Parkinson’s disease (PD) is generally thought of as a disease that only involves movement. In addition to movement (or motor) symptoms such as slowness of movement, tremor, stiffness and balance issues, most people develop other health problems related to Parkinson's. These symptoms are diverse and collectively known as non-movement (or non-motor) symptoms.
While family and friends may not be able to see these symptoms, it is important to realize that non-movement symptoms are common and can be more troublesome and disabling than movement symptoms. Some symptoms, such as loss of smell, constipation, depression and REM sleep behavior disorder (RBD) can occur years before the diagnosis of PD.
Recognizing and addressing non-movement symptoms is important. Always bring symptoms up to your healthcare team, as most are treatable.
Prioritizing mental health is vital to overall well-being, for people living with Parkinson’s, their loved ones and care partners, too. Symptoms of PD can affect mood, cognition, sleep and more, which can impact emotional well-being.
Learn more about PD symptoms that impact mental health:
People with PD may experience depression, apathy, and anxiety more frequently than those without Parkinson’s. In fact, depression — while common in PD — is often overlooked and undertreated. It is important to be aware of these symptoms, so they can be treated effectively if you experience them.
“Not only are there non-motor symptoms such as depression, anxiety and apathy that can occur in addition to sleep changes and cognitive changes, but you’re also coping with a chronic and progressive disorder … it all intermingles with the physiological aspect and can affect you emotionally.”Jessica Shurer, MSW, LCSW
Living with Parkinson's can impact overall well-being. Symptoms can often be frustrating and stressful. Embracing wellness strategies and minimizing stress can help you live better with PD.
- Breathing & Respiratory Problems
- Sleep Disorders
- Small Handwriting
- Speech & Swallowing Issues
Take time to discover how PD can impact your mood and how it impacts you physically. This can help you begin to navigate your feelings, address symptoms and find ways to create calm. Good sleep, ample exercise and engaging hobbies are essential to emotional and physical well-being.
More than 75 percent of people with PD report sleep-related symptoms. This early sign of PD can be incredibly intrusive to quality of life.
Speech & Swallowing Issues
Parkinson’s can cause difficulty chewing, eating, speaking or swallowing. Learn more about managing these symptoms.
The feeling of deep tiredness that does not improve with rest is a common PD symptom. Find out how to address it.
Counseling sessions — alone, with a loved one, with family, or in a group of others with PD— can lift stress and offer support.
Strong connections can also do wonders for your well-being. Join family or friends for dinner, volunteer or get connected with a Parkinson's support group, such as our PD Conversations. A network of support offers you the chance to share experiences, emotions and challenges — and gives you an opportunity to learn from others.
Up to 30 percent of all people with Parkinson's report changes in their memory and thinking ability. Thinking changes can affect understanding, learning, remembering and more.
Learn more about PD symptoms that impact thinking changes:
The same brain chemicals that regulate mood and movement in PD also influence mental processing. PD medications can also cause thinking changes.
More than 50% of care partners or spouses of people with PD, who attended the Parkinson's Foundation 2020 Care Partner Summit, said thinking changes were a significant challenge — regardless of their loved ones' stage of Parkinson's.
Keep in mind that there are many other factors that can impact cognition other than PD. These can include age, sleep or other health problems, fatigue, neurogenic orthostatic hypotension (nOH) — a persistent drop in blood pressure that occurs upon moving from sitting to standing or from lying down to sitting up or standing — and more.
It is important to discuss any cognition changes with your doctor, who can help identify causes, potential medication interactions and offer management strategies. Some thinking changes are reversible if you identify the cause. Exercise is one way to manage thinking changes. It can slow Parkinson's progression and improves thinking and task performance.
Deep dive into Parkinson's and thinking changes with our book, Mood: A Mind Guide to Parkinson's Disease.
As many as 80 percent of people with PD can experience a broad range of digestive issues. Symptoms such as constipation may even appear before telltale Parkinson's movement symptoms. In fact, some of the earliest signs of PD are found in the enteric nervous system (often called the brain in the gut).
Learn more about PD symptoms that impact digestive issues:
PD-related brain changes, normal aging and PD medications can all influence digestive health. It’s important to log symptoms — when they started and whether you notice any patterns. It can help your doctor rule out potential causes.
Bring your symptom log to every doctor’s appointment, along with a complete list of current prescription and over-the-counter medications and supplements. Your doctor can help you identify strategies to minimize gut issues, and may suggest getting regular exercise, drinking plenty of water and eating a fiber-rich diet.
Parkinson’s can cause sensory issues, affecting four of the five senses.
Learn more about PD symptoms that impact sensory issues:
Smell and Taste
A diminished sense of smell can precede a PD diagnosis. In fact, loss of smell, called hyposmia, can impact people with Parkinson's years or even decades before they are diagnosed with the disease. Because sense of taste is enhanced by the ability to smell, hyposmia might also lead to a reduced enjoyment of food and reduced appetite.
PD can affect the vision system in many ways:
- Double vision can often occur because the eye muscles have trouble working together, especially to see up close (called convergence insufficiency).
- Dry eye due to decreased blinking is associated with PD and can cause blurry vision.
- Blurry vision can be caused by PD medication, especially anticholinergics (such as trihexyphenidyl/Artane® or benzotropine/Cogentin®).
Some people with PD can experience visual disturbances in the form of hallucinations. Hallucinations are more common in advanced Parkinson’s.
"I was diagnosed with Parkinson’s disease in 2018. Four years prior to that, I suffered through shoulder and back pain, foot cramps and hand surgery that didn’t heal. I was also suffering from depression, fatigue and an overwhelming sense of apathy."
Parkinson’s does not clearly impact hearing, although this is not an area that has been widely studied. However, because hearing loss is common with aging, it is relevant to many people with PD.
Hearing loss is a risk factor for the development of cognitive impairment. If those around you tell you that your hearing appears diminished, see an audiologist for a hearing evaluation. Improving your hearing with hearing aids could have positive impacts on your cognition and well-being.
Altered physical sensation is common in PD. Rather than being decreased in the way the other affected senses are, the sense of touch may lead to pain. Peripheral neuropathy is when the nerves, often in the feet and legs, are damaged. There is a higher rate of peripheral neuropathy in people with PD, although more research is needed to understand why.
Neuropathy can lead to numbness, or it can result in sensitivity and burning, prickling, sharp or throbbing pain. Levodopa treatment (especially the intestinal gel formulation) may contribute to lower Vitamin B12 levels, which may contribute to peripheral neuropathy.
Restless leg syndrome (RLS) can cause a similarly uncomfortable sensation in the legs, accompanied by a nearly irresistible urge to move that temporarily alleviates the discomfort. RLS symptoms are often improved by the same medications that help the motor symptoms of PD. Anticonvulsant medications such as gabapentin or pregabalin can be helpful for both painful peripheral neuropathy and RLS.
Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson's Foundation Center of Excellence and Dr. Addie Patterson, Movement Disorders Neurologist at the Norman Fixel Institute for Neurological Diseases at the University of Florida, a Parkinson’s Foundation Center of Excellence.