Tuesday, March 28, 2023

Parkinson’s Non Motor Symptoms

There Are Many Simple Non

Parkinson’s non-motor symptoms explained
  • Wearing compression socks
  • Elevating your legs when sitting
  • Drinking more fluids
  • Increasing your salt intake
  • Elevating the head of your bed by 30 degrees

A physical therapist can also show you exercises to reduce the problems of dizziness when you stand. Since your heart also helps control blood pressure, it is important to discuss lightheadedness or dizziness with your physician.

While psychosis is usually associated with mental disorders like schizophrenia, sometimes Parkinsons itself or side effects of medications can change your perception of reality resulting in Parkinsons psychosis. Estimates suggest as many as 40% of people living with Parkinsons may experience some type of psychosis.

Parkinsons psychosis typically takes the form of hallucinations , delusions or both. Hallucinations and delusions are more common in people who have been living with Parkinsons for a long time. Some people are aware that what they are experiencing is not actually real, while others are not.

Hallucinations in Parkinsons can be common, especially during later stages of living with it. Often, they are non-threatening visual hallucinations or visions of things that are not really there.

What To Expect From Diagnosis

Theres no single test for Parkinsons, so it can take some time to reach the diagnosis.

Your doctor will likely refer you to a neurologist, who will review your symptoms and perform a physical examination. Tell your doctor about all the medications you take. Some of these symptoms could be side effects of those drugs.

Your doctor will also want to check for other conditions that cause similar symptoms.

Diagnostic testing will be based on your symptoms and neurologic workup and may include:

  • blood tests

How Blood Pressure Fluctuations Can Affect Parkinsons Patients

The most recent approval was based on findings in the randomized and double-blind clinical trial , conducted at sites that included the University of Maryland. This study assessed the safety and effectiveness of magnetic resonance imaging -guided focused ultrasound delivered to the brain via the Exablate Neuro device.

Its use allows for precision MRI ultrasound targeting to gradually remove damaged tissue in the globus pallidus, a deep-brain region that helps to control voluntary movement.

MRI imaging creates a temperature map of the brain, providing a real-time view of the area for physicians to target with ultrasonic energy or sound waves. Doctors then heighten these energy levels to heat and remove the disease-affected tissue.

Patients are awake and can provide feedback for adjustments during the procedure, which requires no surgical incisions, anesthesia, or brain implants. The non-invasive nature of Exablate Neuro is thought to present a lower risk of infection than deep brain stimulation, which requires surgery to implant a device that treats motor symptoms.

Focused ultrasound has less ominous side effects for patients since theres no risk of infection or damage to blood vessels from the electrodes, Howard Eisenberg, MD, a neurosurgeon at the University of Maryland School of Medicine and the pivotal trials principal investigator, said in a press release.

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Sleep Parkinsons And Living Well Today

Parkinsons can affect sleep in many ways, ranging from trouble falling or staying asleep at night to excessive sleepiness during the day. Good sleep boosts everything from your mood to your ability to think and process to your physical movement. Understanding sleep problems and Parkinsons is often the first step you can take to enhance your sleep. In this conversation, Dr. Ron Postuma discusses the causes of sleep problems in Parkinsons, the difference between sleep changes related to aging and those related to Parkinsons, the difference between sleepiness and fatigue, the connection between sleep and medication, and types of sleep disorders and how to treat them.

Symptoms That May Be Related To Pd

What are the non

These symptoms can be associated with PD, but are also commonly associated with other medical conditions, so more testing is necessary. For example, weight loss may be associated with PD, but may also be a sign of a gastrointestinal problem or cancer. Pain may be associated with PD, but could be also due to arthritis, spinal stenosis, cancer, or a whole host of other causes.

There is a fourth category of non-motor symptoms that I would like to focus on now:

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Symptoms That May Be Related To Pd But That Few People Know About

People with PD and care partners may suspect that a particular symptom is related to PD, but they cant find information about it, so they are not sure. Two symptoms that pop up in this category are runny nose and breathing problems, which well focus on today. Of course, if these are new symptoms for you, they could be indicative of a new problem, including infection with COVID-19, so make sure to get yourself checked out by your doctor. However, if all else is ruled out, PD could be to blame. Excessive sweating and specific skin disorders are in this category as well and have been addressed previously.

