Many people with Parkinson’s experience changes in libido and sexual function, sometimes even before the first movement symptoms. The causes can be many- some related to PD and some not. Increased sexual desire can be associated with dopamine medicines especially dopamine agonists. Listed below are just a few of the causes:
Parkinson’s related motor symptoms
- Trouble with movement- tremor, stiffness, slowness, dyskinesia, dystonia
- Stamina, Pain
Parkinson’s related nonmotor problems
- Autonomic nervous system changes- altered neural control of sexual function
- Sleep changes
Medicines used to treat Parkinson’s symptoms
- Antidepressants (especially SSRIs)
- Muscle relaxants and sleep aids
- Dopamine agonists (increase sexual desire)
Other medical problems or medicines
- High blood pressure, heart disease, thyroid disease, constipation,obesity, arthritis, bladder control, diabetes, prostate disease
Psychological factors that affect sexual health
- Self esteem, Loss of control, Anger/resentment, Negative body image, Changing role with loved one, Fear
Issues for partners and couples
- Fatigue, Change to caregiver role, Anger/resentment, Fear, Depression, Anxiety, Stress, Loss of interest, Focus on disease, Communication problems
DBS treats movement symptoms of Parkinson’s specifically tremor, dystonia motor offs and dyskinesia. DBS does not typically improve speech and in some cases can be associated with worsening speech. The following information may help you understand the complex association between speech changes with Parkinson’s and DBS:
- DBS typically helps motor symptoms that also respond to medicine. Although difficult to predict, DBS may improve speech if levodopa also significantly improves speech. However, in most cases, speech is not helped by medicines suggesting DBS will also not help.
- If speech is still responsive to levodopa, under-medication can also worsen speech. Medicines are often reduced after surgery.
- Subthalamic (STN) DBS surgery can affect ‘verbal fluency’. This can be noticed as a difficulty ‘finding or getting the right word out’.
- DBS programming can worsen speech as a noted side effect to over-stimulation. This is probably the most common cause of significant speech change after surgery.
- Speech can worsen as Parkinson’s progresses over time even with DBS. This is usually a gradual decline.
- Immediate change in speech after surgery can occur as a result of brain bleeding or other problem during surgery. This can improve over time.
- A speech therapist can help you understand the potential impact of DBS on speech and help improve communication at any stage of your disease.
This information serves as a guide only. Only your healthcare provider can answer the questions about how DBS will impact speech for you.
Movement symptoms such as tremor, rigidity and slowness are the hallmark symptoms of Parkinson’s disease. Yet research confirms that these movement problems are not the main contributors to decline in life quality with disease progression. Trouble with balance and falls are a primary motor problem that occurs later in disease and correlates with a change in life quality. Fortunately early and aggressive Physical therapy and balance exercises can make a difference- whether started early before there is a problem or later after falls occur. The Wellness Center highlights additional information about the role of PT and exercise to improve balance and reduce falls.
Follow these helpful hints:
- See a physical therapy early before you have balance problems to improve your balance and before starting any exercise routine.
- Advocate for yourself and ask your doctor for a referral if you think you would benefit from PT.
- Occupational therapy can help reduce fall risk, offer tips and suggestions to improve your home and community safety by reducing risk of falls
- Remember fatigue and reduced stamina will also increase your chance of falling. Aerobic (cardio) exercise will improve stamina. Get professional advice from your doctor or PT before starting a program.
- Stay hydrated. Low blood pressure from dehydration can lead to dizziness, unsteadiness, fatigue, weakness and confusion- all potential problems that can affect walking.
- The best exercise is often the one that mimics what you want to do- walking and balance. If you can, walk, run, dance, play standing computer games such as the Wii, play tennis or other balance supports.
- Music and a metronome can help you time your gait to a beat.
- Freezing of gait can improve with queing strategies.
- Walking, trekking or hiking poles help with balance.
- Sometimes a walker or cane is needed for balance. This is a positive change not a negative one if this keeps you walking and keeps you safe.
- Multitasking or doing two things at once can worsen balance problems. Try to avoid distractions when possible and focus on the task at hand.
- Yoga and Tai chi can help balance and posture.
Learn more about walking and balance at the Wellness Center.
What is the association between Parkinson’s and depression?
Many people with Parkinson’s experience depression, in fact, up to 50% of people with Parkinson’s.The cause of depression in Parkinson’s is thought to occur from biochemical changes (serotonin, dopamine, and norepinephrine) in brain regions that influence mood. Depression can also be caused by other circumstances and frustrations such as a reaction or response to your Parkinson’s diagnosis, life worries, social isolation, loneliness, or secondary to chronic frustrations when symptoms cause problems with everyday tasks. Depression can be present at all times, as a reaction to having a bad day or when Parkinson’s medications start to wear off just before the next dose of medicine is due. Other facts about depression
- Can be present all the time or as a wearing off symptom
- Can be present with anxiety
- Can be associated with apathy or loss of motivation
- Conversely apathy can be present without depression
- Can worsen sleep, pain, coping, fatigue
- Impacts relationships, lifestyle choices so important to living better
- Is treatable- diet, exercise, relaxation techniques, stress reduction and gratitude all can help
- New antidepressants called selective serotonin reuptake inhibitors and norepinephrine-serotonin reuptake inhibitors improve symptoms
See Wellness Center for more about depression