By Alison P. Monette, R.N., BSN;
Erica L. Liszak, R.N., BSN; and
Michael Rezak, M.D., Ph.D.
http://www.apdamidwest.org/APDA_Midwest/Managing_non-motor_Symptoms.html
Movement Disorders Center
Neurosciences Institute
Central DuPage Hospital, Winfield, IL
Although Parkinson’s disease (PD) is classified as a movement disorder, many people experience a variety of troublesome non-motor symptoms, previously considered non-specific or unrelated to PD. Some of these, like anosmia or loss of smell, may predate the onset of motor symptoms by many years and may now be considered a risk factor for developing PD.
Recognizing and aggressively managing both motor and non-motor PD symptoms is key to helping people with Parkinson’s (PWP) attain their optimal quality of life. Non-motor PD symptoms include:
Sleep disorders
Excessive daytime sleepiness, often a side effect of Parkinson’s medications.
REM Sleep Behavior Disorder, which disrupts the deepest, most restorative stage of sleep by causing people to “act out” their dreams in their sleep, often thrashing and striking their bed partner.
Periodic limb movements of sleep causes excessive, repetitive movements of lower extremities.
Restless Legs Syndrome (RLS), which results in abnormal sensations in the legs when lying still, but disappears with activity.
Sleep apnea, with or without snoring.
Sleep disorders are best diagnosed and treated by a neurologist or pulmonologist.
Mood problems manifested by
depression, apathy, and anxiety
Mood disorders should be discussed with your doctor and not ignored. Medication management can be very effective in treating these disorders. Identifying the underlying causes of mood changes requires careful evaluation of each patient’s medical status.
As many as 80% of PWP may experience depression during the course of their illness. Counseling, or psychotherapy, can be helpful in a “reactive” depression resulting from coping with the diagnosis of PD.
Medications can cause paranoia, hallucinations, delusions and compulsive behaviors.
Cognitive issues involving executive functions that allow us to plan ahead, organize our activities, multitask, and control goal directed activities, occur early in the course of PD. This is different from dementia, which if it occurs in PWP, usually does so in advanced stages of the disease.
Parkinson’s disease dementia
Some 10 – 40% of PWP may experience PDD. It evolves gradually and is distinguished by a specific type of memory disturbance, personality changes, slowed thinking, and impaired problem solving.
A neuropsychologist can objectively diagnose PDD and prescribe medications (cholinesterase inhibitors) that can be helpful and should be considered. Either way, patients are encouraged to stay involved in activities that “exercise” their cognitive skills (e.g. crossword puzzles, Scrabble, etc) and to participate in social events.