Non-motor symptoms 

When many people think of Parkinson’s, symptoms like tremor and slowness of movement often come to mind. But Parkinson’s is more than a movement disorder. 

Non-motor symptoms affect a person in ways not easily seen by others. These symptoms can impact someone’s quality of life and can be experienced before motor symptoms.  

Non-motor symptoms can vary substantially from person to person, and can be grouped into three categories:  

• Emotional (e.g., depression, anxiety, apathy)  
• Cognitive (e.g., problem-solving, speech, memory)  
• Autonomic (e.g., constipation, issues with sleep, pain)  

Emotional 

Parkinson’s can affect emotional health in many ways. Emotional symptoms may include: 

• Depression – persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in activities once enjoyed 
• Anxiety – persistent feelings of worry, fear, nervousness or jitteriness 
• Apathy – low or lack of motivation, desire, or interest in daily activities 

These symptoms may result from changes in brain chemistry caused by Parkinson’s. If left untreated, they can impact your quality of life and make it harder to manage your condition or respond well to treatment. 

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Cognitive 

Cognitive changes are common in Parkinson’s and can vary in type and severity. They may appear early in Parkinson’s progression or develop over time. Some of the most affected areas include: 

• Executive function – This involves planning, focusing, remembering, and multitasking. Many people with Parkinson’s find it harder to start, organize, or complete tasks—especially those with many steps. While it may take longer, tasks can often still be completed with patience and support. 

• Language and speech – Some people know what they want to say but struggle to find the words or speak clearly. This can be frustrating and lead to social withdrawal or misunderstandings with family and health care providers. Just as Parkinson’s can slow movement, it can also impact breathing, voice strength, and speech patterns. 

• Comprehension and memory – Some people experience trouble absorbing or processing information, which can make it harder to follow conversations, understand complex instructions, or complete daily tasks. Memory issues may also arise, adding to the challenges in day-to-day life. 

Some people may experience hallucinations or delusions on their journey with Parkinson’s. Hallucinations and delusions can happen at any stage of Parkinson’s due to changes in the brain but usually happen in later stages of the condition. Sometimes they are caused by issues separate from Parkinson’s, such as dehydration or bladder infection, or as medication side effects. 

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Autonomic 

The autonomic nervous system controls automatic body functions—like digestion, blood pressure, bladder function, and temperature regulation. Parkinson’s can disrupt these systems, leading to: 

• Constipation – A very common issue in Parkinson’s, often due to reduced dopamine levels that slow down gut movement. It can also be worsened by medications, inability to exercise regularly, or inadequate fluid and fiber intake. 

• Bladder problems – Many people experience overactive bladder, urinary urgency, incontinence, or frequent nighttime urination. These issues can result from the brain’s impaired ability to control the bladder. 

• Sleep disturbances – These may include acting out dreams (REM sleep behavior disorder), difficulty falling or staying asleep, night sweats, or fragmented sleep. Poor sleep can lead to excessive daytime fatigue and reduced quality of life. 

• Blood pressure regulation – Parkinson’s can impair the body’s ability to regulate blood pressure, leading to orthostatic hypotension—a drop in blood pressure when standing up. This may cause dizziness, fainting, nausea, “brain fog,” or weakness. 

• Sexual dysfunction – Decreased interest in intimacy or lack of arousal can sometimes occur as a result of physiological symptoms (e.g., troublesome motor symptoms, fatigue) and emotional symptoms (e.g., depression, apathy). Physical problems such as erectile dysfunction or vaginal dryness may also occur. 

• Drooling and dry mouth – Reduced automatic swallowing can cause saliva to pool and lead to drooling. On the other hand, some people experience dry mouth, often due to Parkinson’s itself, certain medications or the aging process. 

• Temperature sensitivity and sweating – Parkinson’s can interfere with the body’s ability to regulate temperature, causing excessive sweating or sensitivity to heat and cold. 

• Pain – While not always present, some people with Parkinson’s experience pain—usually related to joint stiffness or muscle rigidity, but it can also be more generalized. 

• Loss of smell – A common early symptom, reduced sense of smell can impact appetite and enjoyment of food, potentially leading to weight loss. 

These symptoms can appear at any stage of Parkinson’s—even years before a diagnosis. 

Managing non-motor symptoms 

Just as Parkinson’s affects each person differently, the type, frequency, and severity of non-motor symptoms can vary widely. Keep in mind that not everyone will experience every symptom listed. Importantly, most of the problems are not easily apparent to others, it is important to let your physician and care partner know what you are experiencing. 

There are many ways to manage non-motor symptoms, and doing so can greatly improve quality of life. While the root causes of many of these problems may be complex, there are a variety of treatment options available for symptom management. 

Approaches can include: 

• Medication – Some symptoms respond well to medications, such as antidepressants, cognitive enhancers, or treatments for constipation or sleep. 
• Counseling and support – Therapy can help with mood and coping strategies. 
• Exercise and activity – Regular physical activity can benefit both mood and cognition. 
• Healthy diet – A well-balanced diet can support digestive health and energy levels. 
• Routine and sleep hygiene – Establishing consistent daily routines can help regulate sleep and mood. 
• Working with your care team – Non-motor symptoms are best managed with a team approach. Talk to your neurologist, primary care provider, and specialists such as mental health professionals, physiotherapists, and dietitians.