Non-moter Sx in Parkinsons in afya

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Mask like facies, flexed posture, micrographia, drooling, psych (depression - 40%, dementia, psychosis, sleep distrubance) impaired olfaction, REM sleep behaviour disorder

''Anxiety''
may be related to "off" when motor Sx worse - Rx motor Sx may then dec anxiety
often occurs with depression (35% of those with PD get depression or anxiety)
may have number of triggers - identifying these may help Mx
CBT and SSRI help - avoid tricyclic and benzos as these may inc PD Sx

''Hypothyroid''
low mood, slowed down, weight gain despite poor appetite, expresionless face

''Depression''
low mood, poor concentration, early morning wakening, 
loss of intiative or motivation are features of PD, while loss of pleasure isn't
fatigue, lack of energy and sleep disturbance are features of PD
Apathy can occur separate to depression or fatigue

''Constipation''
try water, fibre (hard to swallow and chew), exercize (hard if severe PD)
avoid liquid paraffin as interferes with drug absorption and can cause lipoid pneumonia

''Bladder''
unstable bladder
difficulty emptying the bladder
poor mobility so difficult to get to the toilet in time

''Seborrhoiec dermatitis''
common with PD
Rx as for non PD

''Xs sweating''
can be caused by PD or by levodopa (including when wearing off)
Rx with BB
may esp occur at night

''Pain''
muscle pain is common (related to rigidity) and responds to PCM, exersize and physio
deep aching related to dyskinetic pain - esp when wearing off
akathisia (restlessness) - discomfort in legs esp at night
burning pain in mouth may occur

''fatigue''
common and difficult Sx - mental as well as physical
inc by daily variability of disease
lifestyle advice impt and cause eg PD or depression (as need to treat cause)

''eating and swallowing''
many issues due to not being able to close lips properly
leads to drooling, messy eating, fear of choking, painful dry swallow, 
altered taste from drugs
SALT may be able to help
high incidence of silent aspiration

''sleep disturbance''
may be increased by wearing off, seligiline may cause insomnia
PD triad makes it painful and hard to turn in bed (may hurt partner)
often nocturia is involved as is anxiety and depression
sleep hygiene, drug times, slippery sheets (satin) and bed rails - can all help
nightmares, sleepwalking and xs daytime sleepiness all occur

''Impulse control disorder''
eg. gambling starts (occurs during on phase)
hypersexuality

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