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Researchers have developed tools to assess wearing-off in Parkinsons patients. In particular, the wearing-off questionnaire has been used in studies as a screening tool to identify which patients experience the wearing-off phenomena.

The team conducted a cross-sectional study to assess the impact of motor and non-motor wearing-off on daily activities and quality of life in Parkinsons patients. All patients were evaluated using the movement disorders society unified Parkinsons disease rating scale , the WOQ-19, and the Parkinsons disease questionnaire-8 to assess quality of life.

Among the 271 patients included, 73.4% had wearing-off. Researchers then classified those patients according to the type: 63.8% had mixed wearing-off , 32.7% motor, and 3.5% non-motor.

As expected, the MDS-UPDRS part I total score which assesses non-motor aspects of daily living was higher in the non-motor wearing-off group. Interestingly, there were no differences in MDS-UPDRS part I score between patients in the mixed wearing-off group and those who did not experience wearing off.

This finding suggests that patients with motor wearing-off may have a lower overall burden of non-motor symptoms, while patients with mixed or no wearing-off have similar burdens, researchers said. Conversely, patients with non-motor fluctuations also have a higher burden of non-motor symptoms.

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Other Rarer Types Of Hallucinations Include:

  • Auditory: hearing voices or music that are not really there.
  • Olfactory: smelling things that are not really there.
  • Tactile: feeling something touching your skin that is not really there.
  • Illusion: seeing things differently than they actually are, such as wallpapers that seem to jump or move.

Hallucinations and delusions may sometimes be caused by issues separate from Parkinsons, such as stress, dehydration, bladder infection or general infection. They may also be exacerbated when certain symptoms of Parkinsons are worse, such as constipation.

Parkinsons-specific and other medications can cause hallucinations as a side effect and other cognitive symptoms such as dementia may also contribute to Parkinsons-related hallucinations or delusions.

Delusions are less common in people with Parkinsons than visual hallucinations but can be harder to manage and live with.

Runny Nose And Parkinsons Disease

Non-motor Symptoms of Parkinson’s Disease: What’s New?

Runny nose, or rhinorrhea in medical jargon, is an annoying symptom that has been shown in a number of studies to be more common among people with PD than those without PD. The rhinorrhea of PD is not associated with a viral infection or environmental allergies, or any other common cause of runny nose.

Rhinorrhea can be an early feature of PD, sometimes present at the time of diagnosis. In fact, studies have shown that rhinorrhea is not correlated with disease duration, disease severity, or whether the PD is characterized more by tremor or gait difficulties. One study tested the smell of those with runny nose versus those without and determined that the presence of rhinorrhea did not correlate with deficits in the sense of smell.

There are no studies in the medical literature addressing how to treat the runny nose associated with PD. Ipratropium bromide is an anti-cholinergic medication that does not cross the blood-brain barrier and is available in two forms an inhaled form to treat asthma, chronic bronchitis and emphysema and a nasal spray that is used to treat allergic and non-allergic runny nose. The nasal spray may be worth a try in PD-related rhinorrhea.

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Discuss With Your Physician

Non-motor symptoms can sometimes be difficult to recognize. Therefore, it is important to make your doctor aware of them.

One useful resource is the PD NMS Questionnaire. You can use this to record your symptoms and discuss them with your doctor.

Dr. Ron Postuma, whose research was funded by donations to the Parkinson Canada Research Program, has also developed tools to help people with Parkinsons and their physicians identify and manage non-motor symptoms.

Finding The Right Treatment

The long list of Parkinson’s non-motor symptoms includes constipation, memory and thinking changes, low blood pressure, depression or anxiety, sleep problems and others. A number of therapies are available to treat Parkinson’s disease non-motor symptoms, but many patients are left wanting not responding well to therapies or seeing enough relief. Some drugs are approved by the U.S. Food and Drug Administration to treat these conditions in people with PD. Most, however, are FDA-approved for the general population but have not been studied in large numbers of people with PD. Still, doctors commonly prescribe them, and people with Parkinson’s often find them beneficial.

