Category Archives: Non-movement Symptoms

Is leg pain a symptom of Parkinson’s?


calfLeg pain can be significant and have many causes; some related to Parkinson’s disease, some that increase in frequency with age and others that are more common in both conditions. Here are just a few:

Pain associated with Parkinson’s

  • Off related pain – diffuse aching and/or throbbing pain that increases at end of dopaminergic medicine dosing or when medication levels are low. Unlike joint pain, this pain is often located in the muscle such as the thigh or calf but not the knee of ankle. PD medications can often improve this pain.
  • Restless leg syndrome – uncomfortable sensations most commonly felt in legs that is worse at night and while resting and relieved with movement. See related post on restless leg syndrome for more information.
  • Dystonia-involuntary contraction of muscle. This can be common as a symptom of PD, an off related symptom or as a form of dyskinesia from medication. An example is early morning foot dystonia described as painful cramping of the toes and feet. Botulinum toxin (Botox, Myobloc) therapy can help

Musculoskeletal

  • Arthritis of the knee, hip or ankle typically causes pain in the join and not muscle. Although this is unrelated to PD, arthritic pain can worsen when the natural biomechanics of the joint is altered with PD rigidity, loss of strength and loss of flexible. Physical therapy and anti-inflammatory agents are an important treatment for this and the condition described next.
  • Achilles tendonitis is pain located at the ankle and plantar faciitis is pain located under the sole of the foot. Both conditions can flare with a change in exercise routine, with improper stretching and secondary to the tightness of the ankle and foot often found in PD.

Neuropathic

  • Peripheral neuropathy is caused by nerve damage that begins in the feet. Associated symptoms are pain, burning, numbness and tingling. The most common causes are aging, diabetes, vitamin B12, deficiency, thyroid deficiency and blood protein disorders. this condition not only causes pain but also can worsen balance. Blood tests can help identify the cause of this problem.
  • Radiculopathy or sciatic nerve compression can cause pain in the thigh, calf in foot depending on the nerves affected. Causes could include arthritis and disk disease of the spin and compression of the sciatic nerve in the buttock region due to muscle tightness,
  • Spinal stenosis is a problem of narrowing of the spinal canal. Often associated with back pain and pain in both legs. this type of pain often improves when a person is bent forward.

General Pain

  • Leg swelling can occur with PD, medications and other medical conditions. Abrupt change in leg swelling associated with pain could be a sign of a blood clot requiring immediate medical attention. Lack of movement and dehydration can increase this risk in PD.

This information does not represent all types of pain that can occur. As always, be sure to talk with your healthcare provider if you are experiencing pain in your legs.

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Filed under Non-movement Symptoms, Self-Care, Symptoms, Diagnosis and Progression

Can you give any additional information about Othello Syndrome in the context of PD?


Othello syndrome describes a form of psychosis in which one has delusional thoughts about their partner having an affair or similar relationship that does not exist. They may misinterpret ‘clues’ to support this delusion.

Delusions and hallucinations can be seen with certain psychiatric disorders and in the setting of Parkinson’s disease with the following conditions:
-High dose dopamine medicines especially dopamine agonists, amantadine and selegiline
-Other medicines that can cause confusion such as anticholinergics, muscle relaxants and pain medicines (narcotics)
-Illicit (street) drugs)Cognitive problems suggestive of dementia
-Coexisting medical conditions such as thyroid disease, vitamin deficiency (B12),infection or dehydration

Treatment includes:
-Reducing medicines when possible
-Occupational therapy evaluation to analyze how someone is taking medicines and help family administer medicines in the event the person with PD is taking more than prescribed
-Antipsychotic medicines- namely clozaril or quetiapine
-Cognitive enhancing medicines such as rivastigmine
-Counseling and psychiatric evaluation to evaluate for other conditions
-There is little evidence to date about the effect of a new antipsychotic.
-A combined neurology and psychiatry evaluation may be needed for this difficult problem.

See related article on hallucinations

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Filed under Caregiving, Cognitive Health, Emotional Health, Medication Side Effects

What causes hallucinations?


Van GoghHallucinations are a side effect associated with dopaminergic medicines used to treat Parkinson’s disease motor symptoms. Hallucinations are an altered perception of how our brain interprets information it receives about our environment, surroundings, senses and/or body sensations. Hallucinations can be visual, auditory or tactile. The most common type of hallucinations in PD are visual in nature. They may range from the experience of a simple illusion such as ‘seeing’ a spot on the wall turn into a well formed object such as a spider or they me be more complex and actual visions that do not exist. Sights of people and animals are common hallucinations. A person can have insight into and reason through the fact that a hallucination is not indeed real. In more advance cases, insight is lost and hallucinations are interpreted as real without the ability to reason that they are not grounded in reality.

