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April is Parkinson's Disease Awareness Month. I've been posed five questions by the Parkinson Society British Columbia and I'll be answering one each Monday.
The third question is, "Parkinson's disease is complex. Did the range of symptoms Sandra experienced come as a surprise to you?"
The primary motor symptoms—those that involve movement—weren't surprising. The tremors, rigidity, slowness of movement, and her susceptibility to falling were part of the disease. They were also the symptoms her neurologist was able to address through medications and surgery. But there were two other symptoms that I hadn't expected.
One was drooling. Swallowing is complicated, involving over forty muscles and nerves. Because Parkinson's affects muscle control, it can impair swallowing. This has two consequences. The first is that she didn't swallow at a normal rate. We all salivate and, unless we're baseball players, we swallow it. Because she couldn't swallow easily, she drooled. My first reaction was embarrassment because I didn't understand what was happening. When someone explained it to me, it became just another part of her disease.
The second consequence of impaired swallowing is aspiration, where food or liquid goes down the wrong pipe and into the lungs. This can produce pneumonia, one of the main causes of death among Parkinson's patients. Which is why it is critical to have a speech language pathologist assess swallowing, particularly in hospital where the staff may not be alert to the problem.
The second symptom—actually set of symptoms—that surprised me involved cognition. These "non-motor symptoms" are receiving more attention now than they did when Sandra was diagnosed. At that time, Parkinson's was thought of as movement disorder. But more and more, clinicians are appreciating the effects on cognition.
With Sandra, these started with problem in word-finding. We all have times when the word we want is "on the tip of my tongue," but we don't struggle with common words such as chair or rain. As her disease progressed, the range of words she had trouble with expanded. I became even better at the annoying habit of completing her sentences.
The non-motor symptoms that most surprised me were hallucinations and anxiety. Her hallucinations were usually benign. There was someone else in the room, or perhaps a child or pet, although sometimes she would awaken insisting the boat we were on was sinking.
She also began having bouts of anxiety over problems that didn't exist. "We have to get the checks in the bank," when there were no checks.
I hadn't expected these symptoms and while they progressed slowly, giving me the chance to adapt, they were an unwelcome complication. Today, doctors appreciate the incidence and impact of non-motor symptoms, and the range of treatments is expanding. But it is becoming clear that Parkinson's is more than just tremors and stiffness. As if that wasn't enough.