Nonmotor 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 nonmotor symptoms of Parkinson’s disease can also have a major effect on a person’s daily life and well-being.
Parkinson’s nonmotor symptoms may affect mood, thinking, sleep, digestion, blood pressure, senses, and other body functions. Some early nonmotor symptoms of Parkinson’s, including constipation, sleep disturbances, and loss of smell, may begin before noticeable movement problems develop.
An individual’s experience may differ from that of other people with Parkinson’s. Understanding these symptoms can help individuals recognize changes and discuss them with their healthcare team.
Mood, mental health, and cognitive changes
Nonmotor 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 mental health.
Apathy can resemble depression, but is a separate symptom involving reduced motivation without feeling sad. If changes in mood or motivation interfere with daily life, individuals should inform their healthcare team. Counseling, medication, physical activity, and social support may help, depending on individual needs.
Pseudobulbar effect
Pseudobulbar affect, or PBA, causes involuntary episodes of laughing or crying that may not match how a person feels. 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 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. Individuals should contact their healthcare team if they 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 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. Individuals should ask their healthcare team about a cognitive assessment if they or someone close to them notices changes in their thinking, as there are strategies to mitigate the risk of dementia.
Autonomic and digestive complications
Parkinson’s can affect the 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 medications, and wearing compression garments. If these conservative strategies don’t work, prescription treatments can help raise blood pressure. Patients should talk with their care team because strategies may change if they have heart or kidney problems.
Constipation is a common nonmotor 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. Patients should inform their healthcare team if digestive symptoms persist or appear to affect how well their 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 a 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.
Patients may also experience excessive or reduced sweating, dry skin, or oily and flaky skin. A 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 a person is experiencing can help a 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.
Patients should tell their healthcare team if they fall asleep unexpectedly and avoid driving or other potentially dangerous activities until they receive 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, healthcare teams can look for potentially treatable factors and help 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. Patients should inform their 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.
Patients may not recognize these changes, so feedback from someone they trust can be helpful. Individuals should inform their neurologist about new or increasing impulsive behavior. These symptoms may be medication-related and are not a personal failing.
Patients should not reduce or stop a Parkinson’s medication on their own. A doctor can determine whether an adjustment is appropriate.
Managing and treating nonmotor symptoms
Managing nonmotor symptoms of Parkinson’s usually involves a personalized combination of medical care, supportive therapies, and practical strategies. Healthcare teams should evaluate new or worsening symptoms because they may be related to Parkinson’s, medication side effects, or another condition.
Some nonmotor symptoms can feel difficult to discuss, but concerns involving mood, thinking, sleep, bladder, sexual health, or behavior are important parts of care.
Tracking symptoms can help patients prepare for appointments. Individuals might 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 they trust to share changes they have noticed
Treatment depends on the symptom, its cause, and how it affects 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 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 the home or routine
Patients should talk with their healthcare team before changing their medication, diet, fluid intake, or exercise routine.
There is no single treatment for Parkinson’s nonmotor symptoms. A care plan should focus on the concerns that affect the patient most, and it may need to change as symptoms change.
Some symptoms may feel difficult to bring up, but patients deserve support for every part of their experience with Parkinson’s. Open communication with a healthcare team can help individuals find strategies that support their 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.
