Disorders of taste (gustatory) and smell (olfactory) may occur normally with advancing years but suffering from a neurodegenerative disorder such as Parkinson’s disease seems to increase chances of such disorders.

Terms
The disorders of smell and taste may be classified as :

• Anosmia – complete loss of sensation of smell or the inability to detect any odor.
• Hyposmia – decreased ability to detect odor.
• Dysosmia – distorted identification of smell.
• Ageusia – complete loss of sensation of taste.
• Hypogeusia – decreased ability to taste.
• Dysgeusia – distorted ability to taste.

Causes of Taste and Smell Disorders in PD

• Age-related olfactory problems caused by epithelial changes in the olfactory system, such as decreased mucus secretion, hormonal changes, and changes in the epithelial thickness. With age, there is a reduction in the number of taste buds in the tongue, roof of the mouth, and throat, but more than this, the changes in taste cell membranes involving altered function of the receptors may be responsible for loss of taste.

• The changes brought about by PD itself and the side effects of PD drugs could possibly have some relation to the smell and taste disorders seen in these patients.

• Problems with taste may also arise due to poor oral hygiene and dental problems seen in many PD patients.

• An alteration in taste or smell may be the primary feature or a secondary symptom of some other disease occurring concomitantly with PD, such as Alzheimer’s disease, nose or sinus problems, use of certain antibiotics or antihypertensives.

It is uncommon to suffer from complete loss of taste. Dysgeusia is the more common symptom likely to occur, especially with increasing age. Most taste disorders are actually, if not very closely related to, smell disorders.

Risks

Loss or impaired sensation of taste and smell may lead to :

• Dangers such as the inability to detect smoke in case of a fire, gas leaks or other dangerous fumes, which can be potentially life-threatening.
• Inability to identify spoiled food thereby leading to food poisoning.
• Increased salt or sugar intake in an attempt to make food taste better (may have disastrous consequences on a hypertensive or diabetic patient).
• Loss of appetite or less enjoyment of food, leading to nutritional deficiencies.
• Anxiety.
• Depression.

Loss of taste and smell can have a significant impact on the quality of life, not least due to impaired enjoyment of food.
An otolaryngologist should be seen in order to diagnose and detect the extent of taste and smell loss in a person. Although age-related loss of taste or smell cannot be stopped or reversed, some causes may be treated, such as taking care of dental problems, or changing or altering doses of medication which could be contributing to the problem.

Early Signs and Symptoms of Parkinson’s Disease

Although tremor, rigidity, bradykinesia (slowness of movement), and loss of postural reflex are considered to be the characteristic features of Parkinson’s. However, not all these symptoms are likely to be present in all patients in the early stages of Parkinson’s disease. Symptoms vary from person to person, and the onset may be so slow as to remain unnoticed for several years.

Some of the very first signs and symptoms likely to be observed are :

• A change in facial expression may be one of the earliest signs. Others may notice the expressionless face and fixed staring gaze without blinking of the eyes (“masked face”). Loss of animation is sometimes mistaken for depression.

• A barely noticeable tremor, usually on one hand, when the hand is at rest is among the first sign noticed by a person or their loved ones. It is also the first symptom which prompts many patients to seek medical help. The tremor may get worse when the person is agitated or stressed. Tremor of the lips, tongue, or chin may also be present. The typical “pill-rolling” tremor of Parkinson’s disease (repeated rolling of the thumb over the fingers) may be observed.

However, some PD patients may not suffer from tremor, which may cause a delay in diagnosis or even misdiagnosis of the condition. Other features that may be noticed include :

• The symptoms are initially present on one side of the body.
• A feeling of internal trembling.
• A general feeling of fatigue and ill-health.
• Loss of arm swing while walking.
• Walking with short shuffling steps and a tendency to lean forwards or backwards while walking.
• Unsteady gait.
• Frequent falls.
• Unnatural posture.
• Walking in a stooped position.
• Slowness of movement, especially in initiating a movement, such as getting up from a chair and walking.
• Sudden freezing of movement while walking, with the person being unable to go forward without assistance.
• Soft, hesitant, slurred speech. The person may speak in a monotone.
• The handwriting may gradually become smaller and end off in a scrawl (micrographia).
• Muscle stiffness, often leading to pain, which may be mistaken for arthritis.
• Irritability, depression, or decreased concentration level may be noticed.
• Memory problems.
• Evidence shows that mood disorders and sleeping problems can start many years before the typical symptoms of PD become evident.