The risk of experiencing hallucinations if you have Parkinson’s disease  increases with the following:

  • High levels of dopaminergic medicines. Specific medicines such as dopaminergic agonists, anticholinergic medicines and amantadine are associated with a higher risk of this problem.
  • Additive effect of other brain active medicines such as sedatives, sleeping aids, muscle relaxants, narcotic pain medicines and some bladder medicines.
  • Cognitive problems, confusion and dementia increases risk of hallucinations associated with Parkinson’s medicines.
  • Visual problems such as cataracts, glaucoma and reduced night vision can increase the risk of developing hallucinations especially at night. (Hallucinations are not directly caused by eye problems but reflect how the brain interprets sensory information. However, poor vision does exacerbate this problem in susceptible individuals.)
  • Stress can increase the risk – whether emotional, physical or the stress on your body from a medical condition or surgery.

Treatment includes:

  • Change or reduction in Parkinson’s medicines and other brain active medicines described above.
  • Antipsychotic medicines. Only two antipsychotic medicines are recommended for PD-clozapine and quetiapine. Other antipsychotics can worsen movement problems due their dopamine blocking activity.
  • Cognitive enhancing medicines such as Aricept or Exelon if dementia is a problem
  • Medical evaluation to insure other medical conditions are not contributing to the problem. Examples include cardiopulmonary disease, thyroid problems, vitamin B12 deficiency, infection, dehydration and kidney disease.
  • Lifestyle changes with a focus on stress management and improved sleep.

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Filed under Cognitive Health, Emotional Health, Medication Side Effects, Non-movement Symptoms, Symptoms, Diagnosis and Progression

How does Parkinson’s affect cognition? What can be done about it?


Cognitive changes associated with Parkinson’s  are mostly a category of thinking skills called executive function. Although many people with Parkinson’s Challenge yourself to learn new things!experience some sort of cognitive change, dementia or signficant problem impacting daily life and function is less common – occurring in about 30%.  The more common thinking abilities are:
  • Speed of movement
  • Word finding and naming problems
  • Multitasking
  • Performing complex tasks or skills
  • Abstract thinking abilities
  • Visual-spatial skills

Behavioral problems that can be associated with cognitive problems include:

  • Apathy or loss of motivation
  • Depression

 Memory abilities with Parkinson’s may be less efficient, but are usually not affected as much as Alzheimer’s patients are affected. People affected by Parkinson’s usually benefit from reminders and memory prompts, but may recall moments or hours after it was needed.  

 
Cognitive changes are treatable. It is important to remember that medicines can worsen confusion and cause hallucinations in people with cognitive problems. When this occurs, it is important to balance the medicines that are most effective for movement with those that have greater thinking related side effects.  Amantadine, selegeline and dopaminergic agonists such as Mirapex (pramipexole), Requip (ropinirole), Neupro have a greater risk of associated i thinking problems and /or hallucinations.
 
Treatment of cognitive changes includes:
1. Review with your doctor all medicines that can impact thinking such  including Parkinson’s medicines, pain medicines, muscle relaxants, anxiety and depression medicines to be sure that they are all needed, reduce or eliminate theones that are not.
2. Check for other medical problems that can worsen thinking problems including strokes, sleep apnea, thyroid problems, vitamin D and B12 deficiency, poor diabetic glucose control, heart problems, low blood pressure.
3. Memory enhancing medicine such as Exelon (rivastigmine) can be tried.
4. Stay mentally active
5. Be mentally engaged
6. Get more exercise especially  higher intensity aerobic exercise if possible. 
7. Eat healthy including foods high in omega 3s (fish oil), vitamin B6 and B12.
8. Reduce stress
9. Simplify life tasks
10. Challenge yourself – learn new things, explore new experiences
11. Stay socially active
12. Do what you love
 
Most important get the help and professional advice you need. See your doctor and consider a referral to a Neuropsychologist and/or Occupational therapist
 
Learn more about hallucinations.

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Can ultrasound treat Parkinson’s tremor?


Tremor is one the cardinal symptoms of ParkinsonsResearchers at the University of Virginia are conducting a research study to investigate a new way of controlling tremor.  The research study is designed to investigate the safety and feasibility of ultrasound waves targeted at the thalamus, a brain region important for tremor control.  Similar to the thalamotomy of the past, this technique causes a lesion or destruction of brain cells  that affect tremor.

