Parkinson’s Symptoms

Constipation is very common in Parkinson's and can precede the diagnosis by years. Parkinson’s constipation is caused by a reduction in the ability of the bowel to contract. While eating bran to increase the bulk of the bowel motion is important for most causes of constipation, in Parkinson's this must be done cautiously as the bowel may not have the strength to move the extra bulk along. Often people need to treat themselves with exercise and extra fluid along with stimulating agents such as fruit extracts. Sometimes a special laxative such as lactulose is necessary.

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Most people develop some form of sleep disturbance. This can include interruption of sleep by tremor, pain or difficulty rolling in bed. A very common pattern is marked tiredness in the evening and falling asleep soon after going to bed. This is followed by waking up around midnight and frequent awakenings through the rest of the night. This pattern is often associated with sleepiness in the early afternoon. It is reminiscent of jetlag, and in fact it may be due to disturbances of the biological clock.

Other people develop a more distinctive sleep disturbance. The most striking of these is Rapid Eye Movement (REM) sleep behaviour disorder. In this situation, the person talks or acts out vivid dreams.

Anxiety is thought to affect up to 40% of people with Parkinson’s to some degree, ranging from mild to severe. Anxiety is often present at the same time as depression although one can be present without the other.

Approximately one third of people develop depression at some time during their Parkinson’s. Depression can sometimes precede the diagnosis of Parkinson's. 

The frequency of depression in Parkinson's is greater than would be expected in people with other chronic conditions; there is much less depression in people with heart disease. The increase in depression in Parkinson's is likely related to chemical changes in the brain, similar to the chemical changes that produce Parkinson's itself. Depressionin people with Parkinson's has traps for both patients and doctors. Many of the symptoms of Parkinson's: namely the slow movement, poor energy and disrupted sleep, are very similar to those of depression and can mask the true diagnosis of depression.

A number of symptoms can point to the development of depression. These include a disturbance of sleep, a lack of energy, a feeling of hopelessness or lack of optimism, poor concentration and forgetfulness, a change in appetite and feelings of sadness.  

 The depression associated with Parkinson's responds to standard anti-depressant treatment. The important point is to recognise the possibility of depression and bring it to the attention of your doctor.

A closely related symptom is a lack of motivation or apathy. Apathy is a reduction in motivation related to not caring enough about things, either because we can’t feel strongly enough about something to act, or because we don’t think that it is important enough. This can be particularly frustrating for family members. So it is important to understand that apathy is a characteristic of Parkinson’s - not the person being lazy or difficult. It is also sometimes mistaken for depression.

Fatigue, daytime sleepiness and a loss of motivation can be common symptoms for people with Parkinson’s. Some find the tiredness can be improved with regular exercise and rest. When tiredness is prominent, people often have to be careful not to take on too many responsibilities or tasks that they cannot complete.