Common complications and side-effects of Parkinson’s disease

As Parkinson’s disease progresses (not all will develop symptoms and associated complications in advanced stages), symptoms have a knock-on effect. Deterioration and impairments in the body can lead to a variety of other health concerns that cause a person great difficulty.

As much as these potential concerns cause discomfort for a person, all are treatable with appropriate medication or therapies.

Associated complications which can arise include:

• Mood and behavioural changes: Having a chronic condition can alter emotions and mental state quite dramatically. It’s not uncommon for many Parkinson’s sufferers to go through periods of depression while trying to get the better of their condition and physical symptoms. Managing a chronic condition can become overwhelming at times and make a person feel less motivated, fatigued, anxious and even fearful.
• Problems with sleep: With physical and emotional disruptions, sufferers of Parkinson’s disease often experience unusual sleeping patterns. Some wake up frequently during the night, while others find that their body clock changes – waking earlier than normal or drifting off to sleep during the day. Some develop REM sleep behaviours (rapid eye movement disorder), making them restless during sleep and frequently ‘acting out’ vivid dreams.
• Fatigue and lethargy: When overwhelmed physically, emotionally and mentally, a person quickly loses energy, and fatigue can set in.
• Thinking difficulties: Being able to think clearly and respond appropriately may begin to trouble a person with Parkinson’s disease, especially during the more advanced stages.
• Other physical difficulties: Inability to swallow comfortably, drooling (due to increased saliva accumulation in the mouth), inability to control urination or difficulty in urinating, bowel movement troubles and constipation (due to a slower digestive tract), sudden drops in blood pressure (orthostatic hypotension) causing dizziness, difficulties with identifying odours or the difference between multiple odours, painful spells in specific areas of the body (or throughout) and a decrease in sexual desire or performance.

How to manage some of the more common side-effects of Parkinson’s disease

The nature of Parkinson’s disease progression means that the condition manifests in a variety of ways, not just in areas of mobility. Non-motor symptoms can sometimes be of more distress to a sufferer, troubling their day-to-day lives even more so than their physical ailments.

Once certain non-motor symptoms are recognised, it is easier to understand why and how they are adversely affecting quality of life, as well as gain control through appropriate treatment.

