Speech problems are not uncommon in PD. Initially, the voice may merely become softer, but may also start off strong and fade away. There
may be a loss of the normal variation in volume and emotion in the voice, and the patient may talk in a monotone, like computer. Speaking rapidly, with the
words crowded together, similar to the short, shuffling, propelling steps when walking, is also characteristic of parkinsonian speech. Sometimes hoarseness
is a problem, and occasionally the patient may slur words. In more advanced disease, a type of stuttering
(palilalia), likened to the freezing phenomenon,makes the patient much more difficult to be understood.
Swallowing: Problems with swallowing (dyshagia). when they occur in PD, happen late in the course of the disease. Swallowing is an automatic but
complex act, and the inability of the tongue and throat muscles in PD to coordinate the movement of food to the back of the mouth and down the upper
part of the esophagus may result in pooling of food in the throat. The patient may feel as if food is getting stuck. Both solids and liquids are a problem.
Drooling (sialorrhea) is similar to the problems experienced with swallowing, in that saliva pools in the back of the throat. When enough is
accumulated in the mouth, it may spill out and the patient may drool. Drooling is probably related to a decrease in the swallowing of saliva, not excess
production of saliva.
A common skin disorder in many people, excessive oily secretions, particularly on the forehead and scalp, may be a
problem in PD. It may cause the skin to be greasy, and the skin becomes red, itchy, and flaky. On the scalp, it results in dandruff.
Another common problem in the general population as people age, swelling (edema)
of the feet and ankles may occur frequently in PD, and occasionally is a side affect of some antiparkinson medications. It
probably is a result of pooling of fluid in the lowest part of the body when there
is reduced muscle movement to squeeze the veins and propel the fluid back to the heart.
Many people have problems with their eyes. Nearsightedness, and cataracts are not related to PD. Sometimes, however,
people complain of some mild double vision or problems with the eyes “bouncing?around, that is, they may have difficulty reading (especially small
print) because they lose the line. These situation may be related to PD.
Loss of weight, sometimes, is a common occurrence in PD, and should trigger an evaluation for some other serious medical problems. In
the absence of other disorders, severe weight loss may easily be attributed to
PD, and although it may be of concern, the weight loss usually levels off. It may result from a generally decreased appetite in PD, swallowing difficulties,
other gastrointestinal disturbances, or excessive movement (either severe tremor, or, in the advanced, treated patient, severe abnormal
Constipation and Other Gastrointestinal (GI) Problems
Constipation is a very common problem, and may occur more in older people and in a
generation taught from an early age that one m u s t move one’s bowels daily. That is not necessarily true. PD, however, may slow the bowels down (just as
the rest of the body is slowed down), and the side effects of antiparkinson treatment may also contribute to this problem.
Abdominal distention or bloating may also occur in PD, and occasionally may cause significant discomfort. Nausea and vomiting may occur in untreated
PD, but more common as an adverse effect of medications used to treat PD, especially in the early stages.
Urinary frequency (urinating very often because the bladder does not empty fully each time) and u r g e n c y (the feeling that one must
void right away, even if the bladder is not full) are not uncommon in PD. The normal reflex mechanisms controlling the bladder may be impaired in PD, and
is a problem mostly at night. There may also be difficulties with hesitancy in beginning to void, slowness in voiding, and overfill of the bladder; the latter
may result in accidents if the patient cannot make it to the toilet in time. It should be remembered that other conditions can cause or worsen these
situations, particularly urinary tract infections, prostate problems in men and, in
women (especially those women who have given birth), a “dropped?bladder or uterus.
Sexual desire (libido) may be reduced in PD; in some cases, there may be complex psychological issues (combining sexual
desire and performance with a medical condition), and in others it may be a direct, neurochemical effect of the disorder. Treatment of PD with antiparkinson
drugs frequently improves libido, and occasionally exaggerates it (which may likewise also create problems). Physical problems, particularly in men with
inability to achieve erections (impotence), inability to maintain erections, or incomplete erections may be part of the PD, or may result from other causes.
Dizziness and Lightheadedness
“Dizziness?is a very vague term to the physician. It could mean imbalance,
lightheadedness (probably the most common description), or actual spinning (vertigo). Vertigo is
probably a result of other conditions and should be addressed accordingly. Lightheadedness, however, may be related to PD, and, when it is severe, may
result in actual black-outs or fainting. This usually results from a drop in blood
pressure upon change of position from lying to sitting or sitting to standing (Orthostatic or postural hypotension). Again, sometimes another medical
condition is present (such as dehydration), but it may be part of the PD or a complication of the medical treatment of PD.
Aches, Pains, and Dystonia
Nonspecific discomfort may be a part of PD. Numbness and tingling (parasthesias) may occur in limbs;
occasionally, they may result from other medical conditions, such as pinched nerves from
arthritis in the neck or low back, but in the absence of these problems, they may be attributed to PD. Tightness and cramping in muscles (dystonia or
dystonic cramps), particularly in the feet and legs, may be common occurrences, and may occur early in the disease, even before treatment is
instituted. The pain in the legs may be so severe as to cause patients to have back surgery for presumed sciatica! Dystonia may also involve twisting or
torsioning of muscles. Any muscle may be affected by dystonia or dystonic cramping, including the neck (torticollis), eyelids (blepharospasm), jaw, arms,
legs and feet. Blepharospasm, where the eyes are forced closed or are unable to be opened normally, occurs more often from too much antiparkinson
medication, whereas toe or calf dystinia more commonly happens in the untreated or undertreated state. Rarely, dystonia can affect the chest wall
muscles involved in breathing (respiratory dystonia), and shortness of breath may result. This can be very frightening. If lung and heart disease are rules
out, however, it should be remembered that respiratory dystonia, although
disturbing, is not dangerous.
As with problems of bowel and bladder, impotence, and blood pressure, sweating in PD may result from
disturbances in the part of the nervous system (autonomic nervous system) that control these autonomic
functions. Disorders of the autonomic nervous system are called dysautonomia. When dysautonomia is acute, we may be dealing with one of
the atypical parkinsonisms called Shy-Drager syndrome. Still, dysautonomia is compatible with a diagnosis of PD, and abnormalities of
sweating, particularly excessive sweating, is not uncommon in PD. It frequently involves the upper part of the body more than the lower, and may be a sign of
untreated or undertreated parkinsonism. Profuse, drenching sweats may occur infrequently but may be very bothersome, and may be associated with the
wearing - off of medication in the advanced patient.