Detection of early symptoms of Parkinson’s disease can help to slow progression of the disease by starting treatment as soon as possible. However, many Parkinson’s patients are either embarrassed or in denial about the first signs and symptoms and often wait till they are unable to cope or pressurized by a loved one to seek medical help.

Cognitive Abilities in Parkinson’s Disease

Cognitive disturbances, as well as mood and behavior alterations, can be as traumatic and frustrating as any physical problem, both for the patient as well as the caregiver. Cognitive deficits can be present even in the early stages of Parkinson’s disease, gradually worsening as the disease progresses, and may ultimately lead to dementia. A person with PD is at a greater risk of developing dementia and this risk gradually increases in proportion to the duration of the disease.

Cognition relates to higher level functions of the brain and may be defined as the mental process involved in gaining knowledge and understanding, which includes the process of thinking, knowing, learning, remembering, decision making, judging and problem solving. Language, imagination, perception and planning are the necessary components.
People with PD often have trouble processing two cognitive acts simultaneously. Mild cognitive impairment may be present in most people with PD. Stress, depression, sleep disturbances, or medication can lead to such changes.

The cognitive deficits seen in PD patients (subcortical dementia) are similar to those caused by frontal lobe damage. Due to the degeneration of the cells of the part of the brain known as substantia nigra in the basal ganglia, there is deficiency of the chemical transmitter dopamine. As a result, there is dysfunction of the circuits connecting the frontal lobe of the brain and the basal ganglia, causing problems with memory, language, concentration, attention, visuo-spatial functions, and executive function of the brain.

Memory Loss in Parkinson’s Disease

Anything that affects cognition can affect memory too. However, sometimes it becomes difficult to differentiate memory loss or impairment due to PD from that due to normal aging process.

Subcortical cognitive deficits, as seen typically in PD patients, are characterized more by problems with memory recall (especially of recent events) than by memory formation, decrease in mental speed or slowed thinking (bradyphrenia), and apathy. It is not that PD patients suffering from bradyphrenia are unable to think. It is only that their thinking process is slow, so they need time to answer questions or make decisions.

Executive impairment may be more pronounced than language deficit. Executive functions involve higher level thinking skills such as logical thinking, prioritizing, organizing, planning, and executing. Dementia may be accompanied by psychosis, agitation, and sleep disturbances.

Personality Changes in Parkinson’s Disease

Personality changes occur frequently in people with PD. Frontal cortical damage could account for some of the behavioral and personality changes that are seen in PD patients, such as depression, mental lethargy, mood swings, and irritability. On the other hand, obsessive compulsive behavior such as binge-eating, hypersexuality, and pathological gambling may be related to some drugs used to treat PD.

A Parkinson’s personality is often mentioned in relation to PD patients. Certain personality traits have been noted in people with PD which includes being hard-working, ambitious, serious-minded, dogmatic and honest. They are less likely to have any addictions to alcohol, tobacco or drugs. These traits may be present even before the development of PD. One theory that may explain this is that loss of dopamine (which is thought to be responsible for these personality traits) starts long before the manifestation of motor symptoms.

]]> http://pdring.com/brain-functioning-and-personality-changes-in-parkinson%e2%80%99s-disease.htm/feed 5 http://pdring.com/dental-diseases-and-oral-health-in-parkinson%e2%80%99s-patients.htm http://pdring.com/dental-diseases-and-oral-health-in-parkinson%e2%80%99s-patients.htm#comments Tue, 20 Jul 2010 22:49:02 +0000 Dr. Chris http://pdring.com/?p=234 As Parkinson’s disease progresses, many other symptoms and problems start developing, some due to the disease process itself and others due to the effects of natural aging. Of these, dental diseases and the problems associated with them need to be tackled as soon as possible so as to make the patient’s life more comfortable.

Causes of Dental Diseases in Parkinson’s Disease

• Motor problems such as tremor and rigidity may make it difficult for a Parkinson’s disease (PD) patient to brush their own teeth. Without proper assistance, a patient may be unable to tend to their daily dental hygiene regimen, which may lead to tooth decay.

• Certain PD drugs cause xerostomia or dry mouth. Lack of or diminished saliva in the mouth can cause tooth decay and periodontal (gum) diseases since saliva is necessary to fight off bacteria in the mouth which cause these dental problems.

