Parkinson’s Information Hub

Early warning signs

Prodromal signs of Parkinson’s disease can significantly impact daily life, as these early symptoms can appear years before the more recognisable motor symptoms. These include loss of, or reduced, sense of smell, changes to handwriting, changes to sleep like restless leg syndrome or REM sleep behaviour disorder, constipation and unexplained mood disorders such as anxiety, apathy, and depression. Understanding the potential symptoms attributable to Parkinson’s can lead to early diagnosis and treatment.

Parkinson’s symptoms

Living with Parkinson’s involves understanding how to manage your symptoms effectively and which treatments, medications and lifestyle changes can help you maintain a good quality of life. Parkinson’s affects both motor and non-motor functions; everyone experiences it differently. They like to say if you’ve seen one person with Parkinson’s, you’ve seen one person with Parkinson’s, so resist the urge to compare your situation with others!

Motor symptoms (movement)

Motor symptoms are a hallmark of Parkinson’s, significantly impacting movement and daily activities. You may experience tremors, bradykinesia (slowness of movement), muscle rigidity (stiffness), postural instability, and episodes of freezing. Understanding and managing these symptoms through medications, physical and occupational therapy, and sometimes surgical interventions can greatly enhance your quality of life.

Bradykinesia (slowness)

Bradykinesia, or slow movement, is a core motor symptom of Parkinson’s. It gradually reduces spontaneous movement, making everyday tasks like buttoning a shirt or walking more challenging. This symptom can significantly impact a person’s quality of life, often leading to difficulties initiating and completing movements. Managing bradykinesia involves a combination of dopaminergic medications, which help replenish dopamine levels, and physical therapy to maintain mobility and function.

Dyskinesia

Dyskinesia refers to involuntary, erratic, and often excessive movements that can occur in individuals with Parkinson’s, typically as a side effect of long-term use of dopaminergic medications like levodopa. These movements can range from mild to severe and may affect various body parts, including the arms, legs, and face. While dyskinesia can be disruptive and uncomfortable, adjusting medication regimens and incorporating other treatments can help manage these symptoms.

Dystonia

Dystonia is characterised by involuntary muscle contractions that cause repetitive or twisting movements. The condition can affect one part of the body (focal dystonia), two or more adjacent parts (segmental dystonia), or all parts of the body (general dystonia). The muscle spasms can range from mild to severe and may be painful, interfering with daily tasks.

Falls

Falls can be associated with Parkinson’s due to a range of symptoms. Taking small or varying steps can lead to instability. When arms don’t swing during walking, balance is affected. Side effects of some Parkinson’s medications can cause dyskinesia, impacting balance. As Parkinson’s progresses, stooped posture and rigid muscles increase fall risk. Reduced activity weakens muscles and raises the risk of falling. Some Parkinson’s medications affect blood pressure, leading to dizziness and falls. Managing falls involves addressing muscle stiffness, mobility, and balance issues. It’s always best to discuss any concerns with your care team.

Festination

Festination, or shuffling gait, is a common motor symptom in Parkinson’s. You may experience short, rapid steps that propel you forward, often resulting in a stooped posture. This gait pattern occurs because your centre of gravity is too far forward, causing you to take quick, shuffling steps to avoid falling. Festination can make walking difficult and increase the risk of falls. Management strategies include physical therapy, gait training, and optimising your medications to improve mobility and safety.

Freezing

Freezing of gait (FOG), where you temporarily lose the ability to move your feet, feeling as if they are glued to the ground, can be a challenging and common symptom of Parkinson’s. This phenomenon often occurs during walking, particularly when starting to move, turning, or navigating through narrow spaces. Episodes can last from a few seconds to several minutes and significantly increase the risk of falls. Management strategies include optimising medication regimens, using visual or auditory cues to start movement, and physical therapy to improve gait and balance.

