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Non motor symptoms of Parkinson’s

Non motor symptoms of Parkinson’s

To the world, Parkinson’s is a disease that causes tremors, involuntary shaking, and slower gait. However, there is more to Parkinson’s than just deterioration of motor function.

Non-motor symptoms of Parkinson’s disease (PD) can sometimes be more disabling and troublesome than its motor symptoms. There have also been instances where the non-motor symptoms, also called non-movement symptoms, presented themselves years before a PD diagnosis was made.

Over the years, there have been significant leaps in the treatment of motor symptoms of PD. However, the treatment for non-motor symptoms is not a one-shoe-fits-all type. Since the symptoms are so varied and can differ extensively from patient to patient, its treatment is also subjective.

At Plexus, we believe that the best treatment for Parkinson’s is a holistic rehabilitation program that restores motor function, mitigates non-motor ailments, and improves the overall quality of life of the patient.

Let’s take a look at the non-motor symptoms of PD and try to understand how best we can care for our loved one living with the disease.


More than drowsiness or extreme tiredness – this is how patients usually describe the extent of tiredness. Fatigue is rather challenging to treat with just medication. And that is why physical therapy can prove to be beneficial to manage this particular symptom. At the same time, your doctor needs to ascertain whether the fatigue is being caused by any other symptoms like sleep deprivation or mental health woes.

Depression, apathy, and anxiety

Mental health is the most severely impacted in PD. Since PD is a diagnosis that can quite literally change the course of the life an individual would have imagined for themselves, it is quite natural for them to find it difficult to come to terms with this new change that is here to stay!

Depression, particularly, is extremely common among patients, but is sadly overlooked most of the time. It is important to understand that depression can affect cognitive and motor function in patients, and so it must be treated in a manner deemed appropriate by the doctor.

Apathy sets in when motor function begins to decline. Imagine not being able to stand up and walk to the kitchen for a glass of water. How debilitating it must be for the patient. Apathy causes the patient to stop participating in life’s activities. A sense of what is the point of this sets in. This phase can be excruciatingly painful to watch for caregivers and loved ones.

The changes in the chemistry of the brain, that is the brain’s inability to produce dopamine, can lead to anxiety. Research shows as many as 2 out of 5 patients with PD will experience anxiety in any of its forms – social avoidance, anxiety attacks, obsessive compulsive disorder, generalised anxiety disorder.


While constipation is categorised under non-motor symptoms, it can be caused by the degeneration of muscles in the bowel, specifically the internal and external sphincter muscles. As a first step of treatment, exercise, diet, and change in lifestyle may be prescribed. Fibre supplements, laxatives, stool softeners, enemas, and other medication that helps treat chronic to severe constipation may be prescribed as a second step.

Urinary problems, specifically incontinence

The most commonly experienced symptom by a patient with PD is an urgent and frequent urge to urinate, even when the bladder is not full. For some, this can also lead to accidental loss of urine or incontinence. Since patients with PD are prone to bladder and/or urinary infections, any urinary issue needs to be immediately taken up with the doctor. 


Changes in the chemistry and structure of the brain can cause memory and thinking problems in patients with PD. Alpha-synuclein is a protein central to Parkinson’s. It causes sticky clumps, clinically known as Lewy bodies, to disrupt the regular functioning of the brain. This disruption leads to dementia.

Dementia brought on by PD is of two types. These can be distinguished by their symptoms.

  1. Parkinson’s disease dementia (PDD) – the patient experiences a substantial decline in cognitive function particularly after a year or more of experiencing reduced motor function


  1. Dementia with Lewy Bodies (DLB) – the patient can either experience cognitive decline right in the initial stages of PD; or along with a decline in motor function (both will progress together)


Sometimes attributed to the beginnings of dysphagia (swallowing difficulties), patients with PD swallow their saliva less often. As the disease advances and as they lose muscle control, this can lead to drooling, which can be isolating and embarrassing.


Pain is one of the most common and debilitating symptoms of PD as the disease progresses. This pain is divided into five categories:

  1. Musculoskeletal pain: impact of PD on bones, muscles, tendons, ligaments, and nerves
  2. Neuropathic/radicular pain: caused by damage to nerves
  3. Dystonic pain: from repetitive muscle twitching, cramping, or spasms
  4. Akathisia: feeling of restless or inability to sit still
  5. Central pain: impact of PD on central nervous system

 Below are some common bone and skeletal changes with PD that can also result in severe pain:

  • Frozen shoulder
  • Stooped posture
  • Scoliosis
  • Flexed fingers, toes or feet
  • Leaning sideways
  • Osteoporosis (most common with old age, female sex, smokers, and people with low body weight)
  • Dropped head
  • Bone fractures

 Low blood pressure

Orthostatic hypotension (commonly known as blood pressure) occurs when changing positions, such as from sitting to standing. Improved diet, physical therapy, and behavioural therapy are often prescribed by doctors to raise the blood pressure.

