Many people think of Parkinson’s as shaking (tremour) or slowness of movement (bradykinesia). But Parkinson’s is a highly individual condition, and there are a huge number of other symptoms that a person with Parkinson’s can experience.

Below is a full list of known symptoms, followed by more details on each, which have been separated into motor (movement-related) and non-motor symptoms.

Rarely will anyone have all of these symptoms and each person will experience them in different ways.

What are the symptoms of Parkinson’s?

The medically acknowledged Parkinson’s symptoms are:

Motor symptoms, i.e. related to movement:

  • Tremor (shaking), particularly when at rest
  • Slowness of movement (bradykinesia), and smaller movement, such as handwriting
  • Rigidity (stiffness) which makes movement difficult
  • Posture and balance problems, for example turning or getting out of a chair
  • Falls
  • Freezing
  • Involuntary movements (dyskinesia) and muscle spasms (dystonia)
  • Issues with walking and gait
  • Eye problems
  • Eating, swallowing and saliva control
  • Speech changes
  • Restless leg syndrome
  • Wearing off and motor symptom fluctuations

‘Non-motor’ symptoms, i.e. not related to movement:

  • Anxiety
  • Depression
  • Stress
  • Apathy
  • Compulsive and impulsive behaviour (Impulse Control Disorders)
  • Mild memory and thinking problems
  • Dementia
  • Hallucinations
  • Fatigue
  • Changes in sleep
  • Bowel and bladder difficulties
  • Loss of smell
  • Pain
  • Low blood pressure
  • Skin problems and sweating
  • Sexual dysfunction

Motor Symptoms

Click the titles below to find out more about the types of Parkinson’s symptoms related to movement of the body, and a summary of the treatment options available.

Tremor (shaking)

Tremor or shaking is often one of the first symptoms people first notice. It affects up to 70% of people with Parkinson’s, typically beginning in the fingers of one hand and then spreading to the arm, and eventually may affect the rest of the body.

Tremor is caused by a lack of the chemical dopamine in the brain, which results in the rapid and alternating contraction and relaxation of muscles. The continuity and rhythmic pattern of tremors separate them from other abnormal involuntary movements, such as tics, jerks, and spasms.

There are two types of tremor associated with Parkinson’s:

Rest tremor, which is most commonly associated with Parkinson’s, happens when your body is relaxed, for example when sitting on a chair or lying in bed. It usually affects the hands, but can also occur in the legs, lip and tongue. It may also stop when an intended action is carried out.

Action tremor, which occurs while doing things (like holding a cup or using cutlery) or when maintaining a particular posture. This is common in Parkinson’s, but is also a key symptom of Essential Tremor (ET), which is a condition that is often mistaken for Parkinson’s. Find out more about Essential Tremor

Tremor generally gets more noticeable over time, although the rate of progress varies from person to person, and its severity can change from day to day.

Treatment of tremor can include:

Slowness of movement (bradykinesia)

Bradykinesia is when your natural movements slow down and become more difficult to start. It affects up to 98% of people with Parkinson’s and is one of the key symptoms looked for to make a diagnosis.

This symptom involves:

  • Your movements slowing down until it takes longer to do things – it’s not that your muscles are weaker – they’re just taking longer to react.
  • Reduced coordination
  • Taking slower, shorter steps.
  • Hypokinesia – where your movements become smaller, such as a softer voice and smaller handwriting
  • Akinesia, which is a loss of movement, such as less facial expressions and less eye blinks.
  • Feeling tired more quickly

It’s often an early sign of Parkinson’s, noticed first by family and friends. It can affect just one limb or side of your body, or your whole body, and can vary from moment to moment.

Treatment of bradykinesia generally involves:

Rigidity (stiffness)

Rigidity – meaning stiff or inflexible muscles – affects between 90-99% of people with Parkinson’s.

Everyone’s experience is different, but rigidity can often start with aching, stiffness or a feeling of muscle weakness, usually beginning in one arm before spreading to the rest of the body. It’s caused by the gradual reduction of dopamine levels in the brain.

Over time, rigidity can prevent muscles from stretching and relaxing as they should, which can lead to:

  • Stiff and/or inflexible muscles
  • Reduced facial expression or a mask-like face
  • Stooped posture
  • Pain and muscle cramps
  • Difficulty turning when walking, turning in bed and getting out of a chair or bed
  • Reduced arm swing when walking
  • Difficulty with everyday activities like dressing and cutting food

Treatment of rigidity can include:

  • Medication, for example levodopa
  • Physiotherapy, including exercises to improve the range of your mobility, and strategies to perform daily tasks more easily, like getting up from a chair.
  • Occupational therapy can suggest devices and aids to help in your everyday life
  • Speech therapy can teach you facial exercises to help with speech and communication
  • Exercise, as keeping active can strengthen your muscles and alleviate the aches and pains that rigidity can cause
  • Coping strategies to help with day-to-day life

Posture and balance problems

When James Parkinson first documented Parkinson’s, he noted that one of the condition’s key features was ‘a propensity to bend the trunk forwards’, and indeed many people with Parkinson’s experience a hunching forward from the top of the spine as their condition advances.

While this bending of the spine (known as degenerative scoliosis) is a normal part of ageing, it can be more exaggerated in people with Parkinson’s, which can lead to:

  • Moving your centre of balance, which makes you more likely to lean forward as you move, increasing the risk of tripping or catching your toe when walking. This can lead to falls.
  • Increased muscle rigidity and stiffness due to the change in your balance, meaning you can’t pick up or move your feet as quickly, or catch yourself if you’re unbalanced.

