When most people think of Parkinson’s disease (PD), the image of trembling hands or slowed movements often comes to mind. However, experts stress that these visible signs are only part of the story. Parkinson’s is a complex neurological disorder that impacts much more than just motor function. Increasingly, doctors are urging patients and carers to recognise non-motor symptoms, which can appear well before movement-related difficulties emerge.
Parkinson’s disease is now understood to progress in three stages: the preclinical phase, where no symptoms are evident; the premotor phase, characterised by non-motor symptoms; and finally, the motor phase, where physical signs become more apparent.
Dr Pradeep Kumar Sharma, Livasa Hospital, Mohali, says that non-motor symptoms of PD can affect multiple systems in the body. "These may include autonomic issues such as dizziness due to low blood pressure (orthostatic hypotension) and gastrointestinal troubles like constipation, urinary incontinence, and sexual dysfunction," he says.
Emotional and sensory symptoms like depression and a diminished sense of smell (anosmia) are also frequently seen. Cognitive challenges, including difficulty concentrating, memory issues, and even Parkinson’s-related dementia, can further complicate the disease. Sleep disorders such as REM sleep behaviour disorder, restless legs syndrome, and periodic limb movement disorder are also common and often distressing for patients.
Dr Sharma adds that advanced treatment options like Deep Brain Stimulation (DBS) are helping to improve the quality of life for those with PD. “DBS involves implanting a small, pacemaker-like device in the brain that sends gentle electrical impulses to help regulate irregular brain activity and ease symptoms,” he explains.
Dr Rohit Pai, KMC Hospital, Dr B R Ambedkar Circle, Mangalore, also stresses that Parkinsonism is not just a movement disorder. "It is characterised by slowness, tremors, rigidity, and postural instability, but non-motor symptoms—those unrelated to movement—are equally significant," he says.
Dr Pai explains that cognitive dysfunction in PD can range from mild cognitive impairment to severe dementia. Sleep disorders, which may affect up to 90% of patients, are among the most common non-motor symptoms.
“Decreased sleep, daytime fatigue, nocturnal awakenings, and even excessive daytime sleepiness with sudden sleep onset—a feature resembling narcolepsy—are seen in Parkinson’s patients,” Dr Pai says. REM sleep behaviour disorder, where patients physically act out dreams, and restless legs syndrome, involving abnormal leg movements at night, are other frequent disturbances.
Autonomic dysfunction in PD, according to Dr Pai, affects cardiovascular, gastrointestinal, and urinary systems. "Orthostatic hypotension, excessive sweating, nocturnal sweating, reduced sweating, hypersalivation, and gastrointestinal problems like difficulty swallowing, reduced gastric emptying, and constipation are all common," he explains.
Sexual dysfunction, particularly erectile and ejaculatory abnormalities, may affect up to 50 per cent of patients, while urinary urgency or incontinence is often reported.
Olfactory abnormalities, or loss of smell, are a particularly specific feature of Parkinson’s disease, affecting more than 95 per cent of patients, Dr Pai says. "This may precede motor symptoms by several years and is predominantly seen in idiopathic Parkinsonism," he adds.
Ultimately, as both experts agree, Parkinson’s is far more than a movement disorder. Early recognition and treatment of non-motor symptoms are crucial for improving patient outcomes and quality of life. As Dr Pai concludes, “Recognising non-motor symptoms will help in treating them at the earliest.”
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