in Parkinsons may occur due to medications or medication dosages. Some side effects of Parkinsons medications may affect blood pressure, dizziness, and balance. Higher doses of Duopa , for instance, have been associated with increased falls. Drugs used to treat other conditions, like blood pressure, may also cause dizziness and balance issues.
I am dizzy from the meds. Does anyone else have problems with the carbidopa/levodopa? asked one MyParkinsonsTeam member.
People with Parkinsons disease may also lose their balance and fall if there are items like furniture out of place, or if their home has not been adapted to meet their mobility needs. People get used to the arrangement of household items and grow comfortable moving around those spaces. If something gets moved out of place, it may pose a fall risk to someone with Parkinsons.
Walking With Parkinsons: Freezing Balance And Falls
Parkinsons disease can change the way a person walks. Movement Symptoms like stiff muscles, rigidity and slow movement make it harder to take normal steps. In fact, short, shuffling steps are a common sign of PD, as is freezing, the feeling that your feet are stuck to the floor, for people with mid-stage to advanced PD.
On their own, these changes are distressing enough. But add the fact that Parkinsons affects balance and they also become dangerous, putting people with PD at risk of falling. The good news is that with exercise and physical therapy, people with PD can improve their balance. What can you do to minimize freezing and avoid falls? Read on to find out.
The following article is based on the latest research and a Parkinsons Foundation Expert Briefings about Parkinsons-related freezing, balance and falls hosted by Fay B. Horak, PhD, PT, Professor of Neurology at the Oregon Health & Science University, a Parkinsons Foundation Center of Excellence.
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Physical Therapy For Parkinsons Disease
Its well-known that exercise of all kinds is beneficial for patients with Parkinsons disease. But physical therapy, in particular, is key. Why? A professional can guide you through the right moves to increase mobility, strength and balance, and help you remain independent, says Denise Padilla-Davidson, a Johns Hopkins physical therapist who works with patients who have Parkinsons. Here are things a therapist may work on:
Note: Please discuss any exercise program with your physician/neurologist and get a referral to a physical therapist or trainer with expertise in Parkinsons disease before starting any specific program.
Directing Focus To Stay One Step Ahead
The subthemes focused attention internal dialogue and anticipating and planning group together to form this theme. Participants described having to place an increasing amount of conscious effort into dealing with the present moment and, more specifically, performing activities without falling. They were more careful and aware of challenging situations and had begun to implement a sort of strategic carefulness, which could entail staying seated on the bus until it had come to a full stop or walking on the middle of the train platform instead of near the edge.
Yes exactly, and at the same time, if I walk on a path and meet someone I let them pass in a way that I do not have to step aside, because then I would be afraid that I might fall.
While in the moment of performing a certain balance-demanding task, such as walking, participants described having to concentrate on this 1 task with undivided attention.
Yes I do that, when I walk from the kitchen counter to the sofa I do that. But the thing is that I concentrate on just that one thing that I am doing right then, and then when I sit down, then I relax a little. But I cant relax while Im walking.
The subtheme internal dialogue concerns how participants pep-talked themselves when faced with environmental demands such as icy streets, stairs, or an oncoming crowd of people. It also entails how they communicated with their body to prepare for and thereafter perform the action in a goal-directed manner.
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Role Of The Funding Source
This study was supported by grants from the Doctoral School in Health Care Sciences, the Swedish Research Council for Health, Working Life and Welfare , Parkinson Research Foundation, the Swedish Parkinson Foundation, and the Swedish Research Council. The funders played no role in the design, conduct, or reporting of the study.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
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Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
Physical Issues Of Your Sex Drive
Parkinsons affects ones autonomic nervous system, which controls sexual response and functioning. Parkinsons acts upon neurons in the brains substantia nigra, causing dopamine-producing nerve cells to die. Since dopamine is a chemical that transmits signals between parts of the brain that usually coordinate smooth muscle movement, this is critical to sexual function on two fronts.
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First, this dopamine drop may result in a decreased sex drive and sexual interest. Second, the lower levels of dopamine that result are believed to cause ones loss of balance, changes in walking pattern and posture, muscle rigidity, Bradykinesia , and tremors when resting. The symptoms of Parkinsons can also be seen in:
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