often becomes less animated (the so-called ‘poker’ or ‘mask’
face) and speech may become slower and more
monotonous, though it usually remains comprehensible.
• Stiffness of the muscles (rigidity) is the other major symptom.
Other symptoms can include tiredness, depression, difficulties with communication (including speech and facial expression), and balance problems.
My father, who has come to live with us, has Parkinson’s. I think he is settling down but he does not look very happy and hardly ever smiles. Is this the Parkinson’s too?
Almost certainly. Lack of facial expression is a feature of Parkinson’s (as mentioned in the previous answer) and is often noticed first by relatives, particularly husbands or wives. While it can be helpful to the specialist in making a diagnosis, it is a distressing feature of the condition for the people themselves and for their relatives and can lead to much misunderstanding. We have discussed this important topic further in Chapter 5 and 7.
Speech and language therapists can advise on ways of overcoming problems with facial expression. See the Physical therapies section of Chapter 3 for more information on the role of speech and language therapy in Parkinson’s. The PDS also has information on all aspects of communication and Parkinson’s.
I used to be proud of my handwriting and won prizes at school. Now it is small and spidery. Can I blame
Parkinson’s for this?
Writing is often affected by Parkinson’s. Characteristically it does get smaller (micrographia), and so you can probably blame your Parkinson’s for the change in your handwriting. There are other causes of handwriting problems although they rarely have the effect of making the writing smaller. For example, very trembly writing is usually caused by a form of essential tremor rather than by Parkinson’s. Difficulty with writing which is unaccompanied
by other problems is usually caused by writer’s cramp, which is a form of dystonia. (There is more information about essential tremor in the previous section of this chapter on Problems of diagnosis and more about dystonia in the next section on Other possible symptoms.)
An occupational therapist can advise on ways of overcoming problems with handwriting (see the Physical therapies section of Chapter 3 for more information on their role in Parkinson’s).
The PDS has an information sheet on Handwriting (FS23).
I love walking but now my feet do not always cooperate.
How does Parkinson’s interfere with walking?
Before we actually answer your question, we would like to stress how important it is for you to try and carry on walking, particularly as you like it so much. Keeping active, both mentally and physically, is a very important way of dealing with Parkinson’s. You might find that having a companion with you on your walks or simply using a walking stick will give you extra confidence and there are further suggestions in Chapter 9 which could help.
Parkinson’s can certainly affect walking in a number of ways through the combined effects of slowness and rigidity. As with most of the other features of Parkinson’s, it varies enormously between individuals and usually responds well to medication, especially in the early years.
The mildest way in which Parkinson’s affects walking is through the loss of arm swing on either one or both sides, something which does not have any serious ill effects. In time the walking can slow down and there is a tendency to hunch the shoulders; later it may develop into a shuffling, somewhat unsteady gait. At a more advanced stage, there may be particular difficulties with cornering, starting off and stopping, or going through doorways.
A physiotherapist can advise on ways of overcoming problems with walking. See the Physical therapies section of Chapter 3 for further information on their role in Parkinson’s. The PDS has an information sheet on Physiotherapy (FS42).
Sometimes when walking I stop suddenly and my feet seem to be stuck to the floor. I think it is called ‘freezing’.
What makes it happen?
You are quite right that this is known as freezing. Nobody under-stands quite why it happens. Sometimes it is triggered by being anxious or in an unfamiliar or crowded place. Approaching a doorway or negotiating confined spaces can create special problems, but at other times it can occur out of the blue. There are ways of trying to overcome it, which we will discuss in Chapter 3 on Treatment and Chapter 9 on Managing at home.
The PDS has an information sheet on Freezing (FS63).
I know that lack of balance and falling are fairly common among people with Parkinson’s. Why should this be?
Loss of balance and falling are indeed features of Parkinson’s, because the part of the brain that is affected by Parkinson’s is one of the areas which is important for balance. However, such problems are very rare in the early years, nor do they happen to everybody, however long they have had the illness. Chapter 9 on Managing at home gives some ideas that may help you overcome the problem. The PDS has an information sheet on Falls(FS39).
My husband’s voice has become quite quiet but, more upsetting for me, is the loss of colour and expression.
Is this a common feature of Parkinson’s?
Some people with Parkinson’s do get problems with their voices. It is rarely the first feature to be noticed and more often develops later when other parts of the body are more seriously affected. However, what you have noticed is not uncommon – that is that the voice becomes quiet and monotonous. The loss of colour and expression is upsetting for both the person with Parkinson’s and for those who are close to them. There is often, but not always, a good response to drug treatment. Speech therapy can help improve communication.
Chapter 7 on Communication contains more information.
I take my tablets and get around fairly well but I get dreadfully tired and often cannot do the things I want.
Why should this be?
Tiredness can be a feature of Parkinson’s, particularly if your response to treatment has not been very good. The extra effort needed for actions that used to be spontaneous can be exhausting. It may be worth asking your GP or specialist whether you are taking as much medication as is desirable, or whether it would be worth taking more, at least for a trial period. It is also possible that your tiredness is due to depression. Depression is an odd word often used differently by the man or woman in the street and by doctors. Sometimes people who would be diagnosed by doctors as depressed (and so considered for antidepressant medication) do not think of themselves as depressed. Rather they complain of being tired all the time, or of the response to their treatment being less good than they expected. There is a question at the beginning of the next section about depression in Parkinson’s. The PDS has an information sheet on Fatigue (FS72).
Are the symptoms likely to be worse when I am feeling under stress?
Very much so. In Parkinson’s, as in many aspects of life, stress is unhelpful: the more you are stressed, the worse your symptoms will appear to be. And just as anyone can tremble if they are very stressed, so stress is likely to exaggerate any tremor from your Parkinson’s.
It is actually quite difficult for any of us to recognize when we are under stress. There may be occasions when your doctor thinks some of your symptoms are related to stress, even though you yourself do not feel particularly stressed at that time.
Many people who are under stress also sleep badly. Sleep is important in Parkinson’s and, like most other people, you will probably feel better after a good rest. Keeping active and learning how to relax are important but, if you have serious problems with sleeping, you should consult your doctor.