Nonmotor Symptoms of Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder of the brain and central nervous system that most people recognize by its motor symptoms, which include tremors, muscle rigidity, impaired balance, and slowness of movement (bradykinesia). Many Parkinson’s patients, however, also develop nonmotor symptoms, which ultimately may be even more disabling.

Such nonmotor symptoms can include depression and anxiety, sleeping problems, fatigue, and cognitive changes.

While these symptoms do not affect movement, coordination, or physical tasks, they usually worsen over time and can make managing the disease more difficult. Some nonmotor symptoms of Parkinson’s also can begin years before a person is diagnosed with the disease.

Parkinson’s motor and nonmotor symptoms often are considered as separate problems. But it’s important to note that these symptoms can overlap and affect each other, informing each person’s disease experience. For example, problems with the muscles that control the mouth and throat — a motor symptom — can lead to complications that aren’t directly motor-related, such as excessive drooling and difficulties with speech.

Sudden drops in blood pressure — another nonmotor symptom — can lead to dizziness and, in extreme cases, to a loss of balance that can cause falls.

The following are the main nonmotor symptoms of Parkinsons:

Types of nonmotor symptoms

  • Emotional and mood changes, which can include depression, anxiety, and irritability. Antidepressant drugs can be taken to treat depression. Counseling also may be effective in dealing with such problems.
  • Cognitive changes or dementia associated with memory, language, and thinking problems.
  • Hallucinations and delusions — collectively referred to as psychosis — causing people to see, hear, or experience things that aren’t real (hallucinations), or to hold irrational beliefs (delusions). Nuplazid is an approved medicine for the treatment of hallucinations and delusions associated with Parkinson’s disease.
  • Orthostatic hypotension, or a sudden drop in blood pressure that occurs when a person stands up from a sitting or lying position. It causes dizziness and, in extreme cases, a loss of balance or fainting.
  • Sleeping problems such as insomnia, nightmares, emotional dreams, and restless sleep. Daytime sleepiness is also a frequent issue.
  • Constipation or urinary problems.
  • Skin problems such as oily skin, particularly on the forehead and at the sides of the nose, and in some cases, on the scalp. In other cases, the skin becomes very dry.
  • Pain associated with muscle and joint rigidity. Treatment with levodopa, a medication that temporarily restores dopamine in the brain, can help relieve pain symptoms, as can certain types of exercise.
  • Fatigue and loss of energy, which may result from other symptoms, such as depression, sleep problems, or muscle stress. Exercise, good sleeping habits, staying mentally active, or not engaging in too many activities may help in relieving these symptoms.
  • Sexual problems. Parkinson’s affects nerve signals from the brain, which may affect sexual responses and result in problems like erectile dysfunction. Certain medications, such as antidepressants, also may contribute to these problems.
  • Some patients may have pseudobulbar affect (PBA), a condition characterized by uncontrollable outbursts of crying or laughing that do not match the person’s actual feelings. PBA is often mistaken for depression or bipolar disorder and occurs when a nervous system disorder, such as Parkinson’s, affects areas of the brain that control the expression of emotion. Alterations in chemicals in the brain may also contribute to PBA development.

Other nonmotor symptoms include vision problems, excessive sweating (especially in the hands and feet with no or little exercise), loss of smell, weight loss or weight gain, and impulsive behaviors.

Some symptoms can be side effects of Parkinson’s medications.

Last updated: Dec. 29, 2021, by Teresa Carvalho MSc


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