Parkinson’s Disease: 40+ Symptoms

April is Parkinson’s Awareness Month, with Parkinson’s Awareness Week falling on the 7th-13th of April and World Parkinson’s Day taking place on April 11th.

Our campaign for the month is ‘Different for Everyone’, to spread awareness about the many symptoms that come with Parkinson’s Disease and how everyone’s experience is unique. No one person has the same symptoms or journey.

Please click here for more information about our campaign.

You can read more about PD and the many symptoms in the following piece.

What is Parkinson’s Disease?

Parkinson’s Disease (PD) is a progressive neurological disorder, and is classified as a Movement Disorder, as it primarily affects movement. It is variable in its progression, meaning some people progress more slowly than others and the symptoms can be effectively controlled with medication for many years.

PD is caused by a loss of a chemical called dopamine. We all lose some of this chemical as we get older, however, it is only when we have lost about 80% of our dopamine we start to have symptoms. This means that people with Parkinson’s have lost this chemical at a faster rate than others.

When most people think of Parkinson’s Disease, they think of tremors, stiffness or slowness of movement.

However, PD can also affect thinking, behavior and mood. These changes can bring their own challenges and frustrations as they often impact the quality of life. Each person with PD is different, and many people do not develop each symptom.

40+ Symptoms

We have summarized some of the many symptoms of PD in this article to help bring awareness and to educate as many people as we can about how complex PD can be.

Here is a list of just some of the symptoms associated with PD:

• Tremors: Involuntary shaking, typically starting in the hands or fingers.
• Bradykinesia: Slowness of movement.
• Rigidity: Stiffness of the limbs and trunk.
• Postural instability: Difficulty maintaining balance and coordination.
• Gait disturbances: Changes in walking pattern, such as shuffling steps or freezing.
• Micrographia: Small, cramped handwriting.
• Masked face: Reduced facial expression or “mask-like” appearance.
• Speech changes: Softening of voice, slurred speech, or monotone speech.
• Dystonia: Involuntary muscle contractions causing abnormal movements or postures.
• Akinesia: Difficulty initiating movement.
• Fatigue: Persistent tiredness or lack of energy.
• Pain: Musculoskeletal pain, stiffness, or discomfort.
• Sleep disturbances: Insomnia, restless legs syndrome, or rapid eye movement sleep behavior disorder (RBD).
• Constipation: Difficulty passing stool.
• Urinary problems: Urinary urgency, frequency, or incontinence.
• Sexual dysfunction: Decreased libido, erectile dysfunction, or difficulties with arousal or orgasm.
• Cognitive impairment: Mild cognitive impairment, memory problems, or executive dysfunction.
• Constipation
• Depression: Persistent sadness, hopelessness, or loss of interest in activities.
• Anxiety: Excessive worry, nervousness, or fear.
• Apathy: Lack of motivation or interest in activities.
• Hallucinations: Sensing things that are not real, often visual or auditory.
• Delusions: False beliefs or suspicions.
• Orthostatic hypotension: Drop in blood pressure upon standing, leading to dizziness or lightheadedness.
• Seborrheic dermatitis: Skin condition characterized by oily, red patches on the scalp, face, or other areas.
• sialorrhea: Excessive saliva production or difficulty swallowing.
• Dysphagia: Difficulty swallowing.
• Masked seborrhea: Oily skin with or without acne, particularly in the T-zone of the face.
• Olfactory dysfunction: Impaired sense of smell.
• Excessive sweating: Increased perspiration, particularly in the hands or feet.
• Impulse control disorders: Compulsive behaviors such as gambling, shopping, or eating.
• Restless legs syndrome: Unpleasant sensations in the legs, often relieved by movement.
• Sensory symptoms: Numbness, tingling, or burning sensations.
• Hypophonia: Reduced volume or projection of voice.
• Dysarthria: Difficulty articulating speech.
• Hypomimia: Decreased facial expression.
• Swallowing difficulties: Difficulty moving food or liquid from the mouth to the stomach.
• Mood swings: Rapid changes in mood or emotional state.
• Difficulty turning in bed: Problems with mobility and positioning during sleep.
• Bladder issues

Parkinson’s Ireland updated our information leaflets recently. Our Parkinson’s Disease Nurse Specialists Lisa Wynne and Kathy Foley worked extremely hard to re-write each leaflet to provide important information across 24 topics. These include both motor and non-motor symptoms of PD.

