What Are The Primary Motor Symptoms Of Parkinsons Disease
There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.
It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.
Tremors
Rigidity
Bradykinesia
Postural Instability
Walking or Gait Difficulties
Dystonia
Vocal Symptoms
The Profile Of Memory And Cognitive Changes
Even in the very early stages of Parkinson’s disease people can have difficulty with their thinking processes. Most authorities agree that the primary difficulty lies with the so-called executive cognitive functions.
Executive cognitive functions refer to such thinking processes as memory retrieval, planning, generation of words or concepts, attention, and monitoring and adjustment of non-routine and goal-directed behaviors. The common denominator in all of these executive functions is that they require cognitive control in order to operate smoothly.
The term cognitive refers to processes or operations involved in the processing of all kinds of information. So cognitive control processes are those processes that are used by the mind and brain to regulate the storage, retrieval, and usage of information .
Problems with executive functions are typically mild in early PD. They usually involve a generalized slowing of cognitive processing speed and subtle deficits in attention and working memory. It may be difficult, for example, to hold two different pieces of information in the mind at the same time, or to efficiently generate words and concepts as quickly as one used to. As the disease progresses, these executive cognitive deficits are made more severe by common Parkinson-related mood disorders and Parkinson-related emotional problems such as depression and anxiety.
Changes In Sleeping Patterns
As Parkinsons progresses, you can also develop problems with sleep patterns. These may not happen in the early stages, but can be noticeable later. You might wake up often in the middle of the night or sleep more during the day than you do at night.
Another common sleep disturbance for people with Parkinsons is rapid eye movement sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable if someone is sharing your bed. Dr. Rundle-Gonzalez says many times a bed partner will be the one to notice sleep problems.
REM sleep behavior disorder can also happen in people who dont have Parkinsons. However, if this isnt something youve dealt with before, its likely related to your disease. There are medications your doctor can prescribe to help you sleep comfortably through the night.
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One Of The Most Difficult Neurological Disorder Symptoms Of Parkinsons
Why might this be important to families challenged by PD? Because the biggest source of conflict in families occurs when loved ones fail to recognize that a person with brain changes is not the same person who existed at an earlier time in life. Human beings greatly value continuity in personality but by expecting the person to be the same as they once were, loved ones are unfair to the person with brain insult. This person could no more return to an earlier personality state than he or she can will away tremors or rigidity. Energy expended in any way other than coming to terms with this new person is fruitless. There is actually some fascinating research in this area and it is likely to be a topic for a great deal more discussion in future blogs.
Because of the greater likelihood for executive dysfunction and dementia, personality change is easier to see among individuals with more advanced PD. Motivation is frequently affected, resulting in apathy that diminishes how actively an individual interacts with other people and with the world . Thinking or cognition changes can cause the person to process information more slowly and with less focus and concentration . A previously methodical, consistent individual often becomes increasingly chaotic in their response to their environment . One easily becomes less interested and hopeful about the future .
Depression And Parkinsons Disease
Depression can be a disabling symptom of PD, and it may negatively affect a persons long-term outcomes by causing them to withdraw from social situations, avoid activities like exercise, or being more reluctant to seek care. Some people experience depression as an early symptom of PD before the characteristic motor symptoms appear.2
Depression has a variety of symptoms, not all of which are experienced by every patient. Symptoms of depression can also range in severity or vary over time. Common symptoms of depression include:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies or activities, especially those which were previously enjoyable
- Difficulty concentrating, remembering, and making decisions
- Difficulty sleeping, early-morning awakening or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide
- Restlessness, irritability
- Persistent physical symptoms3
There are many treatment options for depression that work well in people with PD. There are several types of antidepressants, including selective serotonin reuptake inhibitors , tricyclic antidepressants, and selective norepinephrine reuptake inhibitors . Many people also experience relief from their depression through psychological counseling, such as cognitive behavioral therapy. In addition, regular exercise has been shown to ease symptoms of depression.1,4
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The Psychosocial Impact Of Stigma
Several studies have found correlations between perceived stigma and depression in people with PD. Participants in qualitative studies have repeatedly reported embarrassment and shame about having PD. From a social relations perspective, it is argued that these feelings are, in part, a result of stigmatizing attitudes and actions of other people because PD is seen as breaking social rules. The shame experienced by people with PD can be considered public shame, with their home and private world being experienced as safer, which highlights the social relational nature of shame .