Treatment of posture and balance problems include:

  • A Movement Disorder Specialist will check for changes in your balance as one of the main signs of Parkinson’s diagnosis and progression. This is called a retropulsion test where you are pulled backwards by the specialist to see if you can stop yourself from falling backwards.
  • A physiotherapist can give you exercises to help your muscles stay flexible and adjust your posture
  • An occupational therapist can suggest ways to arrange your home to minimise challenges to your balance

Falls

Not everyone with Parkinson’s is more susceptible to falls, but it is statistically more likely – this is due to a range of Parkinson’s symptoms that affect movement, most commonly poor balance, freezing and changes to your walking pattern or gait.

Falls can lead to bruises, cuts or even broken or fractured bones, so it’s important understand the causes of falls and know how to minimise the risk:

Movement issues: like issues with posture, balance, and freezing can reduce your reflexes and make your more unsteady on your feet, so more likely to fall. Make sure you take your medication correctly, as this can help alleviate movement issues. A physiotherapist can also teach you exercises to make moving about as safe as possible.

Low blood pressure: this can be a side effect of some Parkinson’s medications, making you go light-headed or event faint when moving from lying/sitting to standing up. Prevent this by getting up slowly, and speak to your doctor to see if your low blood pressure might be caused by your medication.

Eyesight: blurred vision or difficulty with spatial awareness and depth perception can make it more difficult to safely move past objects or through narrow spaces without falling. Always have regular eye check-ups, and discuss any eye problems with your doctor.

Hazards: Things like household clutter or room layout can increase your fall risk, especially if you’re in a rush. An occupational therapist will be able to advise on ways to reduce risks in your home or at work and help make daily activities more manageable.

Muscle weakness: this can make posture more stooped (bent forwards) which also increases the risk of falling. It’s important to stay as active as possible so as to prevent muscle weakening and to stop joints from getting weak or stiff.

Foot problems: a podiatrist (also known as a chiropodist) can help if you have a foot problem that may be causing you to fall, for instance by recommending suitable footwear to prevent falls.

Freezing

Freezing is sometimes described by people with Parkinson’s as feeling like your feet are glued to the ground, although the top half of your body is still mobile. It can happen suddenly, and last for a few seconds or minutes.

Freezing makes it difficult to initiate leg and foot movements and is known as ‘start hesitation’ or ‘gait ignition failure’

Not everyone with Parkinson’s will experience freezing. It can occur more frequently as Parkinson’s progresses. Freezing can also happen more often during “OFF” periods, i.e. when your medication is wearing off.

The exact cause of freezing is unclear, but it usually happens when there is an interruption to a familiar or automatic sequence of movements. For instance:

  • Walking towards doorways, chairs or around obstacles
  • Turning or changing direction, especially in a small space
  • While distracted by another task when you are walking
  • In places that are crowded, cluttered or have highly patterned flooring
  • When your “flow” is interrupted, or you start to concentrate on something else
  • When you’re in a group situation or in conversation
  • When walking from smooth to uneven ground, or from open to narrow spaces

Treatment of freezing can include:

  • Medication
  • Occupational therapy can recommend ways to adapt your home to avoid freezing, for example moving furniture or putting lines on the floor in doorways
  • Physiotherapy can teach you techniques to avoid freezing (including your choice of footwear, and appropriate exercise) and how to deal with it when it does occur
  • Deep Brain Stimulation (DBS) may help treat freezing episodes
  • Coping strategies like using visual or rhythmic clues

Dyskinesia (involuntary movements)

Dyskinesia is unintended, involuntary and uncontrollable movements. These include twitches, jerking, twisting or simple restlessness but not tremor. Different parts of the body can be affected but the most common areas are the limbs and trunk.

Dyskinesia affects everyone differently – from being mild and infrequent to being bad enough to disrupt your daily activities – and can also occur more just before or after taking your medication.

It’s thought to be caused by how your body absorbs levodopa over time and is more common as Parkinson’s progresses.

Generally speaking, dyskinetic movements are rapid and dance-like and can occur without the person noticing.

Treatments for dyskinesia include:

  • Adjusting your levodopa dosage to get the balance right between preventing dyskinesia without reducing control of other symptoms like tremor and rigidity.
  • Deep Brain Stimulation (DBS) may help some people
  • Dietary changes, such as reducing the amount of protein you eat during the day (but speak to a doctor or dietitian first)
  • Exercise  like walking or swimming
  • Coping strategies, like finding a comfortable position to relax in
  • Complementary therapies like yoga, Tai Chi and massage to help with relaxation and reducing stress

Dystonia (involuntary muscle spasms)

Dystonia is painful involuntary muscle spasms when your muscles do not relax after they have tightened or shortened. Why this happens is not fully understood, but it seems to be related to reduced dopamine levels in the brain, which affects how effectively the brain can communicate with muscles.

Dystonic spasms cause varying degrees of pain, from mild to severe, and can affect anything from one specific body part to most of the body. It can occur at any age, but it is more common in people who are diagnosed with Parkinson’s before they are 40, and in these cases is more likely to affect the whole body.

It tends to develop gradually, and may worsen as Parkinson’s progresses.

Some examples of how you might experience dystonia include:

Feet: the most common dystonia in Parkinson’s. Typically the toes curl up into a claw-like position, the foot turns inwards at the ankle, or the big toe sticks up.
Hands: ‘writer’s cramp’ in the hands during handwriting.
Neck: the head may twist to one side, forwards or occasionally backwards.
Eyelids: the eyelid muscles contract, involuntarily closing the eye ( blepharospasm).
Vocal cords: making speaking difficult or strained.
Jaw area and side of the face: The jaw may be pulled either open or shut, and speech and swallowing can be difficult.