          Gait disturbances

Gait disturbances are common in Parkinson’s. Small, shuffling steps characterised by reduced stride length and walking speed is known as Parkinsonian gait. You may also experience festination, where steps become quicker and shorter, and freezing of gait, a sudden inability to move the feet forward. The good news is, there is a wide range of treatments that can help with gait disturbances, offering hope and reassurance.

Masked face aka hypomimia

People with Parkinson’s often exhibit masked facial features, a condition known as hypomimia. Without sufficient dopamine, the muscles, including those in the face, become rigid and slow to respond. It may result in loss of facial expression and impact non-verbal communication cues. It can help to regularly perform facial exercises to maintain muscle tone and improve responsiveness, work with a speech pathologist, and optimise Parkinson’s medications to improve dopamine levels and muscle control. Be mindful of emotions and consciously express them through facial movements.

Micrographia

Micrographia, a common early symptom of Parkinson’s, is characterised by abnormally small and cramped handwriting. You may struggle with everyday tasks that require writing, such as filling out forms or signing documents. Managing micrographia involves a combination of strategies, including handwriting training to improve motor skills and assistive devices like larger, weighted pens or digital tools. Regular practice and personalised management plans developed with your care team can help you cope with this challenging symptom.

Postural instability

Postural instability in Parkinson’s refers to difficulty maintaining balance and stability, making you more prone to falls. This symptom often appears in the later stages of the disease and is characterised by unsteadiness when standing, walking, or making sudden movements. You may exhibit a stooped posture, small shuffling steps, and a tendency to lean forward while walking. The risk of falls increases significantly, which can lead to injuries. However, there is hope. Managing postural instability involves effective physical therapy, exercise, and home safety modifications to reduce fall risks, empowering you to take control of your condition.

Rigidity (muscle stiffness)

Rigidity in Parkinson’s disease is a primary motor symptom characterised by muscle stiffness and resistance to movement. Rigidity can affect your arms, legs, and trunk. This stiffness goes beyond what would be expected from normal aging or arthritis and can lead to a decreased range of motion. There are two main types of rigidity: lead-pipe rigidity, where the resistance is constant throughout the movement, and cogwheel rigidity, where the resistance is intermittent, creating a ratchet-like effect. Rigidity can cause discomfort, pain, and difficulties with everyday activities, such as walking, dressing, and writing.

Slowed blink rate

It’s important to note that a reduced frequency of blinking is common with Parkinson’s. The normal blink rate is about 15 to 20 times per minute, but people with Parkinson’s may blink significantly less, sometimes only 3 to 4 times per minute. This reduced blink rate can lead to dry eyes, discomfort, and vision problems. Blinking helps spread tears across your eye’s surface, keeping it moist and clear. Managing this symptom involves using artificial tears and consciously blinking more frequently.

Tremor

Tremor, a primary symptom of Parkinson’s, manifests as an uncontrollable movement that affects a part of the body. It occurs in around 80% of people with Parkinson’s. Parkinson’s tremor often starts on one side of the body and can appear at rest (like a ‘pill-rolling’ motion) or during action (such as holding a magazine). Some people may also experience internal tremors. Medication may help control it, and assistive technology can help minimise the impacts on daily life.

Non-motor symptoms (autonomic)

Parkinson’s also presents a range of non-motor symptoms that may be more impactful than the motor symptoms. Memory problems, difficulty concentrating, and slowed thinking are common cognitive symptoms. Autonomic symptoms, which involve the body’s automatic functions, can include issues like constipation, urinary problems, and blood pressure fluctuations. Understanding these non-motor symptoms is crucial for managing Parkinson’s.

Anxiety

Anxiety is a common symptom of Parkinson’s due to changes in brain chemistry. The reduction in dopamine levels can lead to chemical imbalances in the brain, which contribute to anxiety. The stress of living with a chronic condition and the motor and non-motor symptoms of Parkinson’s can exacerbate feelings of anxiety. This combination of neurological and psychological factors makes anxiety a prevalent non-motor symptom in people with Parkinson’s. However, anxiety is manageable with medication, exercise, and therapy to maintain mental wellbeing.

