Parkinson’s disease is commonly associated with its visible impacts on motor skills, such as tremors, stiffness, cramping, and balance. However, non-motor skills are sometimes equally, if not more, affected for people with Parkinson’s.

Common non-motor symptoms of Parkinson’s disease include:

• Sleep issues
• Gut health issues
• Eating and swallowing challenges
• Fatigue
• Pain
• Vertigo & dizziness
• Sensory issues
• Communication issues
• Mental health challenges

PD’s non-motor challenges can occur years before a diagnosis and significantly impact a person’s overall well-being and mental health. This is why knowing the signs, symptoms, and treatments is essential.

Here is an overview of the common non-motor symptoms of Parkinson’s disease, their causes, and management tips.

Sleep Issues

Sleep disorders are common in people living with PD. These may be caused by cognitive impairments associated with the disease, medications used to treat PD, and mental health disorders such as anxiety and depression.

People with Parkinson’s may experience the following sleep issues:

• Circadian rhythm disruptions, which impact the sleep-wake cycle
• Nocturia, a condition that causes a person to wake frequently to urinate
• Sleep apnea, which causes lapses in breathing
• REM sleep behavior disorder, where people unknowingly act out their dreams in real life
• Restless leg syndrome, an early sign of PD that affects between 30% and 80% of people living with the disease

Managing Sleep Issues

Maintaining proper sleep hygiene is critical to managing the common sleep disorders associated with Parkinson’s disease. Incorporating a regular sleep and wake time, night-time routine, and daily exercise may help to improve these symptoms.

A CPAP machine may alleviate symptoms of more severe disorders like sleep apnea.

Gut Health Issues

Studies on the links between Gastrointestinal issues and Parkinson’s disease are relatively new. 

Researchers have found that people with PD typically have fewer nerve cells in their intestines, impacting the functionality of the enteric nervous system. This can result in the following GI issues:

• Constipation
• Diarrhea
• Bloating
• Incontinence
• Weight loss and malnutrition
• Heartburn and acid reflux
• Difficulty swallowing (dysphagia)

Managing Gut Health Issues

When managing gut health, the first step is to incorporate a healthy, nutritious diet and daily hydration. Certain foods significantly impact digestion and can help regulate your gut’s microbiome. You may need to explore medication and therapy options with your physician for more serious side effects, especially for swallowing issues.

Eating & Swallowing Challenges

Parkinson’s disease can significantly impact a person’s ability to eat and swallow. These actions are complex processes requiring precise coordination of various muscles and nerves. Symptoms may include:

• Dysphagia (Difficulty swallowing): Dysphagia can be a significant issue in Parkinson’s disease. People might experience trouble swallowing food, liquids, or saliva, which can lead to coughing, choking, or a sensation that food is stuck in the throat. 

• Drooling: Due to a reduced swallowing frequency, people with Parkinson’s may drool. It’s not that they produce more saliva; instead, they swallow less frequently, leading to an accumulation of saliva that may spill out of the mouth.

• Slow Eating: Movement (motor) symptoms such as slowed movements (bradykinesia) and tremors can make the physical act of eating more time-consuming. Using utensils can become complicated, and food may need to be cut into smaller pieces or pureed.

• Impaired Chewing: Rigidity and lack of muscular coordination can make it difficult to chew food properly. This can lead to swallowing larger pieces of food, increasing the risk of choking.

• Aspiration Pneumonia: This is a serious complication that can occur if food or liquids are inhaled into the lungs due to difficulty swallowing. It can cause pneumonia, a common cause of death in the later stages of Parkinson’s disease.

Managing Eating & Swallowing Issues

Effective management involves a multidisciplinary approach, including speech-language pathologists, dietitians, occupational therapists, and neurologists.

Strategies include dietary modifications, adjustments to eating habits (such as cutting food into small pieces or pureeing foods), exercises to improve swallowing function, medication adjustments, and sometimes, feeding tubes in advanced stages.

Fatigue

Fatigue is characterized by deep mental or physical exhaustion that does not improve with rest. This differs from sleepiness in that a person experiencing fatigue may not necessarily feel the need to sleep.

While the cause of fatigue in people living with PD is still unknown, researchers speculate that it’s partially a result of the taxing motor symptoms of Parkinson’s, such as tremors and stiffness. 

Fatigue may also be a side effect of certain medications or PD-related sleep disorders.

Managing Fatigue

Research to understand fatigue is ongoing. Currently, treatments or therapies that eliminate this symptom don’t exist.

However, incorporating specific health and wellness practices into a daily routine may have an impact. These include daily exercise, eating nutritious foods, maintaining a regular sleep routine, and working with your physician to identify how combining medications or supplements can potentially worsen symptoms.

Pain

Pain is a common symptom of Parkinson’s disease that occurs on a spectrum and across five general categories:

• Musculoskeletal pain is the most common type of pain in Parkinson’s disease, often related to rigidity and reduced mobility. It can feel like a dull muscle or joint ache and affect any body part. However, it’s commonly experienced in the neck, back, hips, and limbs.