Sexual problems

Sexual problems in patients with PD can be involve both emotional and physical challenges. These problems may differ from individual to individual, and between women and men. For instance, the most common sexual problem for men with PD is erectile dysfunction, and for women it is low sex drive and/or pain with sexual intercourse.

Cognitive changes

Mild cognitive impairment (MCI) can be a symptom of PD. The changes in the brain that lead to motor symptoms can also result in the slowness of memory and thinking. Medication, stress, and PD induced depression can also lead to MCI.

Patients may find it difficult to focus, feel overwhelmed when asked to make a decision, have trouble remembering information or finding the right words when speaking.

  • Severe cognitive impairment in PD is most commonly associated with:
  • Cost of treatment
  • Diminished quality of life
  • Caregiver distress
  • Increased mortality
  • Poorer treatment outcomes
  • Deteriorating daily function


Hallucinations and delusions are common in the later stages of PD. Some of these may be terrifying or upsetting. In such cases, most doctors recommend immediate medical treatment.

Hallucinations are not like dreams or nightmares. They occur when the person is awake and conscious, well ‘within their senses’ so to speak. They see, hear or feel something that is actually not there.

Delusions are irrational, illogical, and rather dysfunctional views that are not based in reality. We may think of them as flights of fancy, but to the patient these views are very real and authentic. This can prove to be very dangerous as patients may become argumentative, aggressive, or even agitated.

Not every patient with PD experiences hallucinations and delusions. But there are several factors that can increase the likelihood:

  • Impaired vision
  • PD medications
  • Late stage PD
  • Dementia/impaired memory
  • Old age
  • Depression
  • Sleep issues

Sleep issues

While sleep is extremely critical for patients PD so that the body gets sufficient time to repair and restore itself, the changes to the brain can cause sleep issues in most patients. PD medications are among the biggest disruptors of sleep. Some of the most common sleep issues associated with PD are:

  • Inability to turn over in bed
  • Waking up (sitting up from sleeping position and walking) to go to the bathroom
  • Excessive drowsiness during the day
  • Restless leg syndrome
  • Talking, yelling, or thrashing out while asleep
  • Difficulty falling and/or staying asleep

Sensory issues

PD is known to cause damage to sense of taste and smell, and skin health. It can also induce vertigo and dizziness, which in turn impairs balance even further.

Vision can be seriously impacted by PD and its medication. Many patients complain of double vision, blurry vision, and even decreased blinking which leads to blurry vision.

Some patients experience mild to severe hearing loss.

Stem cell therapy for Parkinson’s

At Plexus Neuro and Stem Cell Research Center, we use autologous stem cells taken from the patient’s own body. As India’s leading stem cell specialists, we assure you of a safe treatment with absolutely no adverse effects.

 Stem cells are injected directly into the basal ganglia. These injected cells have the potential to develop into dopamine-secreting neurons thereby reducing the progression of Parkinson’s and giving the individual a fighting chance to not let the disease get the better of them.

Plexus Parkinson’s Disease Rehabilitation Program works towards mitigating the severity of non-motor and motor symptoms, as well as progression of PD. Our team of experts, headed by Dr. Na’eem Sadiq, founder of Plexus, India’s renowned neurologist and stem cell specialist, will recommend only the best treatment for you or your loved one.

Book an appointment with us today.

Call +91 89048 42087 | 080-2546 0886

080-2547 0886 | 080-2549 0886


What causes non-motor symptoms of PD?

The changes to the structure and chemistry of the central nervous system, especially the brain results in several non-motor symptoms of PD.

What are non-motor symptoms?

Health problems other than those associated with muscle strength and function, balance, coordination, gait, and posture are known as non-motor symptoms.

How do non-motor symptoms affect those with PD?

Non-motor symptoms are more difficult to diagnose because of their lack of visual tangibility. Most of them are based on the patient’s ability to understand if something is amiss. And by the time some patients realise that a particular symptom may actually be that of Parkinson’s, it may alter their life’s course completely. Non-motor symptoms can take a huge toll on the emotional health of the patient.

What are the four cardinal signs of PD?

Tremors, stiffness, slowness and reduced voluntary action (reflexes) are the four major signs of PD.

Are dry eyes a symptom of PD?

Yes, dry eyes are a commonly experienced symptom.

What is usually the first symptom of PD?

Involuntary tremor is usually the first symptom of PD.

Is blurred vision part of PD?

Yes, blurred vision is a commonly experienced symptom of PD.

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