Our Literature Review Reveals The Following Key Findings
– The self-reporting of NMS, as well as the overall occurrence within PD patients in Asia is high. This is similar to studies consisting primarily of Western/White Caucasian PD patients.
– Symptoms of nocturia, constipation, and memory impairment appear to be most frequently self-reported NMS on the NMS Quest.
– Generally, symptoms within the domains of sleep/fatigue, attention/memory, and mood/apathy appear to be the most prevalently reported when using the NMSS.
– Symptoms of bowel incontinence, delusions, and impaired sex drive appear to be the least frequently reported NMS by Asian patients with PD.
We have focused on NMS because of its key importance in the prodromal and clinical stage, as well as the pathophysiology of PD . NMS subtypes are now recognised, and the implicated neuropathology reflects the clinical expression . In addition, NMS are a key determinant of QoL . In spite of this, awareness of NMS remains low in many Asian countries where PD is still largely regarded as a motor syndrome only. Several studies in Europe and other countries performed holistic assessments of NMS, and have outlined important unmet needs in PD care . Studies in Asian cohorts were, therefore, needed and this review reveals that high levels of NMS, as well as some differences in NMS in both occurrence and pattern, are evident.
Apda In Your Community
It is common for a person with Parkinsons disease to attribute every new symptom that develops to PD. That is largely because the list of non-motor symptoms commonly associated with PD is so varied, it can seem that almost anything is a symptom of PD!; But if you take a closer look, there are some symptoms that are very commonly associated with PD, others that are virtually never associated with PD, and some in between.
Lets divide up non-motor symptoms into the following categories:
Tips For Living With Hallucinations
It is important for people with PD to talk about hallucinations with their family and care team, because they are manageable and can be troublesome if not treated. Discuss all possible symptoms with your doctor, no matter how minor, rare or bizarre you may think they are.
- Good lighting and stimulating activities in the evening can help keep hallucinations at bay.
- While a hallucination is occurring, caregivers can help their loved one by reassuring them that they will be safe and validating their partners experience. For example, say, Ill take the cat outside instead of arguing that there is no cat.
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The Clinical Scenario: A Possible Solution To The Neglect Of Non
First, tools such as NMSQuest do not consume clinical interactions; the patient completes them and they help direct the consultation with nurse specialist or consultant. The clinician can then grade the non-motor symptoms burden numerically . Patients are then usually asked to flag the most bothersome symptoms. These are then addressed either through pharmacological, allied health specialist therapies, neuropsychological or neuropsychiatric input . A yearly documentation of non-motor symptoms score helps to chart the progress of these symptoms. Pharmaceutical companies have developed and distributed alternative self-completed toolssuch as the Parkinson well-being mapbut have not been validated in PD. shows the importance of using such tools in the clinic. Two newly diagnosed patients, untreated and with similar motor disability, completed NMSQuests . The first patient reports only five non-motor symptoms: mainly problems with dribbling of saliva at night, urgency to pass urine, unexplained pain and dizziness. The second patient reports a wider range of non-motor symptoms : problems related to sleep, dribbling of saliva and other autonomic symptoms. Each of them needs a different management plan for their non-motor symptoms, as well as the treatment of the motor symptoms. These observations have been confirmed by two recent studies in untreated PD and early PD .
Future Directions And Implications
As populations become increasingly diverse and multicultural, it is crucial to be aware of and respect possible differences to improve the treatment of long-term neurological conditions, such as PD. This will allow a holistic and modern delivery of individualised ethnicity-specific treatment packages. It is thus important to be aware of the specific needs and profiles of NMS in PD patients of varying ethnicity . Ethnicity-related impact on motor and NMS of PD is an unmet need which requires further exploration. Diet, culture, religion, personality, body weight, pharmacogenomics, and access to medical care and management can all influence treatment and consequently the QoL of PD patients in a positive or negative manner. Titova and Chaudhuri among others have recently stressed the necessary switch to personalised medicine to achieve the best possible therapeutic effect. This can only be successful in an increasingly diverse world if we understand the differences in ethnic groups including aspects of cultural, social, environmental, and genetic differences. This review indicates that linguistic validations using standard methodology needs to be adopted where these tools are currently used.
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Discuss With Your Physician
Non-motor symptoms can sometimes be difficult to recognize. Therefore, it is important to make your doctor aware of them.
One useful resource is the PD NMS Questionnaire. You can use this to record your symptoms and discuss them with your doctor.
Dr. Ron Postuma, whose research was funded by donations to the Parkinson Canada Research Program, has also developed tools to help people with Parkinsons and their physicians identify and manage non-motor symptoms.
