6 Signs Your Parkinson's Disease Is Progressing

Health Line

4 days ago

People move through the stages of Parkinson's at a different pace. At each stage, treatments are available to help as symptoms progress.
The progression of Parkinson's is described in five stages. Stage 1 is when early signs start to appear. Stage 5 describes the final stage of the disease, when a person needs around-the-clock nursing care.
For some people, it can take as long as 20 years to move through all the stages.
As you move through the stages, your doctor and care team will make changes to your treatment plan. That's why it's important to tell your doctor about any new symptoms or differences in how you feel.
1. Medication not working the way it used to
In the early stages, taking medication works well to manage symptoms. But as Parkinson's progresses, your medication may work for shorter periods of time, and symptoms may return more easily.
Many people notice a decrease in effectiveness after around 5 years. You may experience involuntary movements or be unable to move at all.
If you notice your medication becoming less effective, inform your healthcare provider. They may:
change the time of the day and frequency of when you use your medication
switch to sustained-release tablets (which release the drug gradually)
change the doses
prescribe additional medications such as COMT inhibitors, NMDA antagonists, anticholinergic drugs or MAO-B inhibitors
add a dopamine agonist in addition to levodopa
2. Increased feelings of anxiety or depression
Anxiety and depression have been linked to Parkinson's and may occur before movement issues. Up to 40% of individuals with Parkinson's will experience some form of anxiety, and up to 50% will experience some form of depression.
It's possible that changes in your emotional well-being can be a sign of changing physical health as well. If you are more anxious than usual, have lost interest in things, or feel a sense of hopelessness, talk with your doctor.
A combination of therapy and medication may be used to help manage symptoms of anxiety and depression. Non-pharmacological complementary approaches can include mindfulness practices and social support.
3. Changes in sleeping patterns
As Parkinson's progresses, you may also develop problems with sleep patterns. Alternatively, the onset of sleep disorders can precede movement difficulties. You might wake up often in the middle of the night or sleep more during the day than you do at night.
Excessive daytime sleepiness occurs in 30 to 50% of individuals with Parkinson's disease. It may be related to medications or poor sleep. Some ways you may be able to prevent this can include:
practicing good sleep hygiene, including a set bedtime and wake-up time
getting exposure to light during the day and darkness at night
avoiding sedentary activities during the day and getting regular exercise
Sleep apnea is also a common sleep disturbance, which occurs in 40% of people with Parkinson's disease. A CPAP machine can help treat it.
Another sleep disturbance for people with Parkinson's is rapid eye movement (REM) sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable — or even dangerous — if someone is sharing your bed.
There are medications your doctor can prescribe to help REM sleep behavior disorder, such as melatonin or clonazepam.
4. Involuntary movements
One of the most effective and commonly used drugs for Parkinson's is levodopa. Over time, as you need to take higher doses of the medication to work, it can also cause involuntary movements (dyskinesia). Your arm or leg might start moving on its own without your control.
Your doctor may adjust your medication dosage or prescribe additional medications, such as amantadine or anticholinergic drugs, to help reduce these involuntary movements.
5. Trouble swallowing
Difficulty swallowing may not present initially, but it can happen at any stage. Some people may experience it earlier than others.
Signs can include:
coughing during or right after eating
feeling like food is stuck or not going down properly
drooling more frequently
trouble keeping food or liquid in your mouth
frequently experiencing heartburn or sore throat
If you notice any changes in the way swallowing feels, speak to a speech-language pathologist. Your primary care provider can refer you to one. They will interview you about and observe your eating and swallowing.
From there, they may recommend training to help strengthen your respiratory muscles and making changes to your food to make it easier to swallow.