The socially created shame about having PD may be internalized and taken on as part of a persons self-identity. Some qualitative studies have explored the concept of self-identity in PD, and participants have described the challenges of living with PD and how it affects their sense of self and their social roles. People with chronic illness may feel discredited, which can be influenced by stigmatizing and disabling societal views of illness .
A person may internalize the negative stereotypes of what it means to have PD. This may be particularly pertinent for people who acquired impairments as adults after they had earlier developed perceptions of impairment from a non-impaired perspective. They may impose their own non-impaired view of illness on themselves. For example, a person with PD may experience negative feelings about being a burden and strive to sustain independence .
Adderall And Personality Changes
The prescription drug Adderall is the brand name for the combination of dextroamphetamine and amphetamine. Its mainly used to treat attention deficit hyperactivity disorder .
Among the reported side effects of stimulants like Adderall are new or increased hostility and aggressive behavior. However, this appears to be related to misuse of the medication.
Children and teenagers may have new psychotic or manic episodes.
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Pd And Medications For Pd May Affect Personality
A diagnosis of PD has been associated with a personality profile characterized by low levels of impulsivity, flexibility, and novelty-seeking, as well as high levels of industriousness, cautiousness, and harm avoidance . Neuropsychiatric symptoms associated with the underlying neuropathological changes of PD, such as depression, anxiety, and apathy , are commonly seen with estimates ranges from 3040% for depression or anxiety to 1770% for apathy . Such changes may affect personality ratings, especially those including negative emotions. Consequently, changes in personality over the course of DBS treatment may be difficult to disentangle from the underlying disease.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
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Autosomal Dominant Genetic Features
People have two copies of each gene. In autosomal dominant inheritance, a child can inherit either a healthy gene or one that is not working correctly. They will have a of inheriting a faulty gene.
Autosomal dominant genes that have associated with Parkinsons disease include:
- SNCA, or PARK1
may not provide useful information to individuals.
For one thing, a wide range of genes may play a role, and it is not possible to test them all. A person may also have a relevant feature but not go on to develop Parkinsons disease.
For example, only around 0.7% of people with symptoms of Parkinsons disease have changes in the LRRK2 gene, and around 0.3% have changes in the PRKN gene, according to a 2020 review.
Finding out in advance if a young person has the gene may help them prepare for the future if there is strong evidence of a family history of the condition. However, the results are unlikely to be conclusive and may cause unnecessary anxiety.
Anyone who is interested in genetic testing should discuss the pros and cons with a doctor and consider genetic counseling if they decide to go ahead.
The Parkinsons Foundation notes that testing is often hard to access. It can also be costly, and health insurance may not cover it. Genetic counseling can be an additional cost.
Thinking & Behavior Changes
Changes in thinking and memory can be frustrating and frightening for both the person with Parkinsons and the family. The videos on this page will help you understand, acknowledge and adapt to these changes so you can provide the best possible care for your loved one.
Part 1 supplies strategies to help you cope with your loved ones confusion and memory problems. Part 2 addresses how to respond to behavior changes that can occur as a result of hallucinations, delusions and dementia. It is important to remember it is the disease talking, not your loved one. For more information, order your free copies of the Parkinsons Foundation publications Cognition and Psychosis: A Mind Guide to Parkinsons online or by calling our Helpline at 1-800-4PD-INFO .