• Necessary dental procedures may be difficult to undertake in a PD patient especially where muscle rigidity, tremor, or other types of agitation prevent the patient from remaining still in a dentist’s chair.

• Bruxism or tooth grinding, especially at night, is common in PD patients and can cause abnormal wear and tear of the teeth. It may also contribute towards temporomandibular joint (TMJ) dysfunction.

Behavioral changes in PD such as disinterest, apathy, forgetfulness and depression may make a PD patient take less interest in maintaining proper dental hygiene.

• Developing a “sweet-tooth” by taking easier to eat carbohydrates in the form of sweets and desserts can increase the risk of cavities.
• Poor denture care.
• PD patients with cognitive changes are more likely to miss dental appointments, or neglect to report dental pain or other problems to their dentist or caregiver. Therefore dental problems may only be noticed at a much later stage.

Types of Dental Diseases

Due to the above factors, a Parkinson’s patient may be more likely to suffer from the following :

• Tooth decay
• Dental cavities
• Toothache
• Accumulation of dental plaque
• Periodontal disease, such as periodontitis or gingivitis (gum inflammation)
• Teeth damage caused by bruxism can present as broken, chipped, or sensitive teeth. There may be associated soreness in the mouth, pain in the teeth and gums, jaw pain, earache, and headache.

Effects of Poor Dental Health

• Chewing difficulties – there is a tendency to avoid food that needs to be chewed, resulting in poor nutrition and weight loss.
• It can lead to swallowing difficulties.
• Speech impairment, frequently due to loose or missing teeth, and defective dentures.
• Difficulty with dentures – small partial dentures may be dislodged and swallowed, while larger dentures may not fit properly. Ill-fitting dentures can cause pain and ulceration of the supportive gum tissue.
• Change in facial contour, distortion of face and lips.

The above factors can lead to loss of self esteem and social isolation.

Management

• Regular dental checkups by a dentist, at least every 6 months.
• Regular brushing with a fluoride toothpaste to fight tooth decay.
• Use of toothbrushes with specially designed handles for better grasp or using an electric toothbrush.
• If chewing is a problem, eat smaller quantities or avoid food that needs chewing and opt for more soft or pureed food.
• Ask for assistance with daily oral and dental hygiene.
• Medicines to stimulate saliva production.
• Mouth guards or dental appliances to protect the teeth against the effects of teeth grinding.

References

1. Dental Health and Parkinson’s Disease. Parkinson’s Disease Foundation
2. Oral Health Conditions in Patients with Parkinson’s Disease. PubMed.gov

It is quite possible, however, for a person with Parkinson’s disease to also suffer from some pre-existing lung or heart condition which may cause some amount of breathing difficulty. If shortness of breath, wheezing, cough or chest discomfort does develop, even without a known medical problem, careful assessment and treatment is definitely indicated.

Causes of Breathing Difficulty in Parkinson’s Disease

Dyspnea, breathing difficulty, or shortness of breath – whatever you may choose to call it – can be very distressing, and even frightening, for the person who suffers with it, especially if there have been severe episodes. The causes could be any of the following :

• Chronic lung diseases such as COPD (chronic obstructive pulmonary disease), chronic asthma, emphysema and chronic bronchitis or an acute exacerbation, can cause shortness of breath accompanied by wheezing, cough or chest discomfort.

• Pneumonia.

• Pulmonary embolism.

• Pulmonary hypertension.

• Heart failure and other heart conditions such as myocardial infarction (heart attack).

• Stroke. The symptoms of a stroke may sometimes be missed in the late stages of Parkinson’s disease as caregivers may mistaken the presentation for the progression of Parkinson’s disease.

• Choking on an object.

• Severe anemia.

• Allergic reactions. This should be monitored carefully to assess if the reaction is caused by any medication.

• Common cold, sinusitis or other nasal problems.

• High fever.

• Associated diseases such as lung cancer or tuberculosis.

• Anxiety or panic attacks. Parkinson’s disease patients often suffer from depression, anxiety disorders, dementia and other emotional problems. This could sometimes be the cause of hyperventilation and breathing problems. When all other causes have been excluded, this diagnosis should be kept in mind.

Shortness of breath could be due to any of the above causes or it may be a symptom of end stages of Parkinson’s disease.