Along with the updated leaflets, our PD nurse specialists also developed new topics, which include fatigue, depression & apathy and cognition in PD. To read and download these leaflets, please click here.

If you want to discuss a specific symptom you are experiencing, please call 1800 359359 and we can arrange a call back from one of our nurse specialists.

In the following piece, we have put together some information on some of the listed symptoms. Please share the following information and graphics throughout April for Parkinson’s Awareness Month, so we can help as many as possible understand how PD really is #DifferentforEveryone

Tremors

When people think of PD, the first symptom they often associate with it are tremors.

However, only about 70% of people with PD will experience tremors.

According to Parkinson’s Foundation, tremors tend to occur in the hands but they can also appear in other parts of the body, including the lower lip, jaw or leg. These tremors can interfere with routine activities such as shaving, dressing, writing, typing and many other tasks that require motor coordination.

Some people report an internal tremor, a shaking sensation inside the chest, abdomen or limbs that cannot be seen.

Fatigue and stress can often make tremors worse. Levodopa is the medication most commonly given to control the movement symptoms of PD, including tremors. To read more, click here.

Balance

Slow movement, freezing and other motor symptoms can often impact how someone with PD walks. Therefore, this can cause a greater risk of falling.

The best way to improve your balance and to avoid freezing and falling is to engage in as much exercise as possible. This can include walking, yoga, physiotherapy and more.

To read more on balance, please read here.

Blurred Vision

Parkinson’s Disease can bring many kinds of vision changes.

According to Parkinson’s Foundation, these can include:

• Double vision: As a result of the eye muscles having trouble working together. This can be aided by wearing special prism glasses.
• Dry eye and blurred vision: As a result of decreased blinking, this can then lead to blurred vision. Blurred vision can also be caused by PD medication.
• Trouble reading: This can occur as the eye movements that usually follow the lines of a page are slowed, and can have trouble starting. It is recommended to change eye position and try blinking more. Levodopa can often help.

To read more about blurred vision and vision changes with PD, please click here.

The content and views expressed are those of Parkinson’s Ireland and not of the sponsors.

Hallucinations

When a person hallucinates, they may see, hear, feel, smell or taste something that, in reality, does not exist.

While the hallucinations may comprise quite complex scenes, they typically involve the person seeing small animals, insects or other people in the room with them. These images do not usually speak or make sounds and they can either disappear quickly or last for some time.

Occasionally, the hallucinations are auditory (where the person hears a voice or sound without seeing anything), or tactile (the person feels something touching them), but for people with Parkinson’s, these are less common than visual hallucinations.

To read more about Hallucinations and PD and how they are treated, please read here.

Anxiety

Anxiety can be an entirely normal feeling and is often an appropriate response to a dangerous or threatening situation. What is often understood as anxiety can range from worry and stress to the bodily symptoms associated with fear or panic. The bodily symptoms of such anxiety may include sweating, pounding of the heart, shortness of breath, tightness in the chest and unpleasant feelings in the stomach.

In Parkinson’s, anxiety may be based on the very real fear of functioning with a disability. However, at times, it can take on a life of its own and be unrelated to the physical state of the person with Parkinson’s.

Some people with Parkinson’s have anxiety related to the ‘on/off’ state of their motor symptoms. When ‘off’ and less able to move well, they may develop significant anxiety symptoms and, at times, may even have panic attacks.

For those who experience mild and intermittent anxiety, conservative measures such as avoiding stimulants, including caffeinated drinks, tea/ coffee, alcohol and cigarettes, along with identifying and avoiding triggers of anxious episodes can be helpful. Some people find other methods, such as relaxation tapes, yoga, massage, acupuncture, mindfulness and complimentary therapies beneficial.