• Dystonia-related pain: Dystonia in Parkinson’s disease refers to involuntary muscle contractions that result in abnormal postures or movements. Upon waking up, this can lead to cramps and pain, often in the feet or hands.

• Akathisia: This is a restless, uncomfortable feeling that can’t be satisfied by moving. It might feel like a deep inner tension or pain.

• Central pain: This type of pain is less understood but originates in the brain and can be severe. People with Parkinson’s describe it as a burning, aching, or sharp pain, which can be widespread or localized to a specific area. It’s often resistant to typical severe pain treatments.

• Radiculopathy: Pain resulting from a problem with the spinal nerve roots. It can lead to sharp, electric-like pain or numbness and weakness in the parts of the body served by the affected nerve.

In addition to the above, many people with Parkinson’s also suffer from secondary pain related to falls, immobility, posture problems, or fractures. As the disease progresses, these can become increasingly problematic.

Managing Pain

Each individual may experience these symptoms to varying degrees, and in some cases, the presentation might not fit neatly into these categories.

Managing pain in Parkinson’s disease can be complex and often requires an interdisciplinary approach, encompassing pharmacological treatments, physical therapy, working with a movement disorder specialist, and other interventions.

Vertigo & Dizziness

Vertigo and dizziness are more common in older people living with Parkinson’s and contribute to a feeling of spinning, faintness, and wooziness. This may be caused by a drop in blood pressure related to Orthostatic Hypotension (OH), medication such as antibiotics, antipsychotics, pain medications, or Deep Brain Stimulation (DBS) treatment.

Managing Vertigo & Dizziness

Diet and lifestyle changes are the first line of defense to manage vertigo and dizziness. These may include increasing hydration, elevating your legs while sitting, increasing salt intake, and elevating the head of your bed.

Medications also exist to treat OH and may be recommended by your physician.

Sensory Issues

Parkinson’s disease can impact the senses in several ways, including:

• Smell: A reduced sense of smell, or hyposmia, is one of the earliest signs of Parkinson’s disease. It may occur years before motor symptoms begin. Some people may completely lose their sense of smell, known as anosmia.

• Taste: Many people with Parkinson’s report a diminished sense of taste, often accompanying the loss of smell. This can impact their enjoyment of food and potentially lead to weight changes.

• Touch: Parkinson’s may alter the perception of touch. Some people report increased sensitivity to temperature or touch, while others may have a diminished response.

• Vision: Visual changes in Parkinson’s can include blurred vision, double vision, visual hallucinations, or difficulty with depth perception. These can be due to eye movement control issues or other ocular issues such as dry eyes.

• Hearing: While not as common, some people with Parkinson’s may experience changes in their hearing, such as a reduced ability to hear certain frequencies or increased sensitivity to certain sounds.

Managing Sensory Issues

Treatment of sensory issues largely depends on the type of issue experienced and its severity. It’s also crucial to note that some sensory issues, like visual hallucinations,  may not be directly caused by Parkinson’s but could be side effects of medication or related to other co-existing conditions.

Addressing these symptoms requires a multidisciplinary approach and individualized care strategies.

Communication Issues

Parkinson’s disease often impacts the critical systems influencing clear and articulate speech. These include respiration, phonation (closure of the vocal cords), and tongue and throat muscles contributing to articulation. The result is soft or sometimes slurred speech.

Additionally, symptoms such as facial masking (when the muscles of the face are stiffened) can make it more difficult to convey meaning or animation. As such, facial masking makes it challenging to communicate emotion. The cadence of speech may also be impacted in people with PD, causing them to speak slowly or rapidly.

Managing Communication Issues

The best practice for managing speech and communication issues is to work with a speech-language pathologist. SLPs evaluate and treat people across a broad spectrum of speech issues and can help suggest personalized strategies for treatment.

Mental Health Issues

Parkinson’s disease can have a marked impact on general emotions and mood. In addition to the anxiety associated with a PD diagnosis, biological changes, including loss of dopamine, can worsen symptoms such as apathy, anxiety, and severe depression.

The common impacts on mental health are:

• Apathy: a loss of interest in regular activities and hobbies, leading to isolation and avoidance.
• Anxiety: feelings of nervousness and worry that contribute to racing thoughts and an unsettled mind.
• Depression: persistent feelings of hopelessness and sadness paired with loss of motivation.

Managing Mental Health Issues

Mental health issues may be treated with medication, therapy, or a combination of the two. 

Additionally, incorporating regular exercise, healthy meals, a regular sleep schedule, and meditation into your routine can help alleviate symptoms associated with apathy, anxiety, and depression.

Parkinson’s Disease: More Than a Movement Disorder

While Parkinson’s disease is known as a movement disorder, non-motor symptoms can be equally debilitating. Engaging with a healthcare professional is essential if you suspect you’re experiencing one or more of these symptoms. It’s vital to get on top of a treatment plan in order to maintain the best quality of life.

For resources and access to a support network, feel free to reach out to PCLA — we’d be happy to help you live your best life with Parkinson’s.