Apathy

Apathy is a common non-motor symptom of Parkinson’s, characterised by a lack of interest, enthusiasm, or motivation. Losing interest in new activities, lacking emotional response to situations, and difficulty initiating or completing tasks are common manifestations of apathy. Unlike depression, which involves feelings of sadness and guilt, apathy is an emotional flatness and a general disinterest in life. You may feel less inclined to exercise, follow medication schedules, or engage in social activities, which can worsen symptoms. Apathy in Parkinson’s can be challenging, but there are strategies to manage it. Stay engaged socially, exercise, and optimise medications and treatments.

Bladder control

Bladder control challenges are common in Parkinson’s, ranging from urinary urgency, having little warning that you need to pass urine, urinary frequency, desiring to pass urine often, usually only passing a small amount at a time, and urinary retention, not being able to completely empty the bladder, to nocturia, waking more than once during main sleep time to pass urine. Manage these issues by staying hydrated and balancing fluid intake to avoid urgency without dehydration. Pelvic floor exercises can strengthen pelvic muscles to improve control. Always consult a continence specialist to seek advice on medications or lifestyle adjustments.

Constipation

Constipation, a prevalent issue affecting 80-90% of people with Parkinson’s, is a result of the impact on the autonomic nervous system. This system, responsible for regulating smooth muscle activity in the gut, experiences disruption, leading to a slowdown in the movement of food through the GI (digestive) tract. Understanding this cause can help manage the symptoms of constipation in Parkinson’s, which include infrequent and difficult bowel movements, straining during bowel movements, hard or pellet-like stools, and a feeling of incomplete evacuation.

Delusions

Delusions in Parkinson’s, false beliefs that are not grounded in reality, can cause significant distress. These delusions can manifest as irrational thoughts, such as believing that someone is plotting against them or that their partner is unfaithful despite no evidence. They are typically a part of Parkinson’s psychosis and are triggered by the progression of the disease, side effects of medications, or coexisting conditions like dementia. Managing these delusions involves consulting specialists to adjust medications or introduce treatments specifically designed for people living with Parkinson’s. This comprehensive approach aims to improve the quality of life for both you and your families, as this symptom can be very distressing for all.

Dementia (Parkinson’s disease dementia)

Parkinson’s disease dementia (PDD) is a condition that affects some people with Parkinson’s. It involves significant changes in thinking and behaviour that develop after the onset of motor symptoms like tremors, stiffness, and slow movements. PDD can lead to memory difficulties, problem-solving and attention issues, and behavioural changes such as apathy, delusions, and hallucinations. This condition typically emerges many years after the initial diagnosis of Parkinson’s. Treatment strategies focus on improving symptoms through medications and lifestyle changes.

Dental & oral health

People with Parkinson’s often face several dental and oral health challenges due to symptoms like tremors and rigidity, as well as side effects from medications. These issues include dry mouth, which increases the risk of cavities, gum disease, and difficulty swallowing, which can lead to choking hazards. Additionally, reduced muscle control can cause excessive drooling and make it hard to maintain proper dental hygiene, leading to poor oral health. Managing dentures can also be problematic due to dry mouth and changes in muscle control, affecting their fit and comfort. Regular dental check-ups and tailored oral hygiene practices are essential to address these challenges effectively.

Depression

Depression, a common symptom of Parkinson’s, affects up to 50% of people with the condition. It’s not just a reaction to the diagnosis or the challenges of living with Parkinson’s, but a direct result of changes in brain chemicals that regulate mood, energy, motivation, appetite, and sleep. You may experience persistent feelings of sadness or a loss of interest in activities that used to bring you joy. Understanding that these changes in brain chemistry are the root cause of depression can help you stay proactive with advice from your care team and mental health supports.