For treatment to be effective, it is essential to understand the trigger or cause of the dystonia.

Treatment for dystonia can include:

  • Medication, including muscle relaxants, a COMT inhibitor or dopamine agonist to improve the effectiveness of levodopa
  • Injecting botox into the affected muscle to prevent muscle contractions.
  • Deep Brain Stimulation (DBS)
  • Coping strategies like sensory “tricks”,
  • Relaxation techniques like massage, using a heat pad, or calming activities like having a bath or doing yoga

For more information about dystonia as a medical condition in its own right, visit the Dystonia Europe website.

Walking and gait

Gait is our manner or pattern of walking. A normal gait is upright, with an even stride, arms swinging at our sides, with good balance.

‘Parkinsonian gait’ is a distinctive, less steady walk that arises from changes in posture, slowness of movement (bradykinesia) and a shortened stride. It can include:

  • A tendency to lean unnaturally forwards in a stooped position when walking and, in some cases, a tendency to lean sideways when standing
  • The head dropped forwards, with shoulders down, hips and knees bent
  • Steps taken on the front of the feet
  • Feet dragging on the ground, resulting in shuffling steps
  • A reduced length of stride
  • A reduced arm swing, particularly on the side on which Parkinson’s is most noticeable

Some features of Parkinsonian gait are likely to become more pronounced over time, which makes movement more challenging, resulting in a reduction in mobility, reduced muscle strength and a lack of confidence moving around.

Treating and managing gait problems can include:

  • Managing your medications with your doctor
  • Physiotherapy can provide you with techniques and exercises to improve your gait, balance and posture, such as looking forward when you walk, not at your feet
  • Occupational therapy can help with walking aids and making sure your home layout is free from obstacles
  • A podiatrist can advise on the best footwear to help your walking
  • Certain exercises can strengthen the muscles that help with posture
  • Coping techniques, such as daily stretches to improve mobility, and auditory and visual clues

Eye problems

Parkinson’s affects movement, and this may include movement of the eyes.

People with Parkinson’s may well experience eye problems, especially as the condition progresses, but not all of these will be movement-related.

Eye problems can significantly affect quality of life, and early intervention can make a big difference, so it’s important to see a doctor as soon as possible.

Some examples of eye problems people with Parkinson’s might experience are:

Difficulty moving the eyes or focusing on moving objects
This can be worse with fast-moving objects, and also make reading difficult as your eye jumps from the end of one line to the beginning of the next. Difficulty moving the eyes up and down is more common in a condition called Progressive Supranuclear Palsy (PSP), a form of parkinsonism

Double vision
The coordination issues and muscle fatigue Parkinson’s causes can stop the muscles that move your eyeballs from tracking objects properly, which stops the eyes from moving in alignment and causes you to see two images where there should only be one.

Blurred vision and difficulty focussing
This can be caused by some Parkinson’s medications, especially when you’re new to them, so your doctor will need to help you.. Also, an optician might also be able to adjust your glasses to help.

Dry eyes
People with Parkinson’s may blink less than normal, which reduces eye moisture and our ability to clear debris from the eyes, and can be sore.
Ask your pharmacist about eye drops or an eye wash to help lubricate the eyes and reduce discomfort, and try to avoid hot, dry, or smoky atmospheres.

Involuntary closure of the eyelids (blepharospasm)
This is caused by muscle spasms (dystonia), and can be helped in mild cases by rubbing the eyelids. The Parkinson’s drug levodopa can also help some people, as can botox injections in certain cases.

Deterioration in visuo-spatial orientation
It might become more difficult to judge the space around you or between objects.
An occupational therapist can help you with techniques to navigate different spaces – but you may also need to give up driving.

Excessive watering of the eyes
This can be a result of excessive blinking (see above) or irritation and is often eased with eye lubricants. More extreme cases might need referral to an ophthalmic surgeon.

Tired eyes
This is very common in Parkinson’s. It can be remedied by taking regular breaks from visual activities like reading or using a computer, and regular reviews by an optometrist also help.

Colour vision, contrast sensitivity and low light conditions
It can be hard to distinguish between different shades of the same colour, especially blues and greens, or to define images on a similarly-coloured background, or read fine print. Levodopa and other Parkinson’s medications may help with these problems.

Glaucoma (high fluid pressure in the eye)
Glaucoma can cause issues with some Parkinson’s medications, for example anticholinergics and levodopa. Always remember to tell your doctor that you have glaucoma when your Parkinson’s medications are being reviewed.

Eating, swallowing and saliva control

Eating and swallowing problems, known as dysphagia, are very common in Parkinson’s, affecting up to 90% of people with the condition. Excessive saliva and drooling (sialorrhoea) occurs in 50-80% of people with Parkinson’s and usually affects men more often than women – an excessively runny nose is also fairly common.

These issues are usually caused by reduced muscle tone in the jaw, lips, tongue and throat. Excess saliva can also be affected by the stooping posture Parkinson’s causes, which can send saliva to the front of the mouth.

Warning signs to look out for include hesitation before swallowing, choking on or regurgitating your food, struggling to move food around your mouth, coughing or clearing your throat a lot (leading to a sore throat), pain in your throat or chest, or struggling with appetite, leading to weightloss.

Eating, swallowing and saliva problems can cause the following issues:

  • Choking or asphyxiation
  • Aspiration pneumonia, when food or liquid accidentally enters the lungs and causes an infection
  • Dehydration and malnutrition
  • Issues swallowing your medication
  • Drooling, which can lead to a sore mouth
  • Social anxiety and embarrassment, even leading to panic attacks before eating

Some people find it embarrassing to talk to a doctor about swallowing and drooling problems, and often suffer in silence, but there are many ways your healthcare provider can help with this common problem.

