Signs and Symptoms – Motor & Non-Motor

Parkinson’s can be a difficult condition to diagnose as it can present itself in many ways and in the early stages signs and symptoms can be subtle. In addition, not everyone with Parkinson’s displays the same symptoms and they don’t happen in a particular order.

Everyone’s Parkinson’s is different and symptoms can change from day to day as well as over a longer period.

Diagnosis is usually made by a neurologist in a clinical setting, it is a complex condition and there is no simple diagnostic test such as a scan or a blood test that can confirm the presence of Parkinson’s.

However there are signs and symptoms connected with Parkinson’s that you or your doctor would have noticed prior to getting a diagnosis. Some of these symptoms may or may not appear as your Parkinson’s progresses.

Remember that you can talk to your healthcare team to get help with any concerns and the Parkinson’s association of Ireland has more information on symptoms and support available.

Signs and symptoms can be broken into two groups – motor and non-motor. Motor symptoms are connected with movement while non-motor symptoms aren’t related to movement. Sometimes people with Parkinson’s aren’t aware that non-motor symptoms are connected to their condition and therefore they are not as easily identified or treated.

Motor Symptoms

A tremor can present itself in Parkinson’s when the hand or leg is relaxed and not in use. This is called a rest tremor and it usually begins in one hand or arm, causing some people hands or bodies to shake.

Anxiety can cause a tremor to get worse so people with Parkinson’s can notice that in times of stress, the tremor can become more noticeable. It is a symptom that many people associate with Parkinson’s’ but not everyone with the condition has a tremor.

Rigidity/Stiffness

Rigidity or stiffness can happen as a result of the muscles being unable to stretch or relax and this can make it more difficult to do everyday things. It can also make movement more painful.

Some people find that their posture can become stooped because of stiff muscles and they may also find it harder to make facial expressions.

Slowness of movement

It can become harder to make movements and may take longer to complete actions such as getting dressed or putting items away. The technical term for this ‘BRADYKINESIA’ and its most clear when carrying out actions that requires a few successive steps. Slowness in movement can show itself through a whole range of things including walking (short shuffled steps), speech and gestures.

Impaired Balance/posture

Balance and posture can deteriorate as Parkinson’s progresses – this can lead to problems walking, turning around and moving out of a chair or bed. It can sometimes also lead to falls as slowness of movement means it’s difficult to correct an overbalance to one side.

Freezing

Many people with PD will experience freezing at some point. “Freezing” is used to describe the experience of briefly stopping suddenly while walking or when initiating walking and being unable to move forward. People feel as though their feet are stuck to the ground. It also commonly occurs when trying to turn in small spaces or when walking through doorways. If you have trouble starting a movement or when you try to step forward just after you’ve stood up, this is sometimes called ‘starts hesitation’. Freezing can also happen with thought. Some people find this when they are trying hard to remember something in particular, for example trying to remember names. Freezing can be most common in times of stress or anxiety. Sensory cues, such as auditory, visual, or touch triggers, are employed to overcome these “Freezing” episodes. There are techniques you can use to get moving again when freezing happens.

Non-Motor symptoms

You may not experience all of these non motor symptoms but they include

Depression
Apathy
Dry mouth
Speech and language problems
Problems with swallowing and/or drooling
Low bloody pressure
Bladder and bowel problems (including constipation)
Pain
Sleep problems
Fatigue
Mood changes
Hallucinations
Loss of sense of smell

Some of these additional symptoms may actually be a side effect of the treatment of Parkinson’s rather than the underlying illness.

Problems with swallowing and/or drooling

Many people with Parkinson’s experience difficulty with swallowing (known as dysphagia) at some point and it can have a big impact upon quality of life.

Both swallowing difficulties and drooling arise due to bradykinesia affecting the swallowing muscles which make swallowing less effective and reduces the frequency of swallowing, causing saliva to build up and spill out of the mouth.

Sleep problems

You may experience problems sleeping at night-time and therefore feel tired during the day time.

Sleep problems can be caused by pain, adjusting to a medication, muscle spasms, moods changes, rapid eye movement sleep disorder (loss of the ability to paralyze oneself while sleeping and therefore acting out dreams) and restless leg syndrome amongst other causes.

Mood changes

These are some of the most common non-motor symptoms of Parkinson and may predate motor symptoms by several years. They include depression, anxiety, apathy, and impulse control disorders.

DEPRESSION can be connected to low mood, trouble concentrating, lack of sleep or oversleeping, lack of appetite and lack of energy
Anxiety can be connected with panic attacks or feelings of social anxiety.
Apathy is when you don’t feel motivated to do very much and may feel disconnected from what is going on around you.
Impulse control disorders – can occur as a side effect of some Parkinson’s medications and are characterized by an inability to resist an impulse. They can include behaviors such as compulsive gambling, binge eating, hyper sexuality and compulsive buying

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