Risk Factors

The associated risk factors may include :

1. Air pollution.
2. Smoking.
3. High altitude.
4. Obesity.

Diagnosis

It is important to diagnose the cause of the breathing difficulty. If the patient has a known medical condition other than Parkinson’s disease, diagnosis becomes easy. Even so, a thorough physical examination will need to be conducted along with other tests if indicated. This may include :

• Blood tests, including arterial blood gases, especially oxygen saturation.
• Chest x-ray.
• ECG.
• Echocardiogram.
• Pulmonary function tests.
• Spirometry.
• Methacholine challenge test.
• Allergy tests.
• CT scan.

Prevention and Treatment

• Regular exercise as appropriate, keeping in mind the condition of the patient suffering from Parkinson’s disease.

• Giving up smoking is very important.

• Immunization. Bed-ridden, depressed and immobile Parkinson’s disease patients are very susceptible to contracting infections because of their low immunity status. Appropriate vaccinations should be administered to prevent infections such as the flu and pneumonia.

• A nutritious diet, including fruits and vegetables, help to build up the immune system. Vitamin and zinc supplements may also help. Avoid close contact with others who have a cold, flu or other infectious diseases.

• Medication to relieve breathing difficulty should only be used if your doctor prescribes it in order to reduce the chances of drug interactions with Parkinson’s disease medicines.

• Oxygen administration can help when breathing difficulty becomes severe. Hospitalization may become necessary at this stage.

How Does Acid Reflux Occur?

When food is swallowed, it moves down through the esophagus (food pipe) into the stomach. The esophageal sphincter, situated between the esophagus and the stomach, opens to allow this action to take place and closes back again so that the food does not go back into the esophagus. In this way, the esophageal sphincter acts as a one way-valve.

In certain situations, the lower esophageal sphincter (LES) becomes weak, so that the stomach contents push against it and give rise to a feeling of fullness, or the stomach acids may regurgitate or flow back into the esophagus through the weakened sphincter and cause a burning sensation in the throat. If the condition is mild, the patient may suffer from heartburn once in a while, but if this acid reflux occurs frequently, the patient is said to be suffering from GERD.

Why are Parkinson’s Disease Patients more Prone to Acid Reflux?

• There is slower action of the nerves supplying the gastrointestinal tract in people suffering from Parkinson’s disease, so that movement of food during the process of digestion is slowed down. Food remaining in the stomach for long causes acid and gas build-up.

• The esophageal sphincter is frequently weakened in a Parkinson’s patient.

• Parkinson’s disease drugs (anticholinergics and dopamine) can cause or aggravate acid reflux.

Symptoms of Acid Reflux

• Heartburn – a burning sensation in the chest, under the sternum (breast bone), usually after a meal. This may be worse at night or on lying down. It can also be aggravated by a heavy meal or on bending or lifting a heavy weight after a meal.
• Belching or burping.
• Regurgitation of food.
• Nausea or vomiting.
• Difficulty swallowing.
• Chest pain.
• Chronic cough.
• Sore throat.
• Hoarseness.

Diagnosis of Acid Reflux in Parkinson’s Disease

Diagnosis can usually be made on the basis of signs and symptoms. If necessary, the following investigations may be done :

• Esophageal gastroduodenoscopy – to detect signs of acid reflux and changes in the esophagus.
• Barium swallow – to detect signs of regurgitation.
• Manometry – to measure pressure of the sphincter muscle.

Treatment of Acid Reflux in Parkinson’s Disease

Certain dietary and lifestyle changes can help.

• Avoid rich, spicy or acidic food and caffeinated drinks.
• Avoid eating anything for several hours before bedtime.
• Eat small frequent meals.
• Avoid alcohol and tobacco.
• Avoid lying down, bending or lifting weights after a meal.
• Lose weight if obese.
• Avoid wearing tight clothes or belts.
• Raise head-end of the bed.
• A change in Parkinson’s disease drug therapy if the symptoms are severe.
• Medication such as antacids, histamine H2 blockers, proton pump inhibitors or a prokinetic drug like metoclopramide may help. Always speak to your doctor about drug interactions before starting any medication.
• Alternative therapies, including homeopathy and herbal treatment should be done only after consulting with the supervising doctor.
• Surgery – a procedure called fundoplication may be done if the symptoms are severe and all other treatments fail.

Dysphagia can lead to shorter survival time in a patient with Parkinson’s disease, not only because the affected muscles of the throat