Drooling

Drooling in Parkinson’s, also known as sialorrhea, occurs primarily due to difficulties with swallowing. Parkinson’s affects the muscles involved in swallowing, reducing the frequency and efficiency of this automatic action. As a result, saliva tends to pool in the mouth instead of being swallowed regularly. It’s important to understand that muscle rigidity and bradykinesia (slowness of movement) play a significant role in drooling, making it harder to keep the mouth closed. While the amount of saliva produced is typically normal, the impaired ability to manage it leads to excessive drooling. Consult with a speech pathologist or dental specialist for treatment options.

Dysarthria (changes to speech)

Dysarthria in Parkinson’s is a motor speech disorder caused by weakened muscles used for speaking. This condition affects nearly 90% of individuals with Parkinson’s. Symptoms include reduced vocal loudness, a monotonous tone, imprecise articulation of consonants and vowels, and a breathy or hoarse voice. These changes also lead to slower, softer, and sometimes slurred speech. Managing dysarthria often involves speech pathology to improve communication and maintain social interactions.

Dysautonomia (changes to automatic functions)

Dysautonomia in Parkinson’s refers to the autonomic nervous system dysfunction, which controls involuntary bodily functions. Heart rate, blood pressure, digestion, constipation, urinary incontinence, excessive sweating, sexual dysfunction and temperature regulation may occur years before motor symptoms. Managing dysautonomia often involves a combination of lifestyle changes, medications, and other treatments.

           Fatigue

Fatigue is a prevalent and often debilitating symptom of Parkinson’s, affecting up to half of those diagnosed. It is an overwhelming sense of tiredness that is not necessarily relieved by rest and can significantly impact daily activities. The exact cause of fatigue in Parkinson’s involves neurodegenerative processes and the side effects of medications. Managing fatigue includes optimising medication regimens, incorporating regular physical activity, ensuring adequate sleep, and addressing any coexisting conditions such as depression or sleep disorders.

          GI issues

GI issues arise because the autonomic nervous system, which controls automatic bodily functions, is compromised in Parkinson’s, disrupting digestive processes. The most common problem is constipation. Other symptoms include gastroparesis, or delayed gastric emptying, which results in bloating, nausea, and early satiety; dysphagia, or difficulty swallowing; and sialorrhea, or excessive saliva production. Additionally, you may experience bloating and abdominal discomfort due to the slowed movement of food through the digestive tract. Managing these symptoms involves dietary adjustments, medications, and the empowering role of lifestyle changes, along with professional guidance, to improve quality of life.

          Hallucinations

Hallucinations can be a symptom of Parkinson’s, particularly in its later stages. These hallucinations are often visual but involve other senses like hearing or touch. They result from changes in the brain due to Parkinson’s, particularly in the regions involved in the perception and processing of sensory information. Hallucinations in Parkinson’s can be treated and managed with medications, counselling and support from your care team.

          Hyperhydrosis (excessive sweating)

Parkinson’s can cause excessive sweating, a condition known as hyperhidrosis. People with Parkinson’s may experience sudden, profuse sweating, especially in the upper body and face. This can be pretty uncomfortable and may require frequent changes of clothing. Managing this symptom involves adjusting medications and using strategies to stay cool.

Hypotension (low blood pressure)

Low blood pressure (also known as hypotension) can occur in Parkinson’s. Lightheadedness, dizziness, and fainting are common. You might experience weakness, blurred vision, or confusion. Shoulder or neck pain, trembling, and cold hands/feet can also occur. Management of hypotension should include drinking enough water to help regulate blood pressure. Prevent constipation, which can worsen symptoms. Avoid sudden movements; get up slowly from chairs and bed. Remember, your care team, including your GP, is here to help. They can recommend treatments to ease symptoms and provide the necessary support.

