What Worsens Parkinson’s Disease’s Motor Symptoms?

Understanding what factors may worsen Parkinson’s symptoms

Many people with Parkinson’s disease (PD) experience variation in their motor symptoms (e.g. tremor, stiffness, slowness, trouble walking, balance difficulties) throughout the day and from one day and the next. This variability is often related to medication dosing, and you and your doctor may focus on adjusting the types of medications that you take as well as the timing and amounts that you take to improve your symptoms throughout the day. You can read more about the possible medication adjustments to improve the amount of time that your medications work, also referred to as ON time.

In addition to medications, however, there are a variety of other factors that can affect how you feel on a particular day.

Additional Factors That May Worsen Parkinson’s Disease Motor Symptoms

Stress and anxiety

When faced with stressful life circumstances, a person can experience a worsening of their PD symptoms. A very common manifestation of this phenomenon is an increase in tremor when anxious or nervous. For example, your tremor might be very well controlled normally, but then emerges during a doctor’s visit, when you are more nervous. Some people report that the increase in tremor “gives away” to other people that they are nervous or anxious.

In addition to tremor, all the motor symptoms of PD, including slowness, stiffness, and balance problems, can worsen or become less responsive to medication when a person is stressed or anxious.

The solution in these situations is not to increase PD medications but rather to utilize relaxation techniques such as meditation or deep breathing exercises. You may need to seek the help of a therapist to better manage your stress and anxiety. If these steps are not sufficient, talk with your doctor about potentially trying a prescription medication for these symptoms.

Depression

Depression is a very common non-motor symptom of PD with approximately 50% of people with PD experiencing depression. Depression can drastically reduce quality of life in many ways, including by worsening the motor symptoms of PD.

Depression and PD symptoms may include:

• Persistent sadness
• Loss of interest in formerly pleasurable activities
• Changes in appetite
• Feelings of helplessness or hopelessness

Depression may respond well to cognitive behavioral therapy as well as medications for depression, so it is very important to discuss this symptom with your doctor so it can be treated.

Learn more about managing depression with Unlocking Strength Within

Poor sleep

A poor night’s sleep is often linked to worsening of PD symptoms the next day. Addressing sleep issues is therefore crucial for managing overall PD symptomatology effectively.

There are a variety of sleep disorders that are common in PD including:

• Insomnia – inability to fall asleep at the start of the night or return to sleep if you wake up in the middle of the night
• Sleep apnea – a condition in which you have pauses in breathing during the night leading to lowering oxygenation levels and frequent awakening
• Sleep fragmentation – a disruption of the normal sleep pattern leading to frequent awakening during the night
• Vivid dreams or nightmares, as well as nighttime hallucinations
• Restless leg syndrome – in which irritating sensations in the limbs before sleep are relieved only by moving the limbs and can interfere with falling asleep
• Nighttime urinary frequency – frequent awakening during the night to urinate
• Nighttime anxiety and confusion
• Nighttime OFF periods which make it difficult to maneuver comfortably in bed

If you find that your PD symptoms are worse after a poor night’s sleep, the strategy should be to discover the cause of poor sleep and address it. For example, if sleep apnea is the cause of poor sleep, then using a continuous positive airway pressure (CPAP) machine, that pushes air into the lungs to maintain oxygenation during the night, may be the solution. Or if nighttime urinary frequency is the cause of your sleep problems, talk to your doctor about potentially initiating a medication to help with this symptom.

Check out a past episode of Dr. Gilbert Hosts on Parkinson’s disease and sleep issues

Dehydration

As people age, they may find that their sense of thirst is blunted. This means that the normal cues that remind you to drink are not as apparent, putting you at risk for dehydration. Dehydration can cause a slew of negative consequences including low blood pressure and constipation and can also worsen your PD symptoms. Avoiding dehydration requires you to drink throughout the day and becomes especially important in the summer months.

Remember that some foods such as watermelon, strawberries, lettuce, and tomatoes (among others) have a very high water content and can be used in addition to liquids to maintain hydration.

Low blood pressure

As mentioned above, being dehydrated will lower your blood pressure and can exacerbate orthostatic hypotension, a common non-motor symptom of PD, in which episodes of low blood pressure occur with changes in head position. Low blood pressure can lead to dizziness and worsening of PD symptoms. If it is suspected, have someone take your blood pressure while you are sitting and standing to document a drop upon moving from one position to another. An array of treatments for orthostatic hypotension ranging from lifestyle modifications to prescription medications can help this situation.

Malnutrition

A person with PD is at risk for inadequate food intake for a variety of reasons including impaired swallowing, reduced ability to prepare meals, decreased appetite, depression, apathy, or poor smell/taste. Poor nutrition can lead to vitamin deficiencies, increased frailty and increased fatigue – which all can worsen PD symptoms. If you don’t think that you are getting adequate nutrition, or if you have noticed weight loss, ask your neurologist for a referral to a registered dietitian for an evaluation, as there are many things you can do to improve your nutritional intake.

Geography, high altitude, and weather

Many people report that the environment in which they find themselves can influence their PD symptoms. Poor temperature regulation can be a non-motor symptom of PD. Therefore, being in an environment that is too hot or too cold can be uncomfortable and can worsen PD symptoms. In addition, changes in altitude are also reported by some people with PD to affect their symptoms. There are lifestyle modifications and other therapies that can help improve your symptoms and comfort level so be sure to talk with your doctor.  

Intercurrent illness

Although PD symptoms can fluctuate from day to day and throughout the day, if there is a drastic and sudden change in symptoms, the culprit is often an intercurrent infection. A urinary tract infection or respiratory infection is often responsible and may need to be treated with antibiotics.

Other medical problems

A variety of other medical problems can worsen PD symptoms, so make sure to routinely visit your primary care physician who reviews your general health.

Examples of medical problems that may impact PD symptoms include:

• Abnormal thyroid function – this can be easily checked with a blood test and corrected, often with a prescription of synthetic thyroid hormone.
• Abnormal Vitamin B levels – these levels can also be checked with blood tests and supplemented orally if necessary.

Tips and takeaways

• Medication adjustments can help you maintain good PD symptom control throughout the day.
• However, there are many other factors that can lead to a variability in PD symptoms during the day and from one day to the next.
• These factors include stress, anxiety, depression, poor sleep, dehydration, poor nutrition, low blood. pressure, intercurrent infections or medical illnesses, geography, altitude, and weather.
• Many of these issues can be successfully treated by your doctor, so be sure to discuss your changing PD symptoms with him/her.