Treatments for eating, swallowing and saliva control problems include:

  • Speech and language therapy, which can help teach swallowing compensating techniques while eating
  • Physiotherapy to improve your posture while eating, and occupational therapy to help choose the right eating utensils
  • Changes to your medication to make it easier to swallow
  • Extra medications, like anticholinergic medications to reduce the amount of saliva you produce, or botox injections into your salivary glands
  • A dietician will advise on diet to maintain good nutrition, tips to make eating easier, and the kinds of foods that are easier to eat and swallow.
  • Coping strategies, including various small lifestyle adjustments you can make to help with swallowing and drooling issues.
  • In extreme cases, radiotherapy to the salivary glands
  • Later on in Parkinson’s, nasogastric and gastrostomy feeding tubes can be used to help with persistent eating issues

Speech changes

Many family members and partners of someone with Parkinson’s say that one of the first things they noticed was that they spoke more quietly and with less expression in their tone of voice. This is linked to muscle rigidity and stiffness, particularly of the facial muscles.

Sometimes people with Parkinson’s think they are speaking very loudly or shouting, but the sound is not travelling out of the mouth to their audience due to the lack of natural muscle movement opening the mouth.

Treatment for speech changes include:

Restless leg syndrome

While there’s a strong link between Parkinson’s and Restless Leg Syndrome (RLS) (also known as Willis-Ekbom disease, or WED), it’s also a pretty common neurological condition in its own right, affecting up to 10% of adults.

It’s characterised by an irresistible urge to move the legs, which interferes with rest and sleep. This can be accompanied by unpleasant sensations including pain, burning and pins and needles.

These symptoms tend to occur most during quiet wakefulness, for example when watching television or when drifting off to sleep, or during sleep. Despite the name, RLS can also affect the arms, head, and other parts of the body.

It’s thought to be caused by reduced dopamine production – hence the link to Parkinson’s – but is also caused by iron deficiency.

RLS can also be difficult to diagnose in Parkinson’s as it may come and go and can be confused with other symptoms of the condition.

Treatments for Restless Leg Syndrome include:

  • Additional medications to treat the symptoms of RLS
  • Your doctor adjusting your Parkinson’s medication
  • An iron supplement, if your RLS is caused by iron deficiency
  • A neurological exam to see if your RLS is caused by nerve damage in your legs
  • In more extreme cases, an overnight stay in a sleep laboratory for further tests
  • Exercise and diet changes
  • Coping techniques, such as stretches, wearing compression stockings, or placing a pillow between your legs in bed

Wearing ‘off’ causing motor symptom fluctuations

If you have been taking a Parkinson’s medication that contains levodopa for some time (usually for five years or more), you may develop some movement difficulties throughout the day, or find your symptoms get worse as your medication wears off.

These “off periods” tend to happen more frequently as Parkinson’s progresses – they’re caused by the brain losing more and more of the cells that produce the chemical dopamine, so your body becomes increasingly dependent on the availability of levodopa medicine to provide it with dopamine.

It can become increasingly hard to predict when your medication will be effective, and you might experience “on/off” periods of fluctuation: feeling “on” and in control of your symptoms after your most recent dose of levodopa, but then experiencing sudden “off” periods as your medication wears off, and symptoms re-emerge.

Symptoms are highly individual, but might include:

  • Increasing tremor, stiffness, or ability to initiate movements
  • Delayed “on” periods as your medication takes longer to take effect
  • Freezing, a sudden uncontrolled and temporary inability to move which can last from seconds to several minutes
  • Involuntary movements (dyskinesia) including twitches, jerking, twisting or restlessness
  • Muscle contractions (dystonia) which lead to  painful and abnormal postures, involuntary twisting and problems controlling movement.
  • Anxiety, fatigue, and mood changes
  • Restlessness
  • Sweating

Treatment of “off periods” and motor symptom fluctuations can include:

  • Keeping a motor diary to help your doctor understand how effective your medications are, recording things like the times of day you have good symptom control, when during each day your symptoms reoccur, and if any foods affect your symptom control
  • Adjusting your levodopa medication
  • Deep Brain Stimulation (DBS)
  • A dietitian may suggest dietary changes as food can affect how quickly your levodopa is absorbed into your bloodstream
  • Adjusting your daily routine to make the most of “on” periods
  • Exercise like swimming or walking may help
  • Getting enough sleep
  • Using complementary therapies like yoga and tai chi to manage stress levels
  • Coping strategies to help with specific difficulties during “off” periods
  • A physiotherapist can help in teaching you techniques to improve movement, including balance, gait and posture
  • An occupational therapist can advise on adapting your home and daily routine to make movement as easy and safe as possible.

 

Non-motor symptoms

Click the titles below to find out more about the types of Parkinson’s symptoms which aren’t related to movement of the body, and a summary of the treatment options available.

Anxiety and depression

It is normal to experience anxiety or low mood when faced with new, challenging or stressful situations – including being diagnosed with Parkinson’s – but these feelings usually subside over time.

Some people feel anxious, fearful or depressed for longer periods of time, and this can affect your daily life and wellbeing, with conditions including:

  • Generalised anxiety disorder (GAD), an excessive and uncontrollable anxiety about everyday matters
  • Panic attacks
  • Phobias
  • Social anxiety
  • Depression, which can cause low mood, low energy, tiredness and sleep problems, appetite changes, reduced libido, feelings of helplessness or that life is not worth living

You might experience anxiety and depression with Parkinson’s for several reasons:

  • Struggling to cope with your diagnosis, and worrying about living with the condition
  • Changes in your brain chemistry
  • Anxiety about symptom fluctuations caused by Parkinson’s medications

It’s important to remember that anxiety and depression are common, affecting up to half of all people with Parkinson’s, and can be effectively treated. Don’t be afraid to ask your doctor for help.

