Primer on Parkinson’s (Part 3A): Non-Motor Symptoms
Most everyone thinks of Parkinson's as a movement disorder. We call the most common motor symptoms of rigidity, bradykinesia (slow movement), tremor, and postural instability, the cardinal signs of Parkinson’s.
Importantly, non-motor symptoms can also occur in many people-with-Parkinson's (PwP). This article will give a brief overview of non-motor symptoms in Parkinson's.
Parkinson's includes non-motor & motor symptoms
Many of us with Parkinson's will experience both motor and non-motor symptoms in Parkinson's. However, the motor symptoms are the ones that we actually see. Unfortunately, dealing with the consequences of the non-motor symptoms of Parkinson's, which are not visible, may ultimately provide more barriers and obstacles to get past than the motor symptoms of the disorder.
A partial listing of some non-motor symptoms in Parkinson's is somewhat intimidating and include:
- anxiety & depression
- sleep disorders
Included in this article is a checklist with many different clinical scenarios related to the non-motor symptoms of Parkinson's. Incorporated under the name of each disorder described is hopefully a relatively straightforward definition that will help you understand and learn about these non-motor issues. In this article, I describe only a few of these non-motor symptoms. And please remember: "There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds." - Laurell K. Hamilton
Quality-of-life with Parkinson's
As one who is living with Parkinson’s, our quality-of-life (QoL) likely varies from person to person depending on the ‘collection’ of motor and non-motor symptoms. Generally, the non-motor symptoms may have a bigger impact on QoL than motor symptoms.
Reduced cognitive functioning
A set of issues is related to reduced cognitive ability, which includes learning and concentrating (cognitive impairment), slowness of thought pattern (bradyphrenia), or just an increased difficulty in finding the right word or recalling/remembering names.
My neurologist and my students assure me that my cognitive functioning remains strong. However, a subset of my cognitive functioning centered around spatiovisual ability (e.g., reading a map on my cell phone) is not working as quickly as I remember.
About 20 percent of PwP have some form of reduced cognitive function. At the extreme of the spectrum, some features of dementia may be found in a majority of PwP within 20 years following their diagnosis. This implies that cognitive function is an important facet of our QoL with Parkinson's, and we should be vigilant to keep our mind as active as possible. Think about these words, "Humans create their cognitive powers by creating the environments in which they exercise those powers" - Edwin Hutchins
Sleep disorders with Parkinson's
F. Scott Fitzgerald said, "The worst thing in the world is to try to sleep and not to."
Sleep issues can combine both motor and non-motor aspects of Parkinson's. The extreme sleep syndrome in Parkinson's is called REM sleep behavior disorder. In some PwP, REM sleep is missing, which leads to acting out of dreams that are vivid and sometimes violent. My sleep disturbance is a subset of the features described above (no hallucinations, vivid dreams, or acting them out) because I have no problem falling asleep, but I can be wide awake 3-4 hrs into my sleep cycle. My internist and I are trying a couple of strategies to help promote a longer sleep cycle and additional deep sleep; if successful, I will write about it in the future.
Fatigue with Parkinson's
Feeling tired may be a common issue for many people, working too much, sleeping too little, life-stresses all contribute to fatigue. However, an understudied and not well-characterized occurrence is fatigue in Parkinson's.
Usually, with rest, fatigue will go away; in contrast, fatigue in PwP may linger and not go away. Linked to sleep disorders, fatigue in Parkinson's is likely a huge burden on your QoL. As one might expect, there is a strong link between fatigue and depression.
Stay hopeful, positive, & strong
Reading this post takes courage. I realize the difficulty we face ahead with Parkinson's. The journey will be complex and filled with challenges.
Stay hopeful that the following can happen, "We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right - one after the other, no slipups, no goofs, everyone pitching in." Atul Gawande
Do you participate in a support group for PD?