Here we describe Parkinson’s non-motor symptom treatments. With all Parkinson’s symptoms, discuss treatment options with your doctor and work together to find a regimen that fits your needs.

  • Dementia

    Parkinson’s disease dementia is when memory or thinking changes interfere with a person’s job, daily activities or social interactions.

  • Exelon is FDA-approved to treat mild to moderate PDD. It increases the amount of the brain chemical acetylcholine, which supports memory and thinking. Exelon is available as a pill, liquid or skin patch.
  • Aricept or Razadyne work in the same way but were developed for Alzheimer’s.
  • Namenda : approved for Alzheimer’s, but sometimes used for Parkinson’s dementia, this drug works on the glutamate brain chemical pathway.
  • Stimulants: Ritalin
  • Viagra
  • Cialis
  • Levitra
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    Typically Three Primary Areas Of Cognition Are Affected:

    • Executive functioning: including multitasking, reasoning, problem-solving, concentration and complex planning.
    • Language: including difficulty finding the right word in your mind or feeling tongue-tied.
    • Memory: trouble retrieving memories that have already been encoded. This is different than Alzheimers, where memories are not able to be encoded.

    In many situations, these challenges do not significantly impact daily life. For some people living with Parkinsons, these changes will never progress beyond mild cognitive impairment. Others experience a very slow cognitive decline over time.

    If cognitive challenges start to have a significant impact on quality of life, such as making it difficult to drive or consistently forgetting important things like where you parked, if you paid a bill or even what you ate, mild cognitive impairment may be better described as dementia. Dementia brings up a lot of fear and can be difficult to discuss, even with your physician. However, physicians can perform objective tests to measure your thinking and memory to help identify when and cognitive impairment should be addressed. Keep in mind that the progression of dementia that can come for some people in the later stages of Parkinsons can be influenced when caught early and managed proactively.

    Apda In Your Community

    Parkinsons disease stock vector. Illustration of ...

    APDAParkinson’s Disease SymptomsCould this be due to Parkinsons Disease? Uncommon non-motor symptoms of Parkinsons Disease

    It is common for a person with Parkinsons disease to attribute every new symptom that develops to PD. That is largely because the list of non-motor symptoms commonly associated with PD is so varied, it can seem that almost anything is a symptom of PD! But if you take a closer look, there are some symptoms that are very commonly associated with PD, others that are virtually never associated with PD, and some in between.

    Lets divide up non-motor symptoms into the following categories:

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    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.




    Postural Instability

    Walking or Gait Difficulties


    Vocal Symptoms

    When To See Your Doctor

    Its easy to assume these problems have other causes, and they often do. But any of these non-motor symptoms can have a big impact on your overall quality of life.

    Having one or more doesnt necessarily mean you have Parkinsons disease or that youll eventually develop it. But its worth consulting with your doctor.

    Tell your doctor if youre concerned about having Parkinsons disease. Although theres no cure, there are medications to help control symptoms.

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    Speech Voice And Parkinsons Q& a

    When we hosted a webinar with speech-language pathologist John Dean , we received so many questions during the session that we werent able to answer them all. So, John was kind enough to do a written Q& A for us. Check out the post to see his expert answers to dozens of common questions about speech, voice, and Parkinsons.

    Weakening Sense Of Smell And Taste

    Medications for Non-Motor Symptoms in Parkinson’s

    This may be due to degeneration of the anterior olfactory nucleus and olfactory bulb, one of the first parts of the brain affected by Parkinsons. This can happen so gradually that youre not even aware of it.

    Losing your sense of smell and taste can make you lose interest in food. You may miss out on important nutrients and lose weight.

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    Breathing Problems And Parkinsons Disease

    Usually, trouble breathing is not thought of as a symptom of PD. Those with PD who complain of this will typically have testing of their heart and lung function. This is necessary since, as we continue to emphasize, a person with PD can develop medical problems unrelated to PD and needs every new symptom evaluated like someone without PD. However, often the testing does not reveal a cardiac or pulmonary abnormality. Could difficulty breathing be a symptom of PD itself?