Treatments for anxiety and depression can include:

  • Relaxation techniques, for instance using complementary therapies like yoga, meditation, massage, acupuncture and tai chi
  • Medication, such an antidepressants, or adjusting your Parkinson’s medication to reduce symptom fluctuations
  • Counselling and psychotherapy
  • Cognitive Behavioural Therapy (CBT)
  • Regular exercise
  • Reducing your intake of caffeine and alcohol
  • Contacting telephone helplines for emotional support and/or practical help
  • Contacting your local or national Parkinson’s organisation
  • Socialising and doing activities you enjoy

Stress

Most of us get stressed at some point in our lives, but stress can make illnesses – including Parkinson’s – worse, so it’s important to seek professional help and find coping strategies that work for you.

Parkinson’s can cause stress for many reasons, including:

  • A diagnosis can make you worried for the future
  • Parkinson’s affects your brain’s dopamine levels, but dopamine is needed to produce adrenaline – the hormone needed to manage stress – so your body doesn’t have enough adrenaline to keep stress levels under control
  • Parkinson’s can affect your daily life, including ability to work and socialise, which can make you feel like you’re losing control of your life

The good news is that – with the right plan in place – you can eliminate many of the sources of stress.

Treatments for stress include:

  • Counselling with a psychologist, who can help you identify your stress triggers and find techniques to overcome and manage them
  • Speaking to your doctor about any Parkinson’s symptoms that are causing stress, such as speech difficulties, bowel problems or sexual issues.
  • Ask your doctor to review your Parkinson’s medications, as some can cause higher stress levels
  • Socialising with family and friends, and talking about what is making you stressed
  • Practise positive thinking and mindfulness
  • Ask a dietician for help with healthy eating, as stress can disrupt your blood sugar levels and cause mood swings and fatigue
  • Try some suitable exercise
  • Pursuing creative therapies and other hobbies you enjoy
  • Complementary therapies like tai chi, meditation and yoga
  • Finding support groups like your local or national Parkinson’s association
  • Coping techniques like deep breathing exercises

Apathy

Apathy can best be described as no or very low feelings of motivation. People characterise it as a lack of emotion, motivation or interest, both in yourself and the wider world. In Parkinson’s, this symptom is normally caused by reduced levels of the “feel-good” chemical, dopamine, in the brain.

Apathy can make you less likely to get involved with hobbies and activities you used to enjoy, and make social interaction harder. While carers and family members might mistake apathy for being lazy or difficult at first, it’s often they who seek help from a doctor on their loved one’s behalf.

Treatments for apathy include:

Compulsive or impulsive behaviour (Impulse Control Disorders)

Impulse Control Disorders (ICDs)are often described as when someone has an overwhelming urge to act a particular way (sometimes repeatedly but also spontaneously), usually to do something which gives instant pleasure, reward or relief.

These behaviours can occur in people with Parkinson’s because of the depleting levels of dopamine in the brain – dopamine plays a big role in controlling reward and motivation. Certain Parkinson’s medications can increase the likelihood of someone experiencing an ICD

Some common types of compulsive and impulsive behaviours include:

  • Pathological or addictive gambling.
  • Hypersexuality – a preoccupation with sexual thoughts and feelings, sometimes accompanied by inappropriate or impulsive sexual behaviour and increased sex drive.
  • Compulsive or binge eating
  • Compulsive shopping
  • Punding – carrying out repetitive, aimless actions, often neglecting personal hygiene, sleep and daily routines in pursuit of relatively unimportant tasks, such as arranging items, or obsessive grooming
  • Addiction to Parkinson’s medications

The person may be unaware of their personality changes, or may be secretive about their behaviours and hide things like financial issues, so it can be difficult for family and friends to address the problem. But these behaviours can cause major problems in the long run, so it’s really important to seek help from a healthcare professional.

Treatment for compulsive and impulsive behaviours include:

  • Your doctor may adjust the dose of your Parkinson’s medication
  • If mental health issues have contributed to the behaviours, counselling or antidepressants may help
  • Interventions by family members, such as blocking access to gambling sites, or restricting access to finances, while treatment is ongoing

Mild memory and thinking problems

Many people experience some changes to their memory or thinking processes in life, but when these difficulties are worse than they should be for the indivicual’s age, they’re medically categorised as  mild cognitive impairment (MCI). This issue is often noticed by friends and family first.

The terms ‘memory problems’ and ‘memory loss’ can be misleading because symptoms affect far more than just the memory, including:

  • Slowed thought processes. You may find it hard to follow a number of steps to complete a task or have problems multi-tasking
  • Difficulties with planning, problem-solving or making decisions
  • Difficulties following and taking part in conversations
  • Difficulty finding the right word
  • Poor concentration
  • Lack of motivation
  • Short-term memory loss – difficulty remembering names or the sequence of recent events
  • Problems with judging distances or direction. Describing how to get from one place to another may become hard

It’s harder to spot cognitive issues in people with Parkinson’s, because the condition also affects facial expressions, body language and thought processes – so cognitive issues may seem worse than they are or be masked altogether.

Treatment for MCI includes:

Dementia

Dementia is a condition that causes problems with cognitive abilities – like concentration, memory and thinking – which can seriously impact your quality of life. There are various forms of dementia, but the most common – accounting for around two thirds of all cases – is Alzheimer’s disease.

In Parkinson’s, dementia may manifest at least a year after initial motor symptoms, or later, and it is usually a direct result of their Parkinson’s rather than other underlying cognitive issues.

