What to watch for

Parkinson’s disease is a progressive, degenerative brain disorder. When you think of Parkinson’s, you probably think of motor problems. Some of the more familiar symptoms are tremors, slowed movements, and poor balance and coordination.

But Parkinson’s disease can also cause an array of non-motor problems, which can be considerably less obvious. Some of these symptoms can pop up years before motor symptoms — and well before you know you have Parkinson’s.

There’s a long list of symptoms associated with Parkinson’s disease, but no one has them all. The realities of the condition vary a lot from person to person. But about 98.6 percent of people with Parkinson’s disease have one or more non-motor symptoms.

What are the earliest non-motor symptoms?

Some of the earliest non-motor symptoms don’t seem at all related to how we think of Parkinson’s disease. At first they can be quite mild, and they tend to progress slowly.

Among them are:

Weakening sense of smell and taste

This may be due to degeneration of the anterior olfactory nucleus and olfactory bulb, one of the first parts of the brain affected by Parkinson’s. This can happen so gradually that you’re not even aware of it.

Losing your sense of smell and taste can make you lose interest in food. You may miss out on important nutrients and lose weight.

Sleep disorders

This includes insomnia, excessive daytime sleepiness, vivid dreams, and talking in your sleep. Sleep problems may be the result of degeneration of the regulators of the sleep-wake cycle. They can also be due jerking movements or muscle stiffness during the night.

Mood disorders

This includes irritability, impulsive behaviors, anxiety, and depression. If you have Parkinson’s, your brain is producing less and less dopamine, a chemical that helps regulate emotions.

Dizziness and fainting

This may be due to having low blood pressure when you stand up (orthostatic hypotension). It may be that your nervous system isn’t making or using norepinephrine correctly, which results in reduced blood flow to the brain.

Constipation

This could be due to degeneration of nerves in your gastrointestinal tract, which slows movement in the bowels.

See a doctor

Of course, these symptoms can be due to any number of reasons that have nothing to do with Parkinson’s disease. Your doctor is the only person who can make a diagnosis, so schedule an appointment if you’re experiencing any unexplained symptoms.

What are some other non-motor symptoms?

There are many potential non-motor symptoms of Parkinson’s. These can start at any point in disease progression.

Some of these are:

Cognitive changes

This includes memory problems, slowed thought, and trouble focusing. Parkinson’s disease can also cause hallucinations, delusions, and dementia.

Cognitive impairment is one of the most common non-motor symptoms of Parkinson’s disease. This may be due to the drop in dopamine or other chemical messengers in the brain.

Gastrointestinal dysfunction

In addition to constipation, degeneration of nerves in the gastrointestinal tract can cause other problems such as acid reflux, nausea, loss of appetite, and weight loss.

Urinary problems

This includes increased frequency and incontinence. This may be due to degeneration of autonomic bladder neurons, motor areas, and higher control areas.

Sexual problems

This includes erectile dysfunction, which may be due to autonomic degeneration. Mood disorders and other physical symptoms can also interfere with your sex life.

Pain

This may be due to degeneration of dopamine-dependent centers that regulate pain inhibition. Pain can also result from other symptoms, such as muscle cramping and rigidity.

Masking

This condition occurs when your expression appears serious, sad, or angry, even when you’re in a fine mood. It may also involve a blank stare or not blinking as often as you should. This can send the wrong signals, making you appear unapproachable and interfering with your ability to communicate effectively.

Other symptoms

Others possible symptoms include:

  • vision problems, including dry eyes, blurry vision, double vision, and eye strain
  • excessive sweating or other skin problems, such as oily or dry skin, flaking, or inflamed skin
  • shortness of breath
  • fatigue
  • stooping or hunching over
  • weight loss

Mixed motor and non-motor symptoms

Parkinson’s disease can affect muscles you use for mouth movements and swallowing.

This can cause symptoms such as:

  • low, soft, or raspy voice
  • excessive saliva or drooling
  • difficulty speaking properly
  • swallowing problems, which can lead to dental problems and choking

When to see your doctor

It’s easy to assume these problems have other causes, and they often do. But any of these non-motor symptoms can have a big impact on your overall quality of life.

Having one or more doesn’t necessarily mean you have Parkinson’s disease or that you’ll eventually develop it. But it’s worth consulting with your doctor.

Tell your doctor if you’re concerned about having Parkinson’s disease. Although there’s no cure, there are medications to help control symptoms.

What to expect from diagnosis

There’s no single test for Parkinson’s, so it can take some time to reach the diagnosis.

Your doctor will likely refer you to a neurologist, who will review your symptoms and perform a physical examination. Tell your doctor about all the medications you take. Some of these symptoms could be side effects of those drugs.

Your doctor will also want to check for other conditions that cause similar symptoms.

Diagnostic testing will be based on your symptoms and neurologic workup and may include:

If your doctor suspects Parkinson’s, you may be given a medication called carbidopa-levodopa. If your symptoms improve while on this drug, it will confirm the diagnosis.

And if you don’t have Parkinson’s, it’s still important to find the cause of your symptoms so you can get the help you need.