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Not Just Tremor: Recognizing depression and other non-motor symptoms of Parkinson’s disease

By Tom Valeo, Neurology Now, www.journals.lww.com/neurologynow

People like boxing legend Muhammad Ali and actor Michael J. Fox have helped to deepen the understanding of Parkinson’s disease (PD) as a movement disorder. Ali shows the most conspicuous symptoms of PD—a slow, shuffling gait; rigid movements; hand tremors; and an expressionless face. Fox, on the other hand, shows many common side effects of treatment for the disease—dyskinesias, which are involuntary movements that produce rocking; unintended facial expressions; and random arm motion.

The motor symptoms of PD—those related to movement—develop when a portion of the brain known as the substantia nigra stops producing enough of the neurotransmitter dopamine, which makes normal movement possible. (See box, “Parkinson’s Disease: The Basics.”)

But PD also causes an array of non-motor problems. These symptoms may elude detection by doctors and even by patients themselves. Many of these symptoms seem to affect the mind more than the body; in reality, they illustrate the intimate connection between the mind and the body.

For example, depression, anxiety, irritability, and social withdrawal are all recognized now as non-motor symptoms of PD. Experts believe they are caused not by the person’s reactions to having PD but by the disease itself and how it changes the physical brain.

Because so many non-motor symptoms of PD can be attributed to other causes, such as aging, stroke, or other neurologic disorders, it’s important for patients and caregivers to inform their neurologist about any changes in mood, attitude, and behavior, says Christopher G. Goetz, M.D., professor of neurological sciences and pharmacology and director of the Parkinson and Movement Disorders program at Rush University Medical Center in Chicago, IL, and Fellow of the American Academy of Neurology (AAN).

“Patients and caregivers feel the burden of these non-motor symptoms,” Dr. Goetz says. “In my experience, they are relieved to find that the lack of energy, loss of endurance, and cognitive problems are part of PD itself. It means that these symptoms are not the patient’s fault, nor are they part of another, separate disease the person has to contend with.” Read the rest of the article here.

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