Non-motor symptoms of Parkinson’s disease
Reviewed by Parkinson’s disease is often associated with movement symptoms such as tremor, muscle rigidity, impaired balance, and slowness of movement, known as bradykinesia. But the non-motor symptoms of Parkinson’s disease can also have a major effect on your daily life and well-being.
Parkinson’s non-motor symptoms may affect your mood, thinking, sleep, digestion, blood pressure, senses, and other body functions. Some early non-motor symptoms of Parkinson’s, including constipation, sleep disturbances, and loss of smell, may begin before noticeable movement problems develop.
Your experience may differ from that of other people with Parkinson’s. Understanding these symptoms can help you recognize changes and discuss them with your healthcare team.
Mood, mental health, and cognitive changes
Non-motor symptoms of Parkinson’s disease are symptoms that do not directly affect movement. These are the kinds of symptoms that are felt rather than seen. They can include depression, anxiety, cognitive changes, hallucinations, sleep problems, constipation, blood pressure changes, pain, fatigue, and bladder or sexual difficulties. The combination and severity of symptoms vary from person to person.
Emotional and mood shifts
Parkinson’s mood changes and depression may involve persistent sadness, anxiety, irritability, apathy, difficulty concentrating, or loss of interest. Changes related to Parkinson’s and the challenges of living with a progressive condition may both affect your mental health.
Apathy can resemble depression but is a separate symptom involving reduced motivation without feeling sad. If changes in your mood or motivation interfere with daily life, tell your healthcare team. Counseling, medication, physical activity, and social support may help, depending on your needs.
Pseudobulbar effect
Pseudobulbar affect, or PBA, causes involuntary episodes of laughing or crying that may not match how you feel. PBA has been reported in people living with Parkinson’s, although estimates of how often it occurs vary
PBA may be confused with depression because both can involve crying. A neurological evaluation can help identify what is causing your symptoms and guide treatment.
Psychosis
Parkinson’s disease psychosis may involve:
- seeing or hearing something that is not present
- holding strongly to a false belief
- misinterpreting something that is present
- sensing that someone is nearby
Parkinson’s disease, cognitive changes, medications, infections, and other health problems may contribute to psychosis. Contact your healthcare team if you notice new hallucinations, delusions, or confusion. A medical and medication review can help identify potential causes.
Nuplazid (pimavanserin) is approved in the U.S. to treat hallucinations and delusions associated with Parkinson’s disease psychosis. Other treatment decisions depend on your symptoms and overall health.
Cognitive decline and dementia
Parkinson’s cognitive decline and dementia may affect attention, planning, problem-solving, language, memory, and awareness of where objects are in relation to one another.
Mild cognitive impairment generally does not substantially interfere with independence, while Parkinson’s disease dementia affects daily activities. Dementia is not a universal problem in Parkinson’s. Ask your healthcare team about a cognitive assessment if you or someone close to you notices changes in your thinking, as there are strategies to mitigate the risk of dementia.
Autonomic and digestive complications
Parkinson’s can affect your autonomic nervous system, which regulates involuntary processes such as blood pressure, digestion, sweating, bladder function, and sexual response. This autonomic dysfunction in Parkinson’s may cause symptoms affecting several body systems.
Blood pressure and digestive symptoms
Orthostatic hypotension is a sudden drop in blood pressure that occurs when a person stands after sitting or lying down. It can cause dizziness, lightheadedness, blurred vision, weakness, or fainting. However, one study found that nearly 40% of Parkinson’s disease patients with orthostatic hypotension did not experience these typical symptoms. Even without typical symptoms, the condition was associated with a higher rate of falls. Other studies have linked orthostatic hypotension in Parkinson’s patients to cognitive problems, although this association has not been confirmed specifically in those without symptoms.
Management may include standing up slowly, increasing water and salt intake, reviewing your medications, and wearing compression garments. If these conservative strategies don’t work, prescription treatments can help raise the blood pressure. Talk with your care team because the strategies change if you have heart or kidney problems.
Constipation is a common non-motor symptom and may begin before movement symptoms. Parkinson’s-related nervous system changes, reduced activity, dehydration, diet, and medication side effects may contribute.
Management options may include:
- adequate fluid intake
- a gradual increase in dietary fiber
- regular physical activity
- a consistent bathroom routine
- medication under medical guidance
Parkinson’s may also be associated with bloating, nausea, reflux, and delayed stomach emptying. Tell your healthcare team if digestive symptoms persist or appear to affect how well your medication works.
