Getting a Grip on Parkinson’s Complications
When you think of Parkinson’s, there may be a certain set of symptoms that come to mind. That’s because Parkinson’s disease, a brain disorder, primarily affects movement—but it can come with other complications that may surprise you, including psychosis—a cognitive impairment that results in hallucinations and delusions. Here we’ll review some of the possible complications of this disease, from tremors to constipation, and how to handle them.
What Is Parkinson’s?
To understand the different potential complications of Parkinson’s disease, it’s important to have a grasp on the basic innerworkings of the disease itself. Parkinson’s occurs when neurons (nerve cells) in the part of the brain that controls movement become impaired or die, according to the National Institutes of Health (NIH). These neurons usually produce the neurotransmitter dopamine, so when they die, the brain no longer gets the amount it needs. Because dopamine helps control movement, this lack can lead to movement struggles and other complications. Keep reading to learn more about these potential struggles.
The cardinal complications of Parkinson’s are motor—or movement—related, says Ling Pan, M.D., clinical assistant professor of neurology and neurosurgery at NYU Langone Health in New York, NY. One such symptom is tremors—involuntary shaking or twitching. “Tremors can be very bothersome to some patients,” says Dr. Pan. “Initially, if they are mild, they can be more bothersome from an aesthetic perspective because it may be a type of resting tremor that does not affect activities.” Tremors with Parkinson’s can cause trembling in the hands, arms, jaw, legs, or head, per the NIH.
Another common motor complication of Parkinson’s disease you may experience is called bradykinesia—this essentially means slowness of movement, says Dr. Pan. Bradykinesia can affect your daily activities in various ways, she says: “For example, sometimes patients will say it takes them 50% more time to do tasks, or it takes them an hour to get dressed in the morning versus a half hour before.”
You may find that your Parkinson’s causes your limbs or trunk to feel stiff or rigid, according to the NIH. “Sometimes patients complain of being very stiff, especially first thing in the morning, and then sometimes gets better throughout the day,” says Dr. Pan. The stiffness can also be painful, she says.
Balance and Coordination Issues
Issues with stability and balance usually happen later on in the course of Parkinson’s as the disease advances, but it’s quite common, explains Dr. Pan. You may lose balance if you try to turn too quickly, for example. You may also experience what’s called “freezing of gait,” where your feet struggle to catch up with your brain while you’re walking, which can throw you off balance, she says. “This may happen when starting to walk, turning, or going through doorways, you can get stuck, so it’s very impairing.”
Managing Motor Complications of Parkinson’s
The motor complications discussed so far—from tremor to balance problems—may all be managed with different Parkinson’s medications, says Jennifer S. Hui, M.D., a neurologist with Keck Medicine of University of Southern California in Los Angeles. “The gold standard medication is levodopa, which is a medication that basically gets converted to dopamine, which is the missing neurotransmitter in the brain in Parkinson’s,” she explains. “It’s very effective at treating the motor symptoms.” Other medications may be used as well, such as dopamine agonists or different delivery methods (such as inhaling levodopa instead of taking a pill), she says.
Parkinson’s can also affect your thinking. The main concern is losing the ability to maintain attention, which often manifests as poor memory, explains Dr. Hui. “For example, if there are two conversations going on at the same time, your brain has to switch from one to the other—but Parkinson’s patients have difficulty doing that and keeping different lines of thought in order.” To help with this, she recommends these tips: “Try to lessen the number of stimuli you receive. If you really want to remember something, write it down, and set timers for medication if you’re often distracted.”
Depression, Anxiety, and Apathy
Mental health and emotional changes may also be complications of Parkinson’s disease, according to the NIH. “Depression and anxiety can actually precede the motor symptoms before diagnosis,” says Dr. Hui. In fact, up to half of people with Parkinson’s may deal with depression or anxiety at some point during their disease, says the Michael J. Fox Foundation for Parkinson’s Research. Antidepressants can help, Dr. Hui says. Apathy—a lack of motivation and interest—may also occur, affecting up to 40% of people with Parkinson’s, per the Foundation. Exercise and a regular sleep/wake schedule can be helpful here too, they say.
Eating and Weight Issues
Because Parkinson’s can affect muscles used for chewing and swallowing, you may experience choking on food or drink, slow eating, or drooling, and, as a result, unintentional weight loss, according to Michigan Medicine. “Patients may lose their appetite due to a variety of issues,” adds Dr. Hui. “Number one, they tend to lose their sense of smell, which makes food not taste as good. They might also have difficulty swallowing because of difficulty with coordination of swallowing muscles, so it’s just harder and slower for them to eat.” Working with a speech therapist and dietitian can be helpful.
Constipation can be a mild or severe issue for people with Parkinson’s—and it may even impact your ability to absorb your medication adequately, per the Michael J. Fox Foundation. That’s because gastrointestinal system movement and processes are all slowed down in Parkinson’s, which means you can get constipated, bloated, and have decreased appetite, says Dr. Hui. Increasing your water and fiber intake, as well as eating smaller meals throughout the day and getting enough exercise, can help keep things moving, per the Michael J. Fox Foundation, as can medications like stool softeners or laxatives.
Psychosis—hallucinations and delusions—may also accompany Parkinson’s disease, says Dr. Hui, either exacerbated by the disease itself or the medications you take for it. “Psychosis mostly presents later in Parkinson’s, not in the beginning of your diagnosis, but more like five to 10 years in,” she explains. If your Parkinson’s comes with cognitive impairments, you are more likely to develop psychosis, which can range from mild to severe, she says. About 20% to 40% of people with Parkinson’s experience this complication, and it can be managed by adjusting your Parkinson’s medications or by adding an antipsychotic to your treatment plan.
Parkinson’s Information: National Institute of Health. (2017.) “Parkinson’s Disease.” https://www.nia.nih.gov/health/parkinsons-disease
Depression and Anxiety in Parkinson’s: Michael J. Fox Foundation for Parkinson’s Research. (2021.) “Depression & Anxiety.” https://www.michaeljfox.org/news/depression-anxiety
Eating With Parkinson’s: Michigan Medicine. (2020.) “Parkinson’s Disease: Eating and Drooling Problems.” https://www.uofmhealth.org/health-library/hw81637
Constipation in Parkinson’s: Michael J. Fox Foundation for Parkinson’s Research. (2017.) “Ask the MD: Constipation and Parkinson’s.” https://www.michaeljfox.org/news/ask-md-constipation-and-parkinsons
Apathy and Parkinson’s: Michael J. Fox Foundation for Parkinson’s Research. (2016.) “Ask the MD: Apathy and Parkinson’s Disease.” https://www.michaeljfox.org/news/ask-md-apathy-and-parkinsons-disease
Psychosis in Parkinson’s: Parkinson’s Foundation. (2021.) “Hallucinations/Delusions.” https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Hallucinations-Delusions