To read more about anxiety and PD, please read here.

Freezing

Many people with mid-stage to advanced Parkinson’s disease (PD) experience “freezing.” Freezing is the temporary, involuntary inability to move. Not all people with PD experience freezing episodes, but those who do have a greater risk of falling.

People feel as though their feet are stuck to the ground. It also commonly occurs when trying to turn in small spaces or when walking through doorways.

It is useful to have ways to overcome “Freezing” when it happens. Every person needs to discover their own way of coping with “Freezing”. Stress and anxiety make you more likely to “Freeze”.

If you experience “Freezing”, make sure those who care for you know about this symptom, as there may be things they can do to help you when it happens. Likewise, it is important that if you are walking with someone and you “Freeze”, that the other person does not try to drag you along to get you going – this will almost certainly result in a fall.

To read more about Freezing and PD, please read here.

Sleep problems

A recent survey suggested that up to 90% of people with the Parkinson’s experience problems with sleeping at night. There are a variety of possible causes and therefore a variety of possible treatments. It is therefore important to discuss difficulties related to sleeping with a nurse or your GP.

Insomnia and other sleep disorders are more common in people with Parkinson’s who have depression and their doctor may therefore also suggest specific treatment for depression.

Some people with PD may also experience Excessive Daytime Sleepiness (EDS). This may cause frequent dozing during normal waking hours. This can then have several impacts, including poor sleep at night.

In some situations, medicines which promote wakefulness may be used to alleviate the issue. However, anyone experiencing sleepiness should use caution when carrying out activities such as driving.

It is important a person with Parkinson’s to let their medical team know if they have experienced sudden onset of sleep, as they may change the anti-Parkinson’s medications. To read more, click here.

Muscle Cramps & Dystonia

People with PD often find that they are prone to a variety of aches and pains. For example, muscular rigidity and a reduction in, or absence of, movement (akinesia) can lead to cramps, which are often quite distressing and which may not be relieved by ordinary painkillers.

Occasionally, people with PD may experience severe muscle spasms or dystonia that are different from ordinary muscle cramps and have different causes and treatments.

Dystonia is a movement disorder characterised by a sustained involuntary contraction of the muscles causing the affected part of the body to go into spasm.

Although more common in young-onset PD, dystonia can affect anyone and can be prolonged and very painful. The contractions and spasms that are the primary symptoms may lead a person to mistake dystonia for muscle cramps caused by the rigidity found in PD. However, dystonia and cramping are very different; both make the muscles hard, but in cramping, muscles become ‘less elastic’ while in dystonia the hardness comes from the muscles contracting without relaxing.

To find out more about dystonia and muscle cramping, please read here.

Facial Masking

The same stiffness and slowness that can impact your walking and other activities can also reduce facial expressions.

Facial masking can affect how we communicate. When the facial muscles are stiff or take longer to move, it can be hard to smile, frown, raise your eyebrows or others.

Medications can help with this, but if miscommunication becomes prominent, try to explain the difficulty with muscle control and expression you are facing as it could help others understand.

Please go to Parkinson’s Foundation for more information on facial masking.

Low Blood Pressure

Parkinson’s and almost all the drugs used to treat the condition (levodopa and dopamine agonists) can cause low blood pressure.

Clinically significant low blood pressure describes a situation where the blood pressure is low enough to produce one or a number of the following symptoms:

• Dizziness/light-headedness (in the extreme this can result in a fall);
• Changes in vision, such as blurred, tunnel, greying or blacking vision;
• Angina-like pain in the chest;
• Weakness and/or Fatigue;
• Feeling muddled or confused.

If medication is being taken to lower blood pressure, it is advisable to have it checked as this, combined with the effects of Parkinson’s, may be making blood pressure too low.

To fund out more, please read here.

Bladder & Bowel Issues

People with Parkinson’s disease are more likely to suffer from bowel and bladder issues, particularly constipation.