• Depression and other mood disorders: As many as 50% of Parkinson’s disease sufferers will develop some degree of depression. Anxiety extends beyond nervousness, apprehension and worry. Between 25% and 45% of individuals will develop an anxiety disorder, where chemistry alterations in the brain occur (not due to Parkinson’s). If a person develops constant feelings of anxiousness, phobias, panic attacks and an intense perception that their state of health is worse than it actually is, medical intervention is necessary. Medications, therapy sessions and general lifestyle changes, such as regular walks or yoga sessions can help to ease off troubles affecting a person emotionally and mentally. It’s important not to confuse depression with apathy. Apathy is more of Parkinson’s disease symptom due to a lack of dopamine in the brain. Apathy and depression may bring about similar characteristics such as a lack of interest in participating in normal activity. Depression is tied to emotions (feelings of guilt or worthlessness), apathy is more emotionally flat (no mood in particular) and a person simply can’t be bothered to make an effort. A doctor can distinguish between the two and treat appropriately.
• Sleep difficulties: As many as 75% of Parkinson’s disease sufferers have trouble with sleep. Night-time difficulties include trouble getting comfortable and falling asleep, staying asleep, waking frequently (due to a need to use the bathroom or as a result of noises made while restless), vivid dreams and nightmares, restless legs syndrome, sleep apnoea, REM sleep behaviour disorder, and disruptions to normal sleep patterns (sleeping more during the day). Day-time trouble may include excessive sleepiness during the day, sudden sleepiness (sometimes due to medication), and taking frequent or long daytime naps. Sleep disturbances can worsen cognitive troubles and depending on the nature of the specific problem, a doctor can prescribe or recommend effective treatment, such as medication or sleep aids. Recommendations may also include changes in lifestyle habits, such as limiting screen time, getting in regular exercise sessions or avoiding heavy meals at night, and developing a different routine.
• Digestive and gastrointestinal troubles: As the digestive tract slows down (due to stiffness and slow movement), muscle function and activity of the enteric nervous system (nerves that line the digestive tract) reduces, causing gastrointestinal problems. Many experience difficulties with their bladder and bowel (often fewer than 3 bowel movements a week), chewing and swallowing and frequent bouts or nausea (due to a slow emptying of stomach contents) and abdominal bloating. Medications can help to treat any of these troubles, along with eating a well-balanced diet with plenty of fibre and liquids, as well as daily exercise. An occupational therapist can assist with regaining some control of facial muscles to help alleviate fears of choking and drooling while trying to eat. This can help with chewing and swallowing (dysphagia) troubles (as well as biting motions and the ability to use the tongue effectively) and keep the risk of inadequate nutrition, dehydration and aspiration at bay. Therapy can also include changes in certain food textures that are consumed, such as thickened liquids.
• Dental problems: Physical symptoms of rigidity and tremor can make it challenging to adequately care for the mouth, teeth and jaw. Sitting still in the dentist’s chair can also aggravate feelings of fear and anxiety. Pain or discomfort in the lower jaw is also common and often results in tooth wear, cracked teeth, tooth grinding and alterations in the fit of dentures (if applicable). Fungal infections (especially at the corners of the mouth when drooling) due to excess saliva in the mouth are also common. Cavities are also common is there is a lack of saliva in the mouth (dry mouth). Dental problems are often better managed with regular check-ups during the earlier stages of Parkinson’s disease. Home-care is also very important and may prove useful to modify toothbrushes for easier grip, such as placing a toothbrush handle inside a bike handlebar grip or tennis ball. Electric toothbrushes may also be easier to use and grip. Tips include regular brushing, flossing and rinsing (with antimicrobial rinses or solutions) using the stronger side of the body or with the aid of a caregiver.
• Range of movement problems: Physical therapy and regular exercise are important in order to improve range of motion, build muscle tone and ultimately aid in improving overall mobility. Parkinson’s affects muscle tone adversely, and by making efforts to counter this, exercise can help to build lost strength. Muscle stress can be alleviated with massage therapies.
• Problems with balance and skeletal issues: Changes in the spine, hands and feet occur as a result of muscle rigidity. It is more problematic in the muscles that flex, such as the limbs and the trunk of the body. A person may begin to slump their shoulders (or have frozen ‘stiff’ shoulders), bend their neck (anterocollis), curl the trunk of the body (camptocormia or stooped posture), or bend (or flex) the wrists, fingers, toes, hips, knees and elbows (worsening as the disease progresses). Postural changes can lead to extreme leaning to one side (Pisa syndrome), sometimes forwards. Muscle spasms (or involuntary muscle contractions – dystonia) and cramps can also contribute to weakening of the bones and even twisting of the spine (scoliosis), which can also affect balance and increase the risk of falls and fracture injuries. If low bone density develops, Parkinson’s disease sufferers are at greater risk of developing osteoporosis. Joint damage can result in osteoarthritis, arthritis of the spine and disorders of the fibrous discs between the spinal bones. Medication or surgery are options to gain control of additional side-effects to the bone and skeletal structures, as are lifestyle or behavioural changes, such as making the home environment safer and maintaining regular exercise routines. Physical therapy and regular check-ups with a doctor can also help to pick up problems at their earliest.
• Problems with pain: As many as 85% of Parkinson’s disease sufferers experience physical pain as their condition progresses. Most often pain is as a result of the separation of tissue pain receptors from the nerves which transmit pain signals in the body (known as nociceptive pain). This results in common Parkinson’s symptoms of rigidity dystonia, and musculoskeletal injuries. Pain which is neuropathic (not directly associated to Parkinson’s disease) can also occur and doctors will be able to distinguish between the two and adequately treat this. Neuropathic pain can be as a result of cancer, shingles, diabetic neuropathy or even carpel tunnel syndrome. Medications taken for Parkinson’s disease may also exacerbate side-effects of pain, which is most often resolved with dosage adjustments. Treatment will involve a thorough evaluation and diagnosis, medications, physical therapy, exercise, nutrition management, stretching and even psychotherapy.

Other problems which can also be effectively managed include:

• Respiratory problems, such as shortness of breath (due to medication ‘wearing off’), respiratory dyskinesia (irregular and rapid breathing), non-Parkinson’s disease associated conditions such as asthma, allergies and others causing shortness of breath, and aspiration pneumonia.
• Cognitive impairment (disorganisation, distraction, short attention span, memory and difficulties with thinking, planning or carrying out tasks) or severe loss intellectual ability (dementia).
• Hallucinations, vivid dreams and unusual visions (usually treated with medication adjustments).
• Impulsive behaviours, such as an irresistible urge to abuse the taking of medications, shop, eat or gamble. Some even experience hypersexuality. Medication adjustments can also help correct this.
• Low blood pressure, skin problems (such as oily, flaky or inflamed skin, dryness, excessive sweating, too little perspiration or skin cancer), and vision changes can all be assisted with medication treatment.