Bladder, sexual, and skin changes
Parkinson’s may affect the nerves involved in bladder control, causing urgency, frequent or nighttime urination, leakage, or difficulty emptying the bladder. It matters whether the urinary symptoms happen predominantly during the daytime versus the evening, and keeping a diary of them can help your doctor determine what to do about them.
These symptoms can feel uncomfortable or embarrassing, but they are important to discuss. An evaluation can help rule out an infection or another medical condition and guide treatment.
Parkinson’s, fatigue, mood changes, autonomic dysfunction, relationship factors, and medication side effects may contribute to erectile dysfunction, vaginal dryness, reduced arousal, or changes in sexual interest.
You may also experience excessive or reduced sweating, dry skin, or oily and flaky skin. Your healthcare team can help identify possible causes and recommend symptom-specific care.
Sleep disturbances, fatigue, and sensory issues
Parkinson’s sleep disorders may affect nighttime sleep and daytime alertness. Identifying the type of sleep problem you are experiencing can help your healthcare team recommend appropriate treatment.
Sleep problems and fatigue
Possible sleep problems include:
- difficulty falling or staying asleep
- restless legs syndrome
- vivid dreams or nightmares
- moving or speaking while dreaming
- excessive daytime sleepiness
- sleep apnea
Moving or acting out dreams may be a sign of rapid eye movement sleep behavior disorder. Parkinson’s medications may also contribute to vivid dreams or daytime sleepiness.
Tell your healthcare team if you fall asleep unexpectedly. Avoid driving or doing other potentially dangerous activities until you have received medical guidance.
Fatigue may feel like ongoing physical or mental exhaustion that is not fully relieved by rest. Sleep problems, depression, pain, medication effects, and the effort required to manage other symptoms may contribute.
Because fatigue can have several causes, your healthcare team can look for potentially treatable factors and help you develop a management plan.
Pain. sensory changes, and impulsive behaviors
Possible pain and sensory symptoms include:
- muscle or joint pain
- burning, tingling, or numbness
- reduced sense of smell or taste
- vision changes
- unexplained weight changes
- drooling or swallowing difficulties
Pain may result from rigidity, involuntary muscle contractions, nervous system changes, or an unrelated condition. Tell your healthcare team about new or worsening pain, vision changes, or swallowing problems.
Impulse control disorders may involve:
- binge eating
- compulsive gambling
- excessive shopping
- compulsive sexual behavior
- repetitive, purposeless activities
These behaviors are more common among people taking dopamine agonists, although they may occur in other circumstances.
You may not recognize these changes, so feedback from someone you trust can be helpful. Tell your neurologist about new or increasing impulsive behavior. These symptoms may be medication-related and are not a personal failing.
Do not reduce or stop a Parkinson’s medication on your own. Your doctor can determine whether an adjustment is appropriate.
Managing and treating non-motor symptoms
Managing non-motor symptoms of Parkinson’s usually involves a personalized combination of medical care, supportive therapies, and practical strategies. Your healthcare team should evaluate new or worsening symptoms because they may be related to Parkinson’s, medication side effects, or another condition.
Some non-motor symptoms can feel difficult to discuss, but concerns involving your mood, thinking, sleep, bladder, sexual health, or behavior are important parts of your care.
Tracking your symptoms can help you prepare for appointments. Consider:
- tracking when symptoms occur
- noting possible connections with medication timing
- listing changes related to sleep, meals, or activity
- bringing a current medication and supplement list
- asking someone you trust to share changes they have noticed
Treatment depends on the symptom, its cause, and how it affects your daily life. Care may include medication, counseling, rehabilitation therapy, or a referral to a mental health professional, sleep specialist, gastroenterologist, urologist, physical therapist, occupational therapist, or speech-language pathologist.
Nonpharmacological and lifestyle strategies
Depending on your symptoms and overall health, supportive strategies may include:
- regular physical activity
- a consistent sleep routine
- adequate fluid and fiber intake
- counseling or support groups
- physical, occupational, or speech therapy
- relaxation or mindfulness exercises
- practical changes to your home or routine
Talk with your healthcare team before changing your medication, diet, fluid intake, or exercise routine.
There is no single treatment for Parkinson’s non-motor symptoms. Your care plan should focus on the concerns that affect you most and it may need to change as your symptoms change.
Some symptoms may feel difficult to bring up, but you deserve support for every part of your experience with Parkinson’s. Open communication with your healthcare team can help you find strategies that support your comfort, safety, independence, and quality of life.
Parkinson's News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
