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Addressing Non-Motor Symptoms in Parkinson’s Disease

When the term Parkinson’s is mentioned, many immediately conjure images of the hallmark motor symptoms of tremors, stiffness and slowed movement. However, Parkinson’s is a multifaceted neurodegenerative disorder that extends well beyond these visible manifestations. While these motor symptoms are indeed hallmarks of the disease, they represent only the tip of the iceberg in terms of challenges faced by people living with Parkinson’s daily.

Consider this statistic: in the United States alone and estimated 90,000 people will receive a Parkinson’s diagnosis this year. That’s roughly one new diagnosis every six minutes. Behind each of these statistics lies a unique journey, as Parkinson’s affects each person differently.

Beyond the visible tremors and rigidity are a myriad of non-motor symptoms, often lurking beneath the surface like a submerged portion of an iceberg. These non-motor symptoms encompass various aspects of cognition, psychiatric wellbeing, autonomic function, sleep patterns, and more. Each facet of Parkinson’s presents its own set of hurdles, demanding comprehensive understanding and tailored approach to management.

In this comprehensive guide, we will delve into the depths of Parkinson’s disease, exploring the range of non-motor symptoms and their effects on the lives of those effected by the condition. From cognitive changes to psychiatric manifestations, from autonomic dysfunction to sleep disturbances, we will navigate through the complexities of Parkinson’s shedding light on often overlooked aspects of the disease.

Early prominence of cognitive changes may raise concerns about Lewy Body Disease. Those living with PD can benefit from interventions such as attention training and medications commonly used for Alzheimer’s disease. However, beyond pharmacological approaches, fostering stimulating and socially engaging environments is essential. Providing meaningful, person-centered opportunities is crucial as individuals navigate progressive physical limitations. Feeling useful and purposeful becomes even more vital amidst the challenges posed by Parkinson’s.

Psychiatric symptoms in Parkinson’s may manifest as depression, anxiety, obsessiveness, visual hallucinations, or delirium. While certain symptoms may necessitate medication prescribed by a Parkinson’s-informed specialist, non-pharmaceutical approaches play a vital role in holistic management. Techniques such as tai chi, creative journal expressive arts™, singing, meditation, visualization, muscle relaxation, massage, and deep breathing can offer significant relief. Establishing and maintaining a structured routine can be particularly beneficial, providing predictability that helps individuals feel in control and regulated. These small interventions not only promote a sense of calm but also help minimize suspicious thinking and enhance overall well-being.

Autonomic Dysfunction in Parkinson’s Disease encompasses a range of symptoms such as constipation, urinary urgency, abnormal sweating patterns, blood pressure fluctuations, and drooling. While medications prescribed by healthcare providers play a crucial role in managing these symptoms, there are several practical strategies individuals can implement without requiring a doctor’s order.

For constipation, lifestyle modifications can be effective. Increasing fiber intake through dietary adjustments, staying adequately hydrated by consuming plenty of water and other fluids, and incorporating regular physical activity into daily routines can promote bowel regularity. Establishing a consistent toileting schedule, aiming to have a bowel movement at the same time each day, can also prove highly beneficial. Furthermore, maintaining adequate fluid intake not only aids in bowel regularity but also contributes to urinary health.

It’s important to exercise patience and understanding when dealing with urinary urgency or difficulties. Some individuals with Parkinson’s may experience challenges with voiding once they reach the toilet or may require frequent trips to the bathroom due to a sense of urgency. These experiences are common and may require patience and understanding from both the individual and their caregivers.

Nocturnal sweating stands out as one of the most common thermoregulatory dysfunctions among people with Parkinson’s Disease. One may notice sweating on their head, face, and trunk. One may experience this as their Parkinson’s medications wear off. One should also pay close attention to what they are consuming to determine if there is a correlation. Keeping a log may help you identify caffeine, spicy food, alcohol or other items as the culprit that may be triggering the sweating.

Drooling may occur because of excess saliva production, but more accurately, it is due to not swallowing as often and automatically. Keep in mind that Parkinson’s is a dopamine story. Dopamine is tied to movement. Movement triggers swallow. So decreased coordination, slowness of movement, and rigidity in muscles in the mouth and throat results in drooling. It can be embarrassing and frustrating for the individual. A great place to start is with a speech and language pathologist consultation. Some tricks to apply immediately include sucking on a hard candy or chewing gum. This stimulates the automatic swallow reflux to help clear saliva for some temporary relief. Another option is to wear a sweat band on your wrist so you can discretely wipe your mouth. In addition, there are medications and Botox that can help. Confide in your physician and ask for recommendations.

In addition to treating blood pressure with medications, we have some hacks to help you. Give yourself time to adjust when changing positions. WAIT before moving to the next step when you are going from lying to seated or seated to standing position. Giving your body a few seconds can make a world of difference and prevent a fall.

Sleep problems, which can affect 98% of people with Parkinson’s, may include Insomnia, sleeping excessively, restless legs, REM Behavior Disorder and Sleep-Disordered breathing. A sleep study will help you understand what symptoms you are experiencing and in collaboration with your medical team, you can determine the best course of action, whether medication, respiratory device, or other intervention. Relaxation therapy modalities, such as tai chi, deep breathing, meditation, guided imagery, biofeedback, progressive muscle relaxation, to name a few, can be an excellent adjunct to treatment.

Other areas to pay attention to for people with Parkinson’s are skin and bone. Melanoma is more than twice as common in people with Parkinson’s as compared to those without Parkinson’s Disease. Seborrhea / Dermatitis is very common. People with Parkinson’s are also subject to Keratosis, Basal and Squamous Cell Carcinomas. Be sure to include a dermatologist in your medical team and make a routine of thoroughly checking skin. While Parkinson’s does not affect bone health, it does affect balance and posture which leads to increased risk of falls. A regular exercise routine that includes functional movement, balance exercises, and stretching tight muscles will be very helpful. For example, Parkinson’s Wellness Recovery, or PWR! includes four basic moves as the building blocks for function that focus on posture and alignment, weight shifting, trunk rotation and transitions.

At The Kensington we offer a specialized program for residents living with Parkinson’s and other Movement Disorders, called THRIVE. Our program is therapeutic, holistic, revitalizing, vocally vibrant and empowering.

In conclusion, addressing non-motor symptoms in Parkinson’s Disease requires a multifaceted approach that acknowledges the diverse challenges individuals face beyond the characteristic motor symptoms. From cognitive changes to autonomic dysfunction, from psychiatric manifestations to sleep disturbances, each aspect demands tailored management strategies that encompass both pharmacological and non-pharmacological interventions. By fostering stimulating environments, embracing person-centered care, and implementing practical tips for symptom management, individuals with Parkinson’s and their caregivers can navigate this complex terrain with resilience and hope. Through knowledge, support, and holistic approaches, we can illuminate the often-overlooked aspects of Parkinson’s disease and empower individuals to thrive despite its challenges. Remember, every journey with Parkinson’s is unique, but with the right support and resources, individuals can continue to live fulfilling and meaningful lives.

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