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The Hidden Side of Parkinson's Disease

Decades before the appearance of the well-known movement problems of Parkinson’s disease, affected individuals may complain of a loss of sense of smell, constipation, depression, and disrupted sleep. Some people reported that their symptoms appeared specifically during times of stress, and then went away, only to reappear several years later.

A large body of evidence indicates that Parkinson’s disease may progress most rapidly in its earliest stages, before noticeable symptoms occur and during the first several years after PD emerges. While Parkinson’s is best known for the motor (movement) problems it causes, recent research suggests that often, it is the less noticeable non-motor symptoms that develop first. Most of these early symptoms may be caused by a range of conditions in addition to Parkinson’s disease. That means they may be misdiagnosed or simply not considered important.

It is important to be aware of non-motor PD symptoms for several reasons:

• Symptoms can interfere with your daily activities and enjoyment of life – needlessly, since most are treatable. 
• If symptoms are early signs of Parkinson’s disease, beginning treatment promptly can help delay ongoing disease progression. 
• If you have been diagnosed with Parkinson’s disease, non-motor symptoms can interfere with your ability to manage motor symptoms as they develop. 
• If you are taking treatment for Parkinson’s, your symptoms may be related to a reversible side effect of medication.

The bottom line is that with the help of your physician, these symptoms can be diagnosed and managed, either by treating them specifically, adjusting medications you are currently taking, or learning ways to adapt to and manage symptom-related limitations.

Some of these problems may occur for a variety of common reasons that are not related to PD. Depression is relatively common in the general population, as are fatigue, constipation, dizziness, and loss of sexual function. When the symptoms are due to Parkinson’s disease, they often have slightly different characteristics, as described in the next section. They may also require a specific approach to treatment different from that used in non-Parkinson’s patients. That’s important because early PD symptoms
may be misdiagnosed and not treated appropriately. You and your family members are in the best position to take note of all your symptoms, and keep your doctor informed to help ensure accurate diagnosis.

Common non-motor symptoms

Any one of these symptoms on its own should prompt a trip to the doctor. If several of these possible signs of early Parkinson’s disease are affecting you or someone you are close to, consult a doctor for a Parkinson’s risk assessment.

Fatigue

Fatigue is a common early symptom of PD, affecting an estimated 50% of all PD patients, including an estimated one in three individuals with untreated Parkinson’s disease. Studies have shown that the fatigue suffered by people with PD is often not associated with other potentially sleep-disrupting non-motor problems such as daytime sleepiness, nighttime sleep problems such as REM sleep disorder, and depression.

Depression and axiety

Depression and anxiety are among the most common early symptoms of Parkinson’s disease; they were reported by 61% of people in one study of early stage PD. These mood changes are often first noticed by family members rather than by the affected individual. Such symptoms are not just a reaction to having a serious condition like Parkinson’s; they are due to the effects of the disease within the brain. Depression and anxiety tend to affect people with Parkinson’s differently than they do the general (non-Parkinson’s) population. For instance, ratherthan causing feelings of guilt and selfblame, depression in Parkinson’s disease is marked by the inability to take pleasure in what would normally be pleasurable, and feelings of pessimism. Anxiety is also a common early feature of Parkinson’s, often occurring in the form of panic attacks, phobias, or general anxiety.

Sleep disturbances

Sleep disturbances may include insomnia, restlessness, frequent awakening, violent dreams, hallucinations or excessive drowsiness. Problems with sleep may be a very early sign that Parkinson’s may develop in some individuals. A condition called rapid eye movement (REM) sleep behaviour disorder causes excessive movement in muscles that would normally be relatively still during the REM phase of sleep. Affected individuals may punch, kick, or cry out in association with dream content. Studies suggest that as many as 50% of individuals with this sleep disorder may go on to develop Parkinson’s or a related disease within five to ten years.

Cognitive function

Cognitive function refers to the various mental abilities involved in processing and using information. Examples include memory, attention, abstract thinking, problem-solving, language, and visual-perceptual abilities. Nearly every person with PD experiences some degree of cognitive change, which can range in severity from a mild nuisance to severe enough to affect performance at work or ability to manage things at home.

Impulse-control disorders

Impulse-control disorders are relatively uncommon, and include a range of behaviours such as compulsive gambling (up to 5% of treated patients) or shopping, hypersexuality, binge eating, addiction to the Internet or to other recreational activities. This may affect individuals at all stages of the disease, although it is often associated with more advanced disease and/or increased medication use. In almost all cases, the impulsive behaviours from the use of PD medications are at odds with the person’s pre-Parkinson’s personality.

The impact of early non-motor PD symptoms

Experiencing non-motor symptoms regularly is often reported to be troublesome and disabling for those affected, and seems to be associated with an increased need for healthcare. Non-motor symptoms may reduce your participation in daily living activities, affect your ability to work, and take a toll on your self-esteem and relationships, especially if your symptoms are not recognized as being due to PD. They can also affect your ability to adjust as motor symptoms emerge.

Fatigue related to Parkinson’s disease has mental and physical impacts, and is known to reduce the affected individual’s day to day activities and quality of life. Similarly, sleep disturbances can be very disruptive and take a toll on the affected person and their family members. Cognitive symptoms may affect many aspects of daily life. They can cause forgetfulness, and slow down a persons’ thinking, causing long pauses before answering a question or processing an idea. Some individuals may have difficulty concentrating or experience a lack of drive or motivation – family and friends may notice that the affected person has become more passive. Visual-spatial processing can also be affected; this can lead to difficulties with everyday tasks such as driving, dressing or even inserting a hearing aid.

Why is early detection of PD important?

Parkinson’s disease is difficult to diagnose in its early stages, although it is hoped that increasing recognition of the early emergence of non-motor symptoms will improve rates of detection. Damage to the dopamine-producing brain cells begins and progresses silently – there are no clear or obvious symptoms until nerve cell damage in the central nervous system is fairly advanced. That is when movement problems begin to emerge. Non-motor symptoms not only appear first, they also occur more frequently as the disease progresses. Similarly, they worsen more quickly if the Parkinson’s disease causing them is left untreated. Patients with cognitive impairment report experiencing loss of interest and motivation, reduced attention span and memory, and psychiatric symptoms. When these effects occurred together, they had a negative impact on the quality of life of those affected and their families.

Considering early treatment

If your symptoms are interfering with your daily activities, it’s important to let your doctor know these details so you can discuss your treatment options. Many of the standard treatments for Parkinson’s have been found to improve non-motor symptoms as well as movement problems. However, PD treatments differ considerably in terms of their benefits and disadvantages. How does the medication fit into my long-term treatment plan?

Now you know…

By being aware of the hidden side of Parkinson’s disease, you may be able to make a difference in your own or someone else’s life. Early recognition and treatment of Parkinson’s helps those affected maintain independence and quality of life.