In 2016, the Parkinsons Foundation hosted a Caregiver Summit that brought together caregivers from all over the U.S. and the world to share experiences and everyday strategies for coping with the complex problems that arise as a result of Parkinsons. If you missed the event, dont worry! All the general sessions were recorded and are available on our YouTube channel.
Watch the video below for a first-hand account of one womans experiences after her husbands diagnosis with what health care professionals call Parkinsons disease psychosis.
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Managing Compulsive And Impulsive Behaviour
Because of the sensitive or private nature of some behaviour it is not easy for family or friends to discuss this with the individual. The person may feel embarrassed or uncomfortable discussing the problem so they may need reassurance that their behaviour does not reflect badly on them and that they can talk in confidence with a healthcare professional.
The person may be unaware of their personality changes so it is very important that family and friends who observe unusual behavioural traits discuss this as soon as possible with their doctor or an appropriate healthcare professional. Although it can be difficult to tackle such sensitive issues, prompt action can usually find effective treatment.
A trial and error approach may be needed as the higher doses of Parkinsons medication required to control motor symptoms may be the cause of the compulsive behaviour. But reducing medication can mean motor symptoms are less well controlled.
Treatment may involve reducing the daily dose of Parkinsons medication, or withdrawing dopamine agonists in favour of levodopa or another type of medication. Any changes should be made gradually to minimise the risk of side effects or withdrawal symptoms such as anxiety or depression. Continuous dopaminergic stimulation , using levodopa/carbidopa or apomorphine for example, has been found to be effective for a number of people.
How Parkinsons Affects The Libido
Parkinsons disease and the sex drive is a complicated issue. is a common complaint in patients with Parkinsons disease. However, certain PD medications particularly dopamine agonists can actually cause an increased sex drive in men and women, known as hypersexuality or sex addiction.
If this happens, and it is out of character for you, it is important to tell your doctor. Other side-effects of PD medications include psychosis and other impulsive behavior such as pathological gambling or heavy drinking. If you experience any of these symptoms, your doctor will most likely change your medication and monitor your mental health.
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Memory Or Thinking Problems
Having issues with thinking and processing things could mean your disease is progressing. Parkinsons is more than a movement disorder. The disease has a cognitive part as well, which means it can cause changes in the way your brain works.
During the final stage of the disease, some people may develop dementia or have hallucinations. However, hallucinations can also be a side effect of certain medications.
If you or your loved ones notice that youre getting unusually forgetful or easily confused, it might be a sign of advanced-stage Parkinsons.
How Is Parkinson Disease Treated
Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
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Living With Parkinson Disease
These measures can help you live well with Parkinson disease:
- An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
- High protein meals can benefit your brain chemistry
- Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
- If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.
Living With Parkinsons Disease
Depending on severity, life can look very different for a person coping with Parkinsons Disease. As a loved one, your top priority will be their comfort, peace of mind and safety. Dr. Shprecher offered some advice, regardless of the diseases progression. Besides movement issues Parkinsons Disease can cause a wide variety of symptoms including drooling, constipation, low blood pressure when standing up, voice problems, depression, anxiety, sleep problems, hallucinations and dementia. Therefore, regular visits with a neurologist experienced with Parkinsons are important to make sure the diagnosis is on target, and the symptoms are monitored and addressed. Because changes in your other medications can affect your Parkinsons symptoms, you should remind each member of your healthcare team to send a copy of your clinic note after every appointment.
Dr. Shprecher also added that maintaining a healthy diet and getting regular exercise can help improve quality of life. Physical and speech therapists are welcome additions to any caregiving team.
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Personality Changes In The Elderly
Minor personality changes in older adults, such as becoming more irritable or agitated, are not unusual. Extreme personality changes, such as a passive person becoming very controlling, could be a sign of dementia due to changes in the brains frontal lobe.
A 2016 study suggests that older adults have different personality traits than those of younger people. For example, neuroticism tended to increase in adults in their 80s.
Some people may revert to a younger age as they grow older. This could be a sign of depression or a way to cope with aging.
What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
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