Your Guide to Nonmotor Symptoms of Parkinson's Disease

So much more than a movement disorder

What was once thought to be primarily a movement disorder defined by the cardinal signs of tremor, rigidity, bradykinesia and postural instability, we now recognize the multitude of symptoms that can be affected by Parkinson's disease. It is these symptoms, considered to be nonmotor that have significant negative impact of a patient''s quality of life. This guide is by no means a comprehensive list and it will be added to as time permits.  

REM Sleep Behavior Disorder (RBD)

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REM sleep behaviour disorder affects anywhere from 25 - 50 % of Parkinson's patients. The violent movements (and vocalizations) can be considered dream-enacting and can result in injury to both the patient and their bed partner. 

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Sleep Disorders in Parkinson's


Close to 80% of people with Parkinson's disease suffer from some sort of sleep disorder ranging from frequent wakings to insomnia, sleep apnea, REM Sleep Behaviour Disorder, Periodic Limb Movement Disorder and Excessive Daytime Sleepiness to name a few. 

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Pain in Parkinson's

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While once not thought to be part of this disease, pain is increasingly being recognized as a very real and serious phenomenon in Parkinson's. The pain can be musculoskeletal, neuropathic, related to dystonia and central pain. This symptoms has a definite negative impact and must be addressed in order to maintain quality of life. 

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Mood Disorders in Parkinson's

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Complicating the physical symptoms of Parkinson's disease, are mood disorders which are fairly common in this population. Depression occurs in 30 - 50% of Parkinson's patients and similarly anxiety affects 25%. Anxiety may manifest as Generalized Anxiety Disorder, Panic Disorder, Obsessive - Compulsive Disorder, Social Anxiety and Phobias.

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Gastrointestinal Problems in Parkinson's

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Problems with the gastrointestinal tract have been long recognized as part of the symptoms of Parkinson’s disease. These include dental deterioration, excessive saliva, difficulty swallowing, slow emptying of the stomach and constipation. 

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Dementia in Parkinson's

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Cognitive changes like dementia occur in 24 - 30% of patients with Parkinson's and this risk increases with age. There are two types of dementia associated with PD - Lewy Body Dementia and Parkinson's Disease Dementia. They may differ to some extent in the presentation of symptoms but any type of dementia can have a devastating effect on patients and their families.

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Apathy in Parkinson's

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It is estimated that approximately 40 – 45% of Parkinson’s patients suffer from apathy. This number however is likely an underestimation. It can manifest as no self-initiative to start or complete necessary tasks or learn new things and self-direct future goals and plans. Along with a medical assessment, there are a number of behavioural changes that can be made. 

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Olfactory Dysfunction in Parkinson's

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Olfactory dysfunction refers to a loss of smell and this phenomenon occurs in almost all cases of Parkinson’s (more than 95%). In fact it is more common than one of the hallmark symptoms of PD – resting tremor. Not to imply that all individuals with a lack of smell have Parkinson’s. 

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So now we know...

There are a vast number of symptoms of Parkinson's disease (these are only a few) that are not related to the motor symptoms of the disease. Since they are strongly correlated with poor quality of life, they must be recognized first and then brought to the attention of your medical team. Nonmotor symptoms require their own management as they don't normally respond to the standard treatments for the motor symptoms of Parkinson's.

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