Non-Motor Symptoms of Parkinson s Disease

Transcription

1 Non-Motor Symptoms of Parkinson s Disease Samantha Holden, MD University of Colorado Movement Disorders

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3 MOTOR SYMPTOMS Rigidity Bradykinesia Tremor Gait Imbalance NON-MOTOR SYMPTOMS Dementia Urinary frequency Depression/Anxiety Psychosis Drooling Runny nose Fatigue Apathy Sexual dysfunction Constipation Pain Insomnia Nausea/Vomiting Decreased sense of smell Orthostatic hypotension Restless Leg Syndrome

4 Non-Motor Symptoms of PD Under-recognized and under-treated Can be more disabling than motor symptoms Not every person gets every possible symptom

5 Smell & Taste Dysfunction Hyposmia or anosmia: decreased or loss of sense of smell Can be one of the first symptoms of PD Can lead to decreased appetite No treatment

6 Drooling Not due to overproduction of saliva, instead due to impaired mouth movements and swallowing If mild, occurs during sleep or with meals Can progress to be nearly constant Embarrassing, can cause choking or aspiration

7 Rhinorrhea Runny nose Can be like a leaky faucet for some people Embarrassing, annoying Can treat with Atrovent nasal spray

8 Choking and Swallowing Difficulty Slowness of movement of the mouth and throat muscles Can lead to malnutrition, aspiration pneumonia CAN BE LIFE-THREATENING LET YOUR DOCTOR KNOW ASAP Can be tested with a Swallowing Evaluation

9 Nausea & Vomiting Common side effect of PD medications Usually improves over time Can also occur without medications Slowed stomach emptying

10 Constipation Extremely common Fewer than 3 BMs per week or straining to pass stools Can be one of the first signs of PD Slowed transit in the bowels

11 Bladder Dysfunction Urinary urgency, frequency, incontinence, nocturia In men, can be confused for prostate issues

12 Pain Can be directly due to PD Stiffness, cramping, spasms Commonly in neck, back and calves Can occur during off periods Early morning dystonia toe cramping and curling before first levodopa dose in AM

13 Dementia Up to 80% of people with PD will have some cognitive trouble during their life Slowness of thought, impaired attention and memory, visuospatial dysfunction Should be screened at least once a year by doctor

14 Psychosis Hallucinations, illusions, delusions More common if dementia present Can be side effect of medications or due to medical illness Especially if sudden onset

15 Depression Very common related to underlying disease, not just reaction to getting/having the diagnosis Can be a very early sign of PD Sadness, lack of pleasure in things you used to enjoy, hopelessness

16 Anxiety Frequently occurs with depression Panic attacks, phobias, generalized anxiety Can be a very early symptom of PD Can occur with wearing off

17 Apathy Lack of interest, initiative, motivation and emotion Indifferent, no goals for the future No longer enjoy activities

18 Impulse Control Disorders Increase in compulsive or impulsive behaviors Shopping, gambling, binge eating, cleaning, hypersexuality Punding repetition of useless tasks, like organizing objects Dopamine dysregulation syndrome addiction to Sinemet, taking more and more pills

19 Sexual Dysfunction Erectile dysfunction, decreased libido, decreased sensitivity, trouble reaching orgasm Hypersexuality, or increased sex drive or inappropriate sexual behavior Can be due to dopamine agonists More common in men than women

20 Orthostatic Hypotension Drop in blood pressure when changing positions Especially lying to standing Can also occur after large meals Symptoms: Lightheadedness, fatigue, malaise, headache, shoulder ache, cognitive slowing, passing out

21 Fatigue Nearly universal symptom in PD Lack of energy, lethargy, feeling drained Not necessarily sleepiness or needing a nap

22 Excessive Daytime Sleepiness Different from fatigue Falling asleep in the middle of the day During meals or conversations, in public places, while driving Sleep attacks with dopamine agonists Not necessarily due to poor sleep at night Overactive sleep drive

23 Insomnia Two types: Trouble getting to sleep Trouble staying asleep more frequent in PD Waking up too early (3-4am) Disrupted circadian rhythm and sleep-wake cycle

24 REM Behavior Disorder Acting out dreams talking, screaming, kicking, punching Can fall out of bed, injure yourself or your bed partner Can be the very first sign of PD (even years prior)

25 Take-Home Points Parkinson s disease affects much more than just movement Being aware of possible symptoms makes them easier to recognize and to obtain appropriate treatment Every person with PD is different

26 Questions?