Unlike traditional thalamotomy, this technique does not require brain surgery that includes drilling a hole in the skull to gain access to the brain and damage the cells but instead relies on MR guidance of these focused wave forms to precisely reach their target.  In some ways it is similar to gamma knife thalamotomy, a technique that is sometimes used to treat tremor through focused  gamma waves that when converging on a brain region can damage tissue (gamma knife is a common radiosurgery technique used for treating brain tumors and a condition called trigeminal neuralgia).  These new techniques are promising and offer a less invasive approach to tremor control. It is important to note that research is just beginning and this current study is being conducted to investigate safety. If proven safe, larger studies will need to be done to test the benefit.  Other considerations for this experimental procedure include

  • Lesioning techniques (damaged cells) are not reversible since tissue is destroyed. If the wrong area of brain tissue is damaged it can not be restored.
  • Focused ultrasound and gamma knife surgery does not have the same risk and recovery period associated with traditional neurosurgery offering a potential treatment for people in which standard surgery carries too much risk.
  • Only unilateral thalamotomy at present is recommended for tremor on one side of the body due to concern of side effects with bilateral thalamotomy such as speech and walking problems.
  • Research is for tremor predominant Parkinson’s disease, a condition in which other non-tremor movement symptoms are minimal compared with tremor. Non-tremor symptoms of Parkinson’s such as rigidity and bradykinesia are not treated with thalamotomy.
  • There is limited experience about the combined effect of thalamotomy and other surgical techniques such as deep brain stimulation (DBS) if this were to be needed in the future.
  • Like gamma knife thalamotomy, cells that are to be destroyed are located with MR imaging. Unlike thalamic DBS where a brain electrode is used to locate this precise area in the operating room by recording and stimulating actual brain cells involved in tremor, there is no ability to record the neuronal activity to further ensure that the area of tissue destruction is accurate for the individual.

Given these issues, researchers at the U of VA have designed a careful sham (placebo) controlled study to help effectively address these concerns.  These new techniques show promise and offer hope for additional therapies in the future.

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What are you grateful for this holiday season?


What are you grateful for?A positive attitude and gratitude for that which adds meaning and value to life can help you deal with life’s set backs, frustrations and improve health related problems. Gratitude can even be found during and even increase in the setting of difficult times. Gratitude enhances positive thinking which can help us deal with health related problems. Gratitude can help us better manage stress which not only worsens how we feel with PD but is linked to health problems such as depression, anxiety, heart disease and cancer.

What is the take home message? Use these techniques to take a moment and reflect on what you are grateful for to improve your sense of well-being, mood, PD symptoms and perhaps general health.

  • Tell yourself something you are grateful for, thankful of, or appreciative of each day.
  • Take this exercise on step further by writing your thoughts of gratitude down in a book or journal.
  • Share your thoughts of gratitude with you partner or someone special in your life.
  • Take a moment out of each week to read your thoughts of gratefulness.

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How can I prevent dizziness?


Dizziness can have multiple causes in Parkinson’s.  Most common, is low blood pressure, specifically a drop in blood pressure with standing a condition caused orthostatic hypotension.  People of use the term dizziness to describe many different problems. The term dizziness is also used to describe a sense of imbalance when standing or walking, vertigo or sense of motion caused by inner ear or vestibular problems and a lack of mental clarity.

Low blood pressure can cause dizziness, ‘passing out’, fatigue, walking problems, and thinking problems.

Dizziness due to orthostatic hypotension can be treated. Most of these treatments work by increasing the volume of blood in your circulatory system, increasing blood pressure and optimizing heart function.