Constipation is the number one reason why a person’s Parkinson’s has become suddenly worse – the levodopa medications used to treat Parkinson’s (Sinemet, Stalevo and Madopar) are absorbed by the bowel, so if it is filled to capacity, you are unlikely to get the full benefit from these drugs.

As with Parkinson’s generally, the more healthy your lifestyle, and the more active and mobile you can keep yourself, the better.

With bowel problems, it is important to make sure that you drink enough and eat a diet with plenty of fibre, such as fruit, vegetables and whole meal bread and cereals. Drink plenty of fluids throughout the day to help the fibre work.

There are two main problems that can occur with the bladder in Parkinson’s– an overactive bladder, and difficulty in emptying.

It is important not to cut down too much on the amount of fluid you drink as this will not help and may lead to bladder infections. It may help to cut out caffeine, fizzy drinks and some types of alcohol. This is very individual, so it is worth experimenting to see what helps you.

You should tell your GP, Consultant or Parkinson’s Disease Nurse Specialist (PDNS) about your problems and they will be able to provide advice on any additional support available to you.

To read more about bladder and bowel issues with PD, please see our website here.

Pain

According to Parkinson’s Foundation, more than 80 percent of people with PD report experiencing pain and many say it’s their most troubling non-motor symptom. Pain can take many different forms, but there are many ways to manage pain in PD. As with other aspects of the disease, how to manage pain can vary person to person.

When a person feels pain, nerves in the skin, joints and organs alert the brain to the location of an injury. Researchers have found that in early PD, there are already changes in the way that the body detects and regulates pain. In PD, pain tends to affect the side of the body where motor symptoms first appeared. If your PD started with a tremor in the right hand, you’re more likely to develop pain in the right shoulder, wrist or fingers.

It is important to make sure you are taking your medication correctly and on time, every time to prevent pain. Exercise and any form of movement can also help. Speaking to a physical therapist can help target the source of your pain. For example, if you experience neuropathic pain, the physical therapist can help improve your posture, which may alleviate pain.

Always speak to a Parkinson’s nurse if you are unsure of any symptom and to help understand how to target your specific pain.

Speech Changes

PD can affect speech in several ways. Some people with PD may speak quietly and in one tone and speech may sound breathy or hoarse. The Michael J Fox Foundation explains that people with PD might slur words, mumble or trail off at the end of a sentence. Most people talk slowly, but some speak rapidly, even stuttering or stammering.

Parkinson’s motor symptoms, such as decreased facial expression, slowness and stooped posture, may add to speech problems. Speech issues can also make it difficult to communicate with loved ones or health professionals.

Speech therapy is the main way to treat any speech changes, such as the Lee Silverman Voice Treatment. Singing is also a great way to exercise your voice, and Parkinson’s Ireland offers singing via Zoom on Tuesday mornings with Dara MacMahon.

Restless Legs

Restless legs syndrome is a condition that causes an overwhelming urge to move your legs and is a common symptom for people with PD. It is often more prevalent in women than men with PD.

According to Parkinson’s UK, restless legs syndrome can be linked to a chemical called dopamine in the brain. If nerve cells in the brain become damaged, the amount of dopamine is reduced, which causes muscle spasms and involuntary movements.

This symptom can be treated with exercise, stretching, massage, warm baths and medication. Always consult with a healthcare professional, such as a Parkinson’s Nurse Specialist, before changing or starting new medication.

Swallow

Parkinson’s UK explain that PD can cause the muscles used to swallow and chew in your jaw and face to become slower and stiff, or rigid. This may make it more difficult to swallow, chew or move food around in your mouth.

Parkinson’s can also cause problems in your tongue muscles, such as a tremor in your tongue, or trouble unsticking your tongue from the roof of your mouth.

PD can also weaken the muscles in your throat, which affects how effectively you swallow.

40+ Symptoms: Quick facts to share

It is important that we use Parkinson’s Awareness Month to share as much information about PD as we can.

Please share the below images with your friends, family and on social media to encourage people to visit our website to educate as many people as possible about Parkinson’s Disease and the many symptoms that are experienced from person to person.

The content and views expressed are those of Parkinson’s Ireland and not of the sponsors.