The Parkinson’s disease is increasingly seeing the manifestations of non-motor symptoms along with typical motor symptoms in the recent years. People with Parkinson’s disease are usually affected with non-motor symptoms before the appearance of primary motor symptoms. The primary motor symptoms are tremors of fingers, rigidity, and difficulty in any kind of movements. The non-motor signs and symptoms depends on the involvement of the brain stem, olfactory, thalamic and cortical structures of the brain.
The non-motor symptoms of the Parkinson’s disease commonly affects the male than females. It is seen after the age 60 years. The course of the illness lies between 10-25 years.
The gross examination of the brain in Parkinson’s disease shows that there is a mild frontal atrophy with loss of normal melanin pigment of the mid brain.
Although the exact cause for the disease is unknown, the genetic or familial reasons are considered as one of the important cause. Other risk factors include head injury, exposure to pesticides, rural living, consumption of well water, male gender, neurodegenerative disorders, cerebrovascular diseases and long term effects of drugs.
The symptoms of Parkinson’s can be grouped into Sensory symptoms and Neuropsychiatric symptoms.
- It includes the inner restlessness, aching of muscles, pain and discomfort in the extremities.
- Drooling, abnormal gait, anosmia, difficulty in swallowing, nausea and vomiting.
- Sleep disorders and impaired daytime alertness are the other most common symptom in Parkinson’s disease. It is mainly due to the recurrence of motor symptoms like tremors and rigidity of the limbs during sleep. There may be difficulty in turning in the bed, involuntary leg movements, rapid eye movements, vivid dreams, hallucinations which result in sleep disorders. Shortness of breath during sleep also leads to sleep apnea conditions.
- There may be Autonomic dysfunction leading to the excessive sweating, constipation, increased urination and difficulty in retention of urine.
- It includes the changes in the mood, cognition impairment and behavioral changes. These are most commonly seen along with motor symptoms of the disease.
- Depression, anxiety disorders, dementia are the common associated symptoms of the disease.
- Depression and Parkinson’s disease are almost inseparable as depression affect more than 50% of Parkinson’s disease cases. It may be usually present before the onset of the disease but most of the time it gets unrecognized and untreated. It accompanies the disease for a long period leading in worsening of the motor symptoms of the disease. There is altered mood swings with guilt or joy, there may also be sadness, anxiety and suicidal tendency in depression.
- The incidence of Dementia (loss of memory) in Parkinson’s disease is 6 times more than in any other person. The anxiety disorders and dementia may result in the difficulty of planning, thinking, memorizing, understanding the complex tasks and also in difficulty of retrieving the new information in the affected person.
- The behavioural and the cognitive impairment can be called as “Impulse control disorders”. It includes extremes of sexual addiction, sexual fantasy, shopping mania, overeating, intense fantasy about the objects, sorting, arranging, repetitive handling of objects, and constant picking at oneself.
Non- motor symptoms also include recurrent urinary tract infection and dehydration in cognitive impaired persons.
A person with a set of 2-3 motor and non-motor symptoms like rigidity, tremors and dementia, impaired behaviour, difficulty balancing can be easily diagnosed with the Parkinson’s disease. It has to be evaluated for the further prognosis of the disease and its complications by MRI and CT scans.
The main goal of the treatment is to maintain the function and quality of the life of the diseased person. Earlier diagnosis helps in the recovery of the patient soon. Doctors advise for the increase in the physical and mental activity for better functioning of the body and brain. Change in sedentary lifestyle is also helpful in patients to recover with the motor symptoms.
Physiotherapy is advised for the correction of tremors or rigidity for a definite period of time.
Depression can be treated with antidepressants. And for patients who are non-responsive or intolerant to anti-depressants, Electroconvulsive therapy (ECT) is adopted which is highly effective.
Patients with cognitive symptoms and autonomic dysfunction respond poorly to the treatment.
The use of medicines like Levodopa and Carbidopa has helped in reducing the sleep disturbances enormously.