Complications:

Parkinson's disease (PD) is not fatal, but it can reduce longevity. The disease progresses more quickly in older patients, and may lead to severe incapacity within 10 - 20 years. Older patients also tend to have freezing and greater declines in mental function and daily functioning than younger people. If PD starts without signs of tremor, it is likely to be more severe than if tremor had been present.

Parkinson's disease can seriously impair the quality of life in any age group. The physical and emotional impact on the family should not be underestimated as the patient becomes increasingly dependent on their support.

Treatment advances are increasingly effective in alleviating symptoms and even slowing progression of the disease. Taking many of the medications over time, however, can produce significant side effects. Newer drugs may help reduce these occurrences.

Swallowing Problems

Swallowing problems (dysphagia) are sometimes associated with shorter survival time. Motor impairment of the muscles in the throat not only impairs swallowing (leading to malnourishment) but also poses a risk for aspiration pneumonia.

Impact on Emotions

Depression is extremely common in patients with Parkinson's. PD poses multiple threats on the emotional health:

• The disease process itself causes changes in chemicals in the brain that affect mood and well-being.
• The complications of its symptoms have a profound impact on daily life that can be emotionally devastating without help and support.
• Some drug treatments (levodopa combined with a dopamine agonist) can cause compulsive behavior, such as gambling, shopping, and increased sexuality. Patients who have pre-existing tendencies to novelty-seeking behavior, or a family or personal history of alcohol abuse, may be more likely to develop compulsive gambling. Deep brain stimulus (DBS) surgery may also increase the risk for compulsive gambling in patients who have a history of gambling.

Effects on Thinking and Mental Status

Impaired Thinking (Cognitive Impairment). Defects in thinking, memory, language, and problem solving skills may occur early on in untreated patients or late in the course of the disease. Medications may play a role in thinking problems. Patients with PD are slower in detecting associations, although (unlike in Alzheimer's disease) once they discover them they are able to apply this knowledge to other concepts.

Dementia. Dementia is three to six times more common in the elderly Parkinson patient than in the average older adult. It is most likely to occur in older patients who have had major depression. PD marked by muscle rigidity (akinesia), rather than tremor, and early hallucinations also increase the risk for dementia. (Visual hallucinations can also occur in about a third of patients from PD medication.) Unlike in Alzheimer's, language is not usually affected in Parkinson's related dementia.

Other Problems that Impair Daily Life

A number of other problems associated with Parkinson's disease affect daily life.

Vision Problems. Vision is also affected, including impaired color perception and contrast sensitivity. These problems progress and can impair motor functioning.

Sleep Disorders. Excessive daytime sleepiness and other sleep disorders are common in PD, both from the disease itself and the drugs that treat it. Many patients also suffer from nighttime leg cramps. Some of the medications used for Parkinson's may cause vivid dreams as well as waking hallucinations.

Impaired Sexuality. Although Parkinson's disease and its treatments can cause compulsive sexual behavior, the disease can also affect patients' self-esteem and inhibit sexuality.

Worsened Sense of Smell. Many patients experience an impaired sense of smell.

Increased Risk for Other Medical Conditions

Osteoporosis. Parkinsonâ ' s disease may increase the risk for low bone density and osteoporosis. Both men and women are at risk. Doctors recommend that patients with Parkinsonâ ' s disease get tested for osteoporosis, especially if they have problems with walking.