Parkinson’s Disease: Beyond Motor Symptoms
Dementia and Psychotic Symptoms: A Common Challenge for Parkinson’s Patients
According to recent studies, dementia and psychotic symptoms are prevalent among Parkinson’s disease patients, adding to the burden faced by their caregivers. While the accompanying photograph is unrelated to this article, it depicts the challenging experiences of individuals with Parkinson’s disease. (Photo courtesy of Lin Jinjia)
By Lin Hongmin and Lin Jinjia
Mr. Wang’s Struggle with Parkinson’s Disease
At the age of 60, Mr. Wang began to experience a gradual decline in mobility, encountering symptoms such as slow movements, body stiffness, shortened steps, and hand tremors at rest. An official diagnosis confirmed his condition as Parkinson’s disease. Although the prescribed medication provided some relief, Mr. Wang continued to suffer from stiffness and pain in his lower legs, restricting his ability to walk freely. Two years later, he started experiencing persistent depression, loss of appetite, sleep disorders, and even delusional thoughts. More recently, he started hallucinating snakes in his house, which led to a terrifying incident where he ran into the street to escape from an imagined pursuer.
Understanding Parkinson’s Disease
Parkinson’s disease is a chronic progressive neurodegenerative disorder characterized by the significant loss of dopamine-secreting neurons in the midbrain’s substantia nigra. This leads to gradual motor function abnormalities. The widely recognized motor symptoms, consisting of slower movements, decreased range of motion, resting tremors, and body stiffness, constitute the four core manifestations of the disease. However, studies have revealed that up to 97% of individuals with Parkinson’s also experience non-motor symptoms. Among these, cognitive and psychiatric disturbances are the most common and troublesome.
Depression: A Common Co-Occurring Condition
Depression and anxiety often accompany Parkinson’s disease, potentially arising from the interplay between the neurodegenerative process and mood-regulating neurotransmitters. Additionally, disruptions in daily life caused by movement disorders can contribute to these mental health challenges. However, diagnosing depression in Parkinson’s patients can be overshadowed, as over 50% of individuals with the disease experience depressive symptoms that mimic Parkinson’s-related manifestations, such as reduced facial expression, fatigue, psychomotor slowness, and decreased appetite. This overlap in symptoms often leads to depression going undetected.
▲ Photograph: This image is unrelated to the article and serves as a situational visual. The individuals depicted do not have any connection to the content. (Photo courtesy of Lin Jinjia)
Cognitive Decline and Psychotic Symptoms: A Hidden Struggle
Dementia further compounds the challenges faced by Parkinson’s disease patients, undermining their ability to carry out daily activities due to cognitive decline. Among the non-motor symptoms, visual hallucinations are particularly common. Mr. Wang, for instance, reported seeing animals and strangers pursuing him within his own home. These psychiatric manifestations often prove more severe and difficult to manage than the motor symptoms. They even play a significant role in increased risk of institutionalization and impose a greater burden on caregivers.
Unfortunately, these non-motor symptoms frequently go unnoticed in individuals with Parkinson’s disease. Therefore, early recognition and appropriate treatment are crucial not only for enhancing the patients’ quality of life but also for effectively managing the condition. Consequently, seeking psychiatric consultation alongside specialized neurological treatment becomes of utmost importance for Parkinson’s patients.
(The authors are Lin Hongmin, a doctor in family medicine at Chimei Hospital, and Lin Jinjia, an attending doctor in psychiatry at Chimei Hospital)
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▲ Dementia and psychotic symptoms are common symptoms for Parkinson’s patients, and they also increase the burden on carers; the photo is a situational photo, and the people in the photo have nothing to do with this article. (Photo courtesy of Lin Jinjia)
Text / Lin Hongmin, Lin Jinjia
Mr Wang, 60 years old, started experiencing slow movements 4 years ago, along with body stiffness, small steps when walking, and hand tremors when resting. After seeing a doctor, he was diagnosed with Parkinson’s disease. After starting drug treatment, although his symptoms improved slightly, he often felt stiffness and pain in his lower legs, which gradually made him unable to walk freely. Two years ago, Mr. Wang began to feel depressed throughout the day, accompanied by poor appetite and sleep disorders, and sometimes even had inconceivable thoughts. Two months ago, I was seeing snakes in my house from time to time, and once I even ran into the street out of fear because I saw a stranger chasing it.
chronic progressive neurodegenerative disease
Parkinson’s disease is a slowly progressive neurodegenerative disease, mainly due to the unexplained massive death of dopamine-secreting neurons in the substantia nigra of the midbrain, leading to progressive abnormalities in motor function. Four core motor symptoms are better known, including slower movements, reduced range of motion, tremors at rest, or body stiffness. However, in addition to the typical motor features, studies have shown that up to 97% of Parkinson’s patients report non-motor symptoms, with symptoms of thought-related disorders being the most common and annoying of these.
Over 50% of Parkinson’s patients also suffer from depression
Among them, depression and anxiety are quite common, possibly due to the interaction between neurodegenerative diseases and mood-regulating neurotransmitters, and more likely due to the stress effect of life disruptions caused by movement disorders. The diagnosis of depression is often overlooked because more than 50% of people with Parkinson’s disease experience depression and the symptoms of depression are similar to those of Parkinson’s disease, such as decreased facial expression, fatigue, psychomotor slowness, and decreased appetite .
▲ Some symptoms of depression and Parkinson’s disease are similar, such as less facial expression, fatigue, etc., so that the diagnosis of depression is often overlooked; the picture is a situational picture, and the characters in the picture are not related to this article. (Photo courtesy of Lin Jinjia)
Cognitive decline with visual hallucinations accompanied by dementia
Dementia is another common problem where patients can gradually lose the ability to carry out daily activities due to cognitive decline. In addition, there are many psychotic symptoms, the most common of which are visual hallucinations. For example, Mr Wang said he sees animals or strangers chasing him at home. These non-motor symptoms can be more severe and more challenging to treat than motor symptoms. Psychiatric symptoms are even a major risk factor for institutional admissions for Parkinson’s disease patients, and can also increase the burden on carers.
These non-motor symptoms are very common in people with Parkinson’s disease, but are often overlooked. Therefore, early recognition of symptoms and appropriate treatment are essential to improve patients’ quality of life and the treatment of the disease. Therefore, in addition to professional neurological treatment, it is very important for patients with Parkinson’s disease to cooperate with a psychiatric consultation.
(The authors are Lin Hongmin, a doctor in family medicine at Chimei Hospital, and Lin Jinjia, an attending doctor in psychiatry at Chimei Hospital)
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