Cognitive Dysfunction In Pd
Cognitive impairment has been recognized as a significant predictor of QoL in PD. Additionally, this non-motor symptom increases caregiver burden, leads to loss of productivity, and increases likelihood of institutionalization. Cognitive deficits in PD include executive dysfunction, memory deficits, language impairment, problems with visuospatial and visuo-constructive abilities, and mild cognitive impairment. At the time of diagnosis, up to 20% of PD patients have some degree of cognitive impairment and up to 83% develop dementia within 20 years of motor symptom onset.
Cognitive Dysfunction And Exercise
Unfortunately, medications aiming to treat cognitive impairment in PD can have associated side effects and are not effective at slowing or stopping progression of cognitive decline. Therefore, it is important to evaluate the potential of different non-pharmacological therapies to improve cognition in PD. Exercise can improve cognitive function and attenuate cognitive decline in older adults. A recent meta-analysis of the effects of exercise on cognition in adults over age 50 showed significant improvements in multiple cognitive domains due to all modes of exercise reviewed . Relevant moderators of this effect were duration of session and intensity of exercise, with best effects for moderate to high intensity exercise of a duration of 4560 minutes per session. At the structural level, exercise in older adults can increase hippocampal volume, suggesting the possibility of neuroprotective effects.
There Are Different Ways To Address Mood Changes Including:
- Taking medications
- Changing medications that have mood-related side effects
- Exercising regularly
Identify mood triggers, add positive energy into your daily life and provide a way to talk with your doctor and healthcare team about treating depression with the help of our Depression Worksheet.
Parkinsons can have many different effects on your sleep, including trouble falling or staying asleep, vivid dreams, waking up frequently during the night and excessive sleepiness during the day. Like other non-motor symptoms, sleep problems can appear before the motor symptoms.
An estimated 30% of people with Parkinsons experience some combination of insomnia and sleep fragmentation . Studies have shown people with Parkinsons have different sleep patterns and that their deepest periods of sleep during the night are shorter and interrupted more often than people without Parkinsons. Often this is made worse by medications that may wear off in the night, causing tremor, painful stiffness or other symptoms to return and disrupt your sleep.
Anxiety, depression nighttime sweating and trouble moving in bed are other non-motor symptoms of Parkinsons that can make getting a good sleep difficult. Fragmented sleep is also exacerbated by how often some people with Parkinsons find themselves waking up often during the night to use the toilet because of the changes in the bladder that come with Parkinsons.
What Is Parkinsons Disease
PD is a disease of the brain that limits your ability to control and coordinate movements. This happens as your brain produces progressively less of a chemical called dopamine, which is needed to carry signals telling your body how and when to move. As the disease progresses, some movements become difficult to make, while other movements may occur involuntarily.
Symptoms always include movement difficulties, and can include cognitive and speech challenges, issues with balance, and handwriting problems, as well, all triggered by nerve-signal interruption in the brain.
Other Rarer Types Of Hallucinations Include:
- Auditory: hearing voices or music that are not really there.
- Olfactory: smelling things that are not really there.
- Tactile: feeling something touching your skin that is not really there.
- Illusion: seeing things differently than they actually are, such as wallpapers that seem to jump or move.
Hallucinations and delusions may sometimes be caused by issues separate from Parkinsons, such as stress, dehydration, bladder infection or general infection. They may also be exacerbated when certain symptoms of Parkinsons are worse, such as constipation.
Parkinsons-specific and other medications can cause hallucinations as a side effect and other cognitive symptoms such as dementia may also contribute to Parkinsons-related hallucinations or delusions.
Delusions are less common in people with Parkinsons than visual hallucinations but can be harder to manage and live with.
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How To Talk To Someone With Hallucinations Or Delusions
- It is usually not helpful to argue with someone who is experiencing a hallucination or delusion. Avoid trying to reason. Keep calm and be reassuring.
- You can say you do not see what your loved one is seeing, but some people find it more calming to acknowledge what the person is seeing to reduce stress. For example, if the person sees a cat in the room, it may be best to say, “I will take the cat out” rather than argue that there is no cat.
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
There Are Many Simple Non
- Wearing compression socks
- Elevating your legs when sitting
- Drinking more fluids
- Increasing your salt intake
- Elevating the head of your bed by 30 degrees
A physical therapist can also show you exercises to reduce the problems of dizziness when you stand. Since your heart also helps control blood pressure, it is important to discuss lightheadedness or dizziness with your physician.
While psychosis is usually associated with mental disorders like schizophrenia, sometimes Parkinsons itself or side effects of medications can change your perception of reality resulting in Parkinsons psychosis. Estimates suggest as many as 40% of people living with Parkinsons may experience some type of psychosis.
Parkinsons psychosis typically takes the form of hallucinations , delusions or both. Hallucinations and delusions are more common in people who have been living with Parkinsons for a long time. Some people are aware that what they are experiencing is not actually real, while others are not.
Hallucinations in Parkinsons can be common, especially during later stages of living with it. Often, they are non-threatening visual hallucinations or visions of things that are not really there.
