Parkinson’s Disease: More than Movement

Parkinson’s Disease:
More than Movement

By Melissa Shepard, MD

One million Americans are estimated to be living with Parkinson’s disease (PD) (Marras, 2018). PD has traditionally been thought of as a “movement disorder”. However, as our understanding has evolved, we have come to realize that the disease affects much more than just movement. Most people with PD will experience “neuropsychiatric symptoms” at some point in their illness. These are symptoms that affect mood and thinking. They can develop years before a diagnosis is made and can be just as debilitating as the movement symptoms (Marsh, 2008).
Research studies have shown that problems with thinking develop in up to 75% of individuals with PD. This may include problems with planning, memory, attention, and ability to sense where objects are in relation to one another (called “visuospatial skills”) (Ding, 2015). While there are no medicines that can reverse these thinking problems in people with PD, we can use a variety of medications to reduce symptoms and slow down the rate of memory decline (Marsh, 2008).
Anxiety and depression are the most common psychiatric symptoms in people with PD, with each occurring in about half of people with PD. Depression causes a persistently low mood or disinterest in previously enjoyable activities, often coupled with changes in sleep and appetite, increased guilt, and poor self-esteem. Depression may cause someone to feel that life is not worth living and can even cause thoughts of suicide (Marsh, 2008).
Anxiety can present as an increase in worries, feeling tense or on edge, panic attacks, and/or the fear of falling. People who have PD and depression or anxiety have more trouble with movement, day-to-day-functioning, and poorer quality of life compared to people with PD who are not depressed or anxious. Unfortunately, depression in particular is often underdiagnosed in PD, because many symptoms of depression overlap with symptoms of PD (such as slowed movement and low energy). Thankfully, we have very effective treatments for depression and anxiety, including therapy and medications (Butala, 2019).
Psychosis is less common, but still occurs in up to a quarter of people with PD. Psychosis is more common in later stages of the disease and can be worsened by some of the medications used to treat PD movement symptoms. In general, psychosis refers to hallucinations or delusions. Hallucinations can occur in any of the five senses, but visual hallucinations are the most common type in people with PD. Visual hallucinations often consist of seeing people, animals, or insects that aren’t there and can be very distressing (although often are not).
Delusions are false beliefs that are very strongly held despite evidence to the contrary. Some common examples in PD are the false belief that one’s spouse is cheating on them, or that people are talking about them or stealing from them. Psychosis is treatable using antipsychotics, but this is done with caution as these medications can worsen movement and tremor in people with PD (Butala, 2019).
To summarize, PD is more than just problems with movement! It can affect the whole brain. If you are suffering from symptoms of depression, anxiety, changes in thinking, or psychosis, know that you are not alone. Talk to your doctor – there are many things we can do to help.

Melissa Shepard, MD atched Alzheimer’s take its toll on her grandfather and saw how difficult it was for him to get the right kind of help. This led Dr. Shepard to the Memory & Movement Center. She is a graduate of the University of Maryland and the University of Maryland School of Medicine. Dr. Shepard did her residency in psychiatry at the Johns Hopkins University School of Medicine. She and her husband, Chris, have one daughter, Cora.