Symptoms develop gradually and can fluctuate throughout the day, and so they may be noticed by friends and family first. Common signs include:

  • Reduced concentration, forgetfulness and slow thought processes, which can make it hard to follow a conversation and communicate
  • Reduced short term memory span, making it hard to recall names or when events occurred.
  • Difficulties with decision making, planning activities and problem solving.
  • Difficulties doing more than one thing at a time, for example walking and talking
  • Reduced energy levels and appetite, and altered sleeping patterns.
  • A lack of interest in things that were previously enjoyed
  • Changes in personality, for example anxiety, irritability, obsessive tendencies, or difficulty controlling emotions
  • Visual hallucinations and delusions in some people

In Parkinson’s Disease Dementia (PDD), impairment of memory is less severe than in Alzheimer’s, and the ability to carry out daily activities is usually retained. More common signs are poor perception, reduced vocabulary and difficulties with complex sentences, behavioural disorders with personality and mood changes, sometimes hallucinations and delusions, or apathy, anxiety, and excessive daytime sleepiness.

Treatment for Parkinson’s-related dementia includes:

Hallucinations and delusions

Parkinson’s can be a cause of hallucinations and delusions.

Hallucinations are a perception of something that doesn’t exist. They’re most commonly visual illusions, but can also involve hearing sounds or voices, physical sensations (like touch), or even experiencing unexplained tastes or smells. They’re not usually distressing – they’re even comforting sometimes – but in some cases they can be frightening.

Delusions, on the other hand, are more frequently upsetting. Instead of physically experiencing something that isn’t there, delusions are more thoughts or beliefs that aren’t based in reality, like being convinced that someone is trying to harm you or there’s a conspiracy against you. It can make you distrustful of people around you, affecting relationships with family and friends.

It is estimated that about 50% of people with Parkinson’s will, at some point, experience hallucinations. They’re more common in those who are older and have had Parkinson’s for some time, and can also occur due to other illnesses like a chest or bladder infection.

Sometimes, people experiencing hallucinations or delusions might not want to admit what is happening, so if you are concerned about someone you know it is important to seek medical help on their behalf.

Treatments of hallucinations include:

  • Adjusting your Parkinson’s medications
  • Improving your sleep patterns
  • Having regular eye check-ups
  • Talking about your hallucinations and delusions with your family and friends, or through counselling

Fatigue

Fatigue is more than a feeling of tiredness – it’s far more extreme, causing exhaustion and a complete lack of energy that limits your daily activities, including socialising, hobbies and your ability to work. Fatigue also isn’t relieved by simple rest.

The majority of people with Parkinson’s experience fatigue, and it can occur at any point during the condition, whether you’ve just been diagnosed or have had Parkinson’s for many years.

There are several causes of fatigue in Parkinson’s:

  • Some Parkinson’s medications can affect your sleep, and increase fatigue
  • Parkinson’s can also cause depression, which usually includes fatigue as a symptom
  • Tremor, rigidity, slowness of movement and involuntary movements (dyskinesia) make your muscles work harder, and fatigue more easily.
  • Sometimes, it’s simply a result of the way the condition damages the basal ganglia area of your brain

Treatment for fatigue includes:

  • Your doctor may adjust your Parkinson’s medication if they think it’s causing your fatigue
  • Your doctor may also prescribe antidepressants, Cognitive Behavioural Therapy or counselling if they think your fatigue is related to depression
  • Techniques to help improve your sleep, such as reducing your caffeine and alcohol intake before bed
  • A physiotherapist can suggest a suitable exercise regime to help reduce fatigue
  • An occupational therapist can suggest adjustments to your daily routine to help manage fatigue
  • A dietician can advise on foods to keep your energy levels up
  • Complementary therapies like yoga, aromatherapy and massage can help reduce things that cause fatigue, such as stress and anxiety

Changes in sleep

Changes to sleep patterns and behaviours are very common in people with Parkinson’s, and are linked to the changes happening in the neuronal networks of the brain. Many people report acting out their dreams and having disturbed sleep before they are diagnosed, while others experience sleep disturbances  due to their rigidity and stiffness stopping them from easily turning over in bed.

Treatment for sleep issues include:

  • A physiotherapist can give techniques for turning in bed
  • An occupational therapist can suggest devices to help you sleep better
  • A neurologist can prescribe medication that may support more consistent and comfortable sleep.

Find out more in our guide to sleep issues in Parkinson’s

Bowel problems

Bowel problems can occur in anyone, but are more likely in people with Parkinson’s.

The most common bowel issue – affecting up to 65% of people with Parkinson’s – is constipation, which can make it harder or more painful to poo, and cause less frequent bowel movements.

A variety of things can cause constipation in Parkinson’s:

  • Slowness of movement and muscle rigidity can affect the bowel muscles, making bowel movements slower and more difficult.
  • Chewing and swallowing issues can make eating fibre-rich foods like fruit and vegetables – which aid bowel function – harder
  • Tremor can make it easier to spill drinks, and fear around this can cause people with Parkinson’s to reduce their fluid intake, making stools harder
  • Exercise is important to stimulate the bowel, and this becomes harder with Parkinson’s
  • Anxiety about the effect of certain Parkinson’s medications can make it difficult to relax the body and muscles effectively to allow a stool to be passed

There are two other bowel problems that can be caused by Parkinson’s:

Delayed gastric emptying (gastroparesis), leading to a variety of symptoms such as feeling full quickly when eating, abnormal discomfort from bloating, nausea, vomiting, weight loss and malnutrition. It can also affect how well your Parkinson’s medications work.