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Symptoms That Are Commonly Associated With Pd
These symptoms include sleep disorders, abnormalities in blood pressure, urinary problems, constipation, depression, and anxiety. Even though these symptoms are so commonly seen in PD, they are also commonly associated with other issues that have nothing to do with PD, so it is vital to keep an open mind about their cause. If any symptom is new or worsening, it could be an indication of a new medical problem. For example, urinary problems are extremely common in PD, but may be a sign of an enlarged prostate, which can be treated in an entirely different way.
Results Of Individual Studies Using Non
The NM-PD-SG Early Career subgroup global survey initiative identified that translations of NMS Quest were available using linguistic validation in Malay, Chinese , while investigator translated use of NMS Quest was reported from Korea, Thailand, and India .
In total, we identified 12 studies that applied the NMS Quest to assess NMS in patients living in Asia and also met all other inclusion criteria . The majority of studies were conducted in China, one in Korea, one in Thailand, one in Taiwan, one in Turkey, and one in India.
One of the first to address NMS in Asia were Cheon et al. who conducted a survey in Korea by applying the NMS Quest to 74 treated PD patients. The most common NMS was nocturia . Furthermore, patients frequently reported restless legs , ; constipation , feeling sad , orthostatic dizziness , and memory problems . Bowel incontinence , delusions , and hallucinations were reported least frequently. About 98.7% of the population reported at least one NMS with an average of 12.4 NMS per patient.
Wang et al. analysed the NMS profiles of 117 Chinese patients and found the most commonly reported NMS was constipation followed by problems remembering things and feeling sad . The least commonly reported NMS included bowel incontinence, vomiting, falling, and delusions.
Zhou et al. reported that 230 PD patients attending an outpatient clinic in Shanghai, China, had a high prevalence of constipation , impaired memory , and nocturia .
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What Are The Primary Motor Symptoms Of Parkinsons Disease
There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.
It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.
Walking or Gait Difficulties
Posture And Balance Difficulties
Movement problems in PD are mostly caused by the diseases impact on dopamine production in the brain. However, as PD progresses to a later stage it begins to cause symptoms tied to other parts of your brain besides those that produce dopamine, a neurotransmitter that helps the brain control and coordinate movement.
Posture is an example. Its not controlled by dopamine. Instead, poor posture may be the result of damage to neurons that produce different chemical messengers such as norepinephrineor acetylcholine. Your posture may become stooped, and you may lean forward as you walk. This affects your balance and makes you likelier to fall forward or backward. About half of people with PD will experience this symptom within five years from the time they were diagnosed.
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Urinary Dysfunction And Exercise
Bladder dysfunction, including nocturia and increased urgency and frequency of micturition, is one of the most commonly reported symptoms of AutD in PD, affecting up to 93% of patients. These symptoms can inhibit social activity, disrupt sleep, and impair quality of life. To our knowledge, no studies to date have investigated the influence of traditional exercise on bladder dysfunction in PD. However, bladder training exercises have been investigated and shown to reduce urinary incontinence in PD. Therefore more studies are required to establish any role of exercise in treating urinary dysfunction in PD patients.
The Lee Silverman Voice Treatment
The Lee Silverman Voice Treatment is the first speech treatment for PD proven to significantly improve speech after one month of treatment.
- Exercises taught in the LSVT method are easy to learn and typically have an immediate impact on communication.
- Improvements have been shown to last up to two years following treatment.
- LSVT methods have also been used with some success in treating speech and voice problems in individuals with atypical PD syndromes such as multiple-system atrophy and progressive supranuclear palsy .;
- Must be administered four days a week for four consecutive weeks.
- On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
- Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
- Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
- If available in your area, participate in a speech group whose focus is on thinking loud.
- A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.
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Clinical Evaluation Of Non
The following symptoms were assessed: hyposmia, neuropsychiatric disorders , autonomic dysfunctions , and sleep disturbances . A clinical interview was conducted to determine the presence of each NMS at the time of the examination. Informations on the current use of medications, such as laxatives, hypnotics, or antidepressants to treat some of these NMS, were also collected.
Smell loss was assessed by the validated Argentina Hyposmia Rating Scale starting by asking the subjects whether they noted a change in their ability to smell. Patients with factors that could impair odor identification, such as: current smokers, medical history of nasal surgery , allergic rhinitis, and traumatic nasal injuries were eliminated. According to these criteria, our sample for this test was restricted to 51 patients . Hyposmia was considered to be present if the AHRS score was lower than 22.
To evaluate the presence of depression and its severity, we used the MontgomeryAsberg Depression Rating Scale . The cut-off scores we used were: <7 absent signs, mild signs = 718, moderate = 1834, and 35 reflects severe depression. This scale consistently has the highest Cronbachs alpha levels reaching 0.92 . Patients with severe depression were excluded from the study. Patients with scores 7 were considered having depression.