Impulse control disorders

Impulse control disorders (ICDs) in Parkinson’s are the inability to resist intense urges that lead to repetitive, potentially harmful behaviours. Common ICDs include pathological gambling, hypersexuality, compulsive shopping, binge eating, and compulsive hobbyism. These behaviours are often linked to the use of dopamine agonist medications, which are commonly prescribed to manage motor symptoms of Parkinson’s. Effective management typically involves adjusting medicines under medical supervision, providing behavioural therapies to enhance impulse control, and educating both you and your caregivers about recognising and managing these challenging symptoms, as your support is crucial in this journey.

Loss of executive function

Loss of executive function refers to changes in cognitive processes essential for planning, organising, problem-solving, and regulating behaviour to achieve goals. You may find it challenging to initiate, switch between, or complete tasks efficiently. Memory functions may also affect your recall of information needed for immediate tasks. This can significantly impact daily life, work performance, and interpersonal relationships. In these moments, it’s important to remember that you’re not alone. Effective support and coping strategies are available to help you manage these challenges, providing reassurance and a sense of support.

Loss of sense of smell

Loss of smell, known as anosmia or a reduced sense of smell (hyposmia), is a common and early symptom of Parkinson’s. Profoundly affecting your ability to detect and recognise odours, it may impact nutritional habits, enjoyment of food, and changes in appetite. It also poses safety risks, as you may struggle to detect hazards such as spoiled food or gas leaks. Psychosocially, scent is linked to memories and emotional connections. Managing changes to your sense of smell requires adaptive strategies to enhance safety, maintain nutrition, and address emotional and social implications.

Mild cognitive impairment

Mild cognitive impairment (MCI) in Parkinson’s refers to a stage where you experience noticeable cognitive changes beyond what is expected due to normal aging but do not yet meet the criteria for dementia. Common symptoms include difficulties with memory, attention, and executive function, such as planning and problem-solving. It can impact daily activities, work performance, and social interactions. You might experience forgetfulness, trouble finding words, or challenges in completing tasks that require complex thinking. While you may still be able to manage independently in most areas of life, these cognitive changes can be concerning and require careful monitoring by your care team.

Pain

Types of pain associated with Parkinson’s include muscle pain, dystonia, radicular (shooting) pain and neuropathy. Unexplained pain is a common symptom in young onset, starting with the shoulder, elbow or hip. Musculoskeletal (muscle) pain is common and related to Parkinson’s rigidity and reduced joint movement. It often feels like an ache or in the neck and back but can affect any body part. Dystonia spasms can be severe and impact areas like toes, fingers, ankles, or wrists. Radicular (shooting) pain is sharp, shock-like pain that travels down the arm or leg. Tingling and numbness are also common. Peripheral neuropathy may also cause burning sensations or tingling. Treatment options are limited, but minimising “off” periods, painkillers and gentle physical activity, along with medication adjustments, behaviour change techniques, pain education, relaxation methods, and complementary therapies like acupuncture, are also used to manage pain.

Peripheral neuropathy

Peripheral neuropathy in Parkinson’s refers to damage or dysfunction of the peripheral nerves. The changes to nerves outside the brain and spinal cord can lead to various symptoms, including numbness, tingling, burning sensations, and weakness in the hands, feet, arms, or legs. In Parkinson’s, peripheral neuropathy may relate to factors such as aging, diabetes (which is more prevalent in individuals with Parkinson’s), or side effects of medications used to treat Parkinson’s.

Skin issues

A common and chronic inflammatory skin condition primarily affecting areas rich in sebaceous (oil-producing) glands is referred to as seborrheic dermatitis. Red, itchy, and flaky patches on the scalp, face (particularly around the eyebrows, eyelids, and nasolabial folds), ears, and upper chest can often be managed effectively with topical treatments such as antifungal creams, corticosteroids, or medicated shampoos. Sometimes, lifestyle modifications and regular skincare routines can help you control symptoms and reduce flare-ups.

