• Orthostatic Hypotension: This refers to low blood pressure when standing up. Research indicates a possible link to a lack of noradrenaline in the brain associated with blood pressure control.
• Little or no swinging of arms when walking.
• Increased perspiration.
• Increased salivation.
• Constipation is very common and results both from the disease and side effects of medication.

• ‘Parkinson’s Mask’ or ‘Masked Facies’ refers to the vacant/fixed stare commonly observed with Parkinson’s patients.
• Visual disturbances. e.g. blinking and blink rate.
• Lack of gestures/expressions/animation associated with emotion, smiling, frowning and grinning.

• Hypophonia refers to softer/whispering voice.
• Hesitation and stumbling over words.
• Speaking in a monotonous tone.
• Slurred speech.
• Repeating words.
• Speech therapy can make a significant improvement.

PARKINSON’S SPEECH ISSUES

• Clearing throat.
• Chewing and swallowing.
• Prone to coughing, drooling (Sialorrhea) and choking.

• Olfactory disturbances.
  • Anosmia: an inability to perceive odors.
  • Hyposmia: decreased ability to smell.  Recent scientific evidence suggests this is a very early sign of Parkinson’s disease.
  • Can cause issues to due with a significant loss of appetite.
• Tingling.
• Numbness.
• Altered sense of pain.

• Changing sleep patterns including:
  • Broken sleep.
  • Insomnia.
  • Sleeping in the day.
• REM Behavior Disorder.
  • Associated with vivid dreams and nightmares.
  • Tendency to act out dreams during night.
  • Frequent dreams involving being threatened or attacked by person or animals.

PARKINSON’S  SLEEP ISSUES

• Lack of fine motor control causes dexterity issues and co-ordination problems.
• Micrographia. Parkinson’s patients handwriting typically becomes smaller, cramped and spidery.
• Practical issues such as problems dressing oneself.

• These can impact the persons ability to carry out certain activities safely e.g. use of machinery or the ability to drive can be affected.
• Worsening motor skills are related to reduced performance. As the changes are gradual, patients may not realize or be in denial that they are no longer able to carry out certain activities safely. Family members or the medical profession have a duty of care to intervene at this stage.

• Sleep problems.
• Depression.
• Muscle stress.
• Akinesia: This is the inability to initiate/carry out movements.
• Incorrect medication levels.

• This can include urinary incontinence or retention.
• Urination may be more frequent or even urgent.

• Altered libido. Although a  lower libido is typical, hypersexuality can result from taking levodopa and dopamine agonists.
• Males may experience erectile dysfunction.
• Females may experience vaginal dryness.

• Increased dry skin or scaling of face or scalp/dandruff.
• Other patients may experience an increased oily skin at the side of nose, forehead and scalp.
• Seborrheic dermatitis: Skin can look greasy, scaly and flaky and similar in appearance to ‘cradle cap’ seen with babies.