Diarrhoea may occur as a side effect of certain Parkinson’s medicines – your doctor can fix this by adjusting your medication.

It can be embarrassing to talk about bowel problems, but there are lots of ways your doctor can help. For instance:

  • A dietician can advise on diet and fluid.
  • A physiotherapist can suggest abdominal exercises to help passing stools.
  • A speech and language therapist can help with swallowing problems.
  • An occupational therapist can suggest ways to overcome eating and drinking issues
  • In some cases, your doctor may prescribe laxatives
  • In extreme cases, enemas (a liquid inserted into the rectum through a tube to trigger bowel movements) can improve severe constipation

Bladder problems

Bladder problems can affect anyone, at all ages, and for a variety of reasons. They can be common in people with Parkinson’s, especially in the later stages of the condition, as the loss of dopamine interrupts signals from the brain telling the bladder to retain or expel urine.

Bladder problems associated with Parkinson’s include:

  • Urinary incontinence, which can cause unintentional passing of urine at any time.
  • Urge incontinence: As Parkinson’s progresses, mobility issues can make it hard to get to the toilet in time before you begin to urinate. This can also cause pain when urinating
  • Night-time incontinence: a more frequent need to pee during the night
  • Difficulty emptying the bladder: As reduced dopamine levels interfere with the efficiency of the bladder muscles, it can take longer to empty the bladder, and some urine can be left behind. This can mean you feel the need to pee more frequently, and can cause urinary tract infections.
  • Bladder issues caused by constipation

It might at first feel embarrassing discussing bladder problems with your doctor, but there are lots of ways they can help, so it’s important to let them know if you’re having issues.

Bladder problems can occur for a number of reasons, so the first approach will be to eliminate causes other than Parkinson’s, such as urinary infections and prostate problems in men.

Treatment of bladder problems can include:

  • Your doctor may prescribe bladder medications – either temporarily while they investigate other treatment options, or more long-term to help reduce unwanted bladder contractions and reduce urine production at night.
  • Treating constipation can also reduce related bladder problems
  • A physiotherapist can suggest pelvic floor exercises to improve bladder control
  • An incontinence advisor or an occupational therapist can help improve  the practicalities of going to the toilet, like your bathroom set-up or daily routine
  • Drinking plenty of fluids during the day but restricting fluid intake before bed
  • Avoiding caffeine and alcohol which can make bladder issues worse
  • Practising controlled waking, including using special enuresis alarms, to help reduce nighttime bladder issues
  • In some, intermittent catheterisation can help empty the bladder
  • In more serious cases, surgery can treat stress incontinence

Loss of smell (hyposmia)

A loss of the sense of smell affects many people with Parkinson’s, and is also known as hyposmia, anosmia, olfactory deficit or olfactory dysfunction.

It’s not certain why it occurs in Parkinson’s, but it’s often a symptom people experience many years before diagnosis..

Crucially, it’s thought screening for a loss of sense of smell using reliable smell tests could actually help with the early detection of Parkinson’s, and identifying those at higher risk of developing the condition.

There is currently no specific treatment to help regain your sense of smell in Parkinson’s, but there are some things you can do, such as:

  • Make sure you have fire and/or smoke alarms in your home as you may not be able to smell gas or smoke
  • A dietician can help if you also have a reduced taste sensation
  • Clearly label food with expiry dates, as you may not be able to smell degraded food

Pain

Pain is a very individual symptom in Parkinson’s, affecting various parts of the body, and having different levels of severity.

Sometimes, common ways of reducing pain like taking painkillers or doing regular, gentle exercise may not help.

There’s various ways to treat pain – from medication to physiotherapy, relaxation and complementary therapies – but it usually depends on the type of pain you’re experiencing:

  • General musculo-skeletal pain comes from the muscles and bones and is usually felt as an ache around the joints in the arms and leg.  It can also be caused by cramps and spasms as a result of muscle rigidity.
    Treatment is usually with medication like ibuprofen or oxycodone, physiotherapy and moderate exercise
  • Shoulder and limb pain can cause a constant ache and stiffness on one side of the body, and is one of the first signs of Parkinson’s.
    It can be relieved by Parkinson’s medications and physiotherapy, but in some cases painkillers or a steroid injection into the joint is needed.
  • Coat hanger pain starts at the back of the neck and radiates to the head and shoulder muscles. It is rare in Parkinson’s, but can be treated by a movement disorder specialist, or by laying down to restore blood supply to your neck and shoulders
  • Cramps in internal organs particularly affect the bowel and bladder.
    Parkinson’s medication such as controlled release levodopa can help, or, if bowel cramps are related to severe ‘off’ periods, injections of apomorphine may help. Cramps may also be caused by constipation.
  • Central pain: some people with Parkinson’s have a constant, dull, aching pain that affects most of the body. This is often related to tissue damage caused by Parkinson’s itself, and can be hard to treat. Sometimes Parkinson’s medication helps, as do some painkillers like oxycodone.
  • Leg and calf muscle cramp can be especially bad at night, or when your Parkinson’s medication is wearing off. It can be treated with muscle stretches or by adjusting your Parkinson’s medication.
  • Dystonia (involuntary muscle contractions) mainly affects the body’s extremities (toes, fingers, ankles or wrists) and can be particularly bad early in the morning or at night. Switching to a slow-release Parkinson’s medication can help in some cases, or in severe cases your doctor may try apomorphine or botox injections.
  • Dyskinesia (involuntary movements) can cause pain before, during or after you move. Your doctor may be able to help by adjusting your Parkinson’s medication.
  • Restless leg syndrome can cause pain – see here for more information.
  • Pain while turning in bed at night could be alleviated by changing your Parkinson’s medication.
  • Mouth and jaw pain is rare in Parkinson’s, but your dentist may be able to help
  • Headaches can be caused by Parkinson’s medications. It’s rare for over-the-counter medication not to work, so in these instances speak to your doctor urgently.
  • Shooting (radicular) pain and pins-and-needles or numbness (paraesthesia) are usually improved with painkillers and exercise. If not, your doctor might recommend an MRI to check for a trapped nerve in your spine.
  • Akinetic crisis might occur in the advanced stages of Parkinson’s, causing severe stiffness, fever, pain in the muscles and joints, headaches and, sometimes, whole-body pain. It’s important to seek doctor’s advice urgently, as this condition can be dangerous.