Sexual dysfunction

Sexual dysfunction in Parkinson’s encompasses a range of issues that can significantly impact intimate relationships and, importantly, your overall quality of life. For men, common problems include erectile dysfunction, difficulty achieving or maintaining an erection due to decreased blood flow or side effects of medications used to manage symptoms. Women may experience reduced libido, difficulty reaching orgasm, or discomfort during intercourse, often related to changes in hormone levels, medication effects, or physical symptoms such as muscle stiffness. You may also face challenges related to intimacy and communication, emotional and psychological aspects of living with a chronic condition. Addressing sexual dysfunction in PD requires a collaborative approach involving your care team, who specialise in neurology, urology, gynaecology, and sexual health.

Sleep issues

A combination of factors, including changes in the brain’s neurotransmitter systems, medication side effects, motor symptoms disrupting sleep patterns, and the presence of other coexisting conditions such as depression or anxiety cause sleep disturbances. These disturbances can include difficulty falling asleep, frequently waking up during the night, insomnia, nocturia, restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder. Proper management involves a comprehensive approach that may include adjusting medications, addressing motor symptoms that interfere with sleep, treating coexisting conditions, and practising good sleep hygiene.

Swallowing

Swallowing difficulties, known as dysphagia, are a common non-motor symptom of Parkinson’s disease. These issues can arise due to the reduced control over muscles in the mouth and throat and affect the ability to chew and swallow food and liquid safely. Symptoms to look out for include drooling, difficulty clearing food from the mouth, food sticking in the throat, a gurgly voice, coughing or choking when eating or drinking, and discomfort in the chest or throat. Adjusting Parkinson’s medication can sometimes help manage dysphagia by improving muscle control. Work with a speech-language pathologist in your care team early for tips, helpful exercises and dietary adjustments.

Temperature control

Regulating body temperature can be a significant challenge for individuals with Parkinson’s disease (PD). This difficulty is due to the impairment of the autonomic nervous system, which is responsible for controlling automatic body functions, including temperature regulation. In PD, the hypothalamus and the autonomic nervous system can be affected, leading to temperature dysregulation. This can make you feel too hot or too cold, or sweat too little or too much. Wear layers, talk to your care team about how to manage these symptoms and stay hydrated.

Urinary incontinence

Urinary incontinence in Parkinson’s can arise from multiple factors related to both the condition itself and its treatments. The neurological changes can disrupt the coordination between the brain and the bladder. Medications commonly used to manage symptoms, such as anticholinergics or dopaminergic therapies, may also contribute to bladder control issues. Additionally, stiffness and slow movement can make it challenging for you to reach the restroom in time. Pelvic floor dysfunction, possibly worsened by reduced physical activity or age-related changes, can further contribute to urinary incontinence. Addressing these factors typically involves a holistic approach, including medication adjustments, pelvic floor exercises, behavioural therapies, and managing coexisting conditions like urinary tract infections to improve bladder control.

Urinary urgency

Urinary urgency refers to a compelling and sudden need to urinate that can be difficult to control. This symptom arises from disruptions in the neurological pathways regulating bladder function. Parkinson’s affects the brain’s ability to correctly signal when the bladder is full or needs to be emptied, leading to an exaggerated sensation of urgency even when it may not be full. Additionally, medications used to manage Parkinson’s symptoms can sometimes exacerbate bladder symptoms, increasing urgency. Urinary urgency can significantly impact your daily life, causing discomfort, anxiety, and challenges in managing social situations. Managing urinary urgency involves strategies such as timed voiding schedules, pelvic floor exercises to improve bladder control, lifestyle modifications like fluid management, and occasionally medications to reduce bladder spasms or urgency sensations.

Voice

Voice changes in Parkinson’s can be an early symptom. You might experience a softer voice, monotone pitch, or a hoarse voice, often because PD affects the muscles that produce speech. These symptoms may be subtle initially, but the changes progress and become more pronounced over time. You may not notice these changes, but friends, family and colleagues may ask you to repeat yourself or speak up. A speech pathologist can provide specialised therapy to improve or maintain vocal strength and clarity and suggest assistive technologies to help. Some medications can help improve muscle control and speech function in PD patients.