    There are a number of ways in which difficulty breathing may be a symptom of PD:

    Shortness of breath can be a wearing-OFF phenomenon

    Some non-motor symptoms can fluctuate with brain dopamine levels, which means that they change as a function of time from the last levodopa dose. For some people, shortness of breath can be one of the non-motor symptoms that appears when medication levels are low. However, shortness of breath can be due to anxiety which can also be a wearing-OFF phenomenon. Sometimes it is not possible to determine whether the key symptom is anxiety or shortness of breath. Treatment involves changing medication dosing and timing so that OFF time is minimized. You can view this webinar which discusses the concept of wearing OFF and potential treatments.

    Abnormal breathing can be a type of dyskinesia

    Restrictive lung disease

    Aspiration pneumonia

    Sleep apnea

  • Central due to decreased drive to breathe in sleep due to brain stem lesion
  • There Are Different Ways To Address Mood Changes Including:

    • Taking medications
    • Changing medications that have mood-related side effects
    • Exercising regularly

    Identify mood triggers, add positive energy into your daily life and provide a way to talk with your doctor and healthcare team about treating depression with the help of our Depression Worksheet.

    Parkinsons can have many different effects on your sleep, including trouble falling or staying asleep, vivid dreams, waking up frequently during the night and excessive sleepiness during the day. Like other non-motor symptoms, sleep problems can appear before the motor symptoms.

    An estimated 30% of people with Parkinsons experience some combination of insomnia and sleep fragmentation . Studies have shown people with Parkinsons have different sleep patterns and that their deepest periods of sleep during the night are shorter and interrupted more often than people without Parkinsons. Often this is made worse by medications that may wear off in the night, causing tremor, painful stiffness or other symptoms to return and disrupt your sleep.

    Anxiety, depression nighttime sweating and trouble moving in bed are other non-motor symptoms of Parkinsons that can make getting a good sleep difficult. Fragmented sleep is also exacerbated by how often some people with Parkinsons find themselves waking up often during the night to use the toilet because of the changes in the bladder that come with Parkinsons.

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    How Are They Treated

    There is currently no known cure for PD. However, there are treatments that can help manage the symptoms. Most treatments of the non-motor symptoms are specific to the symptom.3,4

    For example, there are medicines that can reduce an overactive bladder in people who experience urinary problems. Or, pain may be relieved through a combination of medicine, physical therapy, and exercise.3,4

    Some non-motor symptoms, such as constipation, sleep problems, psychotic symptoms, or impulsive behaviors, may be caused as a side effect of or worsened by drugs used to treat the motor symptoms of PD.3,4

    In this case, people may be able to work with their doctors to adjust their medicine or dose. Complementary therapies, such as acupuncture or massage, may also help relieve some non-motor symptoms of PD.3,4

    The Clinical Scenario: A Possible Solution To The Neglect Of Non


    First, tools such as NMSQuest do not consume clinical interactions the patient completes them and they help direct the consultation with nurse specialist or consultant. The clinician can then grade the non-motor symptoms burden numerically . Patients are then usually asked to flag the most bothersome symptoms. These are then addressed either through pharmacological, allied health specialist therapies, neuropsychological or neuropsychiatric input . A yearly documentation of non-motor symptoms score helps to chart the progress of these symptoms. Pharmaceutical companies have developed and distributed alternative self-completed toolssuch as the Parkinson well-being mapbut have not been validated in PD. shows the importance of using such tools in the clinic. Two newly diagnosed patients, untreated and with similar motor disability, completed NMSQuests . The first patient reports only five non-motor symptoms: mainly problems with dribbling of saliva at night, urgency to pass urine, unexplained pain and dizziness. The second patient reports a wider range of non-motor symptoms : problems related to sleep, dribbling of saliva and other autonomic symptoms. Each of them needs a different management plan for their non-motor symptoms, as well as the treatment of the motor symptoms. These observations have been confirmed by two recent studies in untreated PD and early PD .

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