  • Review your medicines with your healthcare provider. Some dopaminergic medicines such as dopaminergic agonists can lower blood pressure.
  • Avoid dehydration. Dehydration reduces blood volume and blood pressure. Drink plenty of water especially when exercising and in hot climate.
  • Add salt to diet to increase the amount of fluid retained in your circulatory system. Always talk to your doctor or healthcare provider before making any change in diet especially if you have heart or kidney disease.
  • Find the cause of and treat anemia(low red blood cell count) diagnosed by blood tests that measure the amount of red blood cells. Nutrition deficits, alcohol abuse, low iron levels, low vitamin B12 and bleeding are some of the common causes of anemia.
  • Take your time when getting up.  Waiting a few seconds for your circulation and blood pressure to recover when standing will reduce symptoms of dizziness when standing.
  • Avoid increases in intra-abdominal pressure as this pressure is transmitted to the circulatory system and thus reduces the return of blood flow to the heart. Abdominal pressure is increased with stooping or squatting or while ‘bearing down’ for instance during exercise or when having bowel movement.
  • Try elastic stockings.   These stockings extend to the knee or waist.  The pressure they place on your legs keeps fluid from leaking out of the blood vessels and into the tissue.  Some people with movement and coordination problems have trouble getting these on or off. Ask your doctor for a prescription to occupational therapy if you are having trouble getting these on.
  • Keep your feet elevated when sitting to limit leg swelling and pooling of fluid at your feet.
  • Pump your legs and ankles when sitting. This muscle activity massages the lymph vessels and veins in your legs helping your circulation return blood flow to the heart.
  • Sleep with the head  higher than your heart by placing a wedge under your mattress of elevating the head of your bed by placing a lift under the legs at the head of bed.
  • Medicines are available if needed to increase blood pressure.  These medicines must be used with caution as they can cause electrolyte problems and high blood pressure.
  • A cardiac or heart evaluation may sometimes be needed to insure heart health and optimal cardiac output (the amount of blood pumped from the heart into the circulation.)

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How do I treat my cough at night? I am interested in any suggestions that would help in regards to controlling a cough while sleeping at night. I have tried 1 & 2 pillows, drinking water, having a mint to keep my mouth moist and nothing works


Cough at night can have many causes so it is first very important to define the cause of your cough.  The following is a partial list of causes of cough at night:

  • Heart disease such as congestive heart failure
  • Primary lung problems
  • Nose and sinus disease
  • Certain medicines
  • Parkinson’s related  swallowing problems such as aspiration (food, drink and saliva entering the air passages rather than the esophagus)
  • Gastric reflux

Treatments vary and include medicine changes, swallowing therapy, breathing treatments.  Be sure to see your primary doctor for a complete evaluation if your cough persists despite the treatments.  In some cases a consultation with a cardiologist, pulmonologist or Ear Nose and Throat specialist may be needed.  Sometimes coughing can be the only sign of aspiration so a swallowing therapist is also an important step for a Parkinson’s patient.  This specialist can recommend additional swallowing tests, therapy to improve safe swallowing, safe foods and liquids to try.  If you are having trouble with too much secretions, your neurologist may recommend certain medicines, botulinum toxin therapies.   Some people find that papaya fruit or juice reduces thick secretions that are hard to clear.

Since there are so many causes of coughing, it is important that you do not treat the symptoms but first find the cause. Your primary doctor and Neurologist together can set you on the right path.

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Facts about depression


Depression is a symptom of Parkinson’s disease. Find out more:

  • Present in up to 50% of people with Parkinson’s
  • Can co-exist with anxiety, apathy or cognitive problems
  • Can begin before movement problems
  • Can be generalized, or a symptom associated with off periods
  • Impacts life quality as much or sometimes more than movement problems.
  • Is high in caregivers if not recognized and treated
  • Responds to exercise, socialization, diet, stress management, and medicines

Find out more about depression in the July-August Wellness Center update.

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Help for constipation


More than half of individuals with Parkinson’s have trouble with constipation. Constipation may even begin before the movement symptoms are noticeable, a pre-motor symptom.

Constipation is caused by slow movement of digested food through the intestine. Weak abdominal wall muscles, pelvic and sphincter muscle dystonia or excessive contraction can also cause problems with elimination.

Many factors can contribute to constipation. Understanding these factors and making some simple lifestyle changes can make a big difference:

  • Check your Medicines- many medicines worsen constipation such as Benedryl, Narcotics, amantadine, anticholinergics for tremor, sedatives and muscle relaxants, amantadine and some antidepressants (tricyclics)
  • Exercise- especially walking can help tremendously
  • Drink water- this will reduce your risk of dehydration and hard compacted stool
  • Add fiber- 20- 30 grams a day. That is more than most Americans eat.  Adding beans, nuts, whole grains, fruits and vegetables will help.
  • Psyllium is an over the counter source of soluble fiber.  These and other OTC regimens must be taken with plenty of fluid and started care
  • Set up a bowel routine- Take the time to use the bathroom. Do not rush or strain. Set a side time every day to establish a habit.
  • Many other treatments are available from stool softeners to laxatives, to teas that stimulate colon activity.  See NWPF wellness center for more information on constipation and its treatment.

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