Low blood pressure (hypotension)

Blood pressure is a measure of the force your heart exerts to pump blood around your body.

While Parkinson’s doesn’t cause high blood pressure, low blood pressure is a frequent problem, either as a symptom of Parkinson’s itself – as the condition affects the nervous system, which regulates blood pressure – or as a side effect of Parkinson’s medications.

It can cause dizziness, loss of balance or fainting (often when standing up after lying down), as well as weakness, fatigue and reduced mental alertness.

These symptoms are most likely to occur when there are more demands on the body’s circulation during periods of activity, for example first thing in the morning, during physical exertion, or when your body is constipated or dehydrated.

Low blood pressure is also more likely if you are older, have diabetes, or are taking certain medications, like ones to treat prostate problems.

Low blood pressure is not generally dangerous, unless it causes you to faint or black out which can lead to a fall or other injuries, but it can be unpleasant and may cause mild transient confusion. It can also affect your ability to drive safely.

Treatment for low blood pressure can include:

  • Your doctor may change your Parkinson’s medication, or build up your dosage gradually
  • In some cases your doctor may refer you to a heart specialist.
  • Your doctor or an occupational therapist can advise on techniques to prevent the symptoms of low blood pressure, such as getting up slowly and not changing your position too quickly.
  • A physiotherapist can suggest gentle exercises
  • A dietician can advise on things like reducing your caffeine and alcohol intake and eating small, frequent meals

Skin problems and sweating

People with Parkinson’s often experience changes to their skin or the way they sweat. This can occur at any time during the condition, and while it may be distressing, it’s rarely serious.

Skin problems include:

  • Oily skin, particularly around the forehead, nose and scalp, where the sebaceous (oil secreting) glands are concentrated, as Parkinson’s can cause excess secretion from these glands.
    A pharmacist or your doctor can advise on products to treat oily skin.
  • Red, flaky and itchy skin (known as seborrheic dermatitis) which mainly affects the scalp, face (particularly around the nose, the eyebrows and eyelids), ears, chest and folds in the skin such as under the arms, breasts and groin. It’s more likely in men.
    Your doctor may recommend antifungal treatments, anti-inflammatory steroid creams, or special lotions and shampoos to treat the hair and beard.

Sweat problems include:

  • Sweating too little (hypohidrosis), which can cause very dry skin, or make it more likely you’ll overheat during exercise
    You can treat this by avoiding situations where you’d overheat (such as strenuous exercise or visiting a sauna) and using a moisturiser on dry skin
  • Sweating too much (hyperhidrosis), especially night sweats, or when your Parkinson’s medication is wearing off
    You can treat this by avoiding things that cause sweat, such as hot, crowded rooms, spicy food and alcohol, and using cotton bed sheets if your sweat is worse at night. In extreme cases, your doctor might recommend botox injections.

Sexual dysfunction

Having Parkinson’s will undoubtedly affect the many relationships you have with friends, family and your support network. In many cases, this will affect intimacy and sex with your partner.

This can be caused by increased movement difficulties like tremor and slowness of movement, and by emotional symptoms such as anxiety, fatigue, decreased motivation or depression. Over time sexual disturbances may be heightened by falling dopamine levels and by unwanted side effects of some Parkinson’s medications.

The most frequent difficulties are:

  • Decreased sexual desire and motivation to engage in intimate activities
  • Compulsive sexual behaviour or hypersexuality, a feature of impulse control disorders
  • Arousal problems, meaning that you can’t respond physically or emotionally to sexual stimulation or you do get aroused but cannot sustain this. For men this may involve erection difficulties whilst for women vaginal dryness and sexual pain are common
  • Orgasmic problems related to medications used for treating depression and anxiety, to physical limitations in maintaining movements or sexual positions, and to concentration difficulties
  • Difficulties resulting from the need to change roles in sexual activity
  • Limitations or inabilities in intimate touch
  • Limited choice of sexual positions
  • Difficulties in intimate communication

With the right help, these problems can be resolved or alleviated, with treatment options including:

  • Adjusting your Parkinson’s medications, or other medications used to treat Parkinson’s symptoms like fatigue, depression and anxiety
  • A physiotherapist or occupational therapist can advise on positions and effective touching
  • A psychiatrist, psychologist or psychosexual therapist can help treat compulsive hypersexuality or people with orgasm problems
  • Sex aids like vibrators can aid stimulation, orgasm and make pleasure easier for people with tremor or involuntary movements
  • For women, a GP or physiotherapist can suggest pelvic floor exercises
  • Sex therapy and counselling can help overcome a wide range of sexual issues
  • If bowel or bladder problems are holding you back, your doctor can prescribe certain medications, or may suggest an enema before intercorse, or using an anal plug.
  • Sex websites and forums can offer advice
  • Sometimes, it’s as easy as having good communication with your partner, and enjoying relaxing and sensual foreplay together, such as massage, a bath, or enjoying erotic literature or videos together

Read our full guide to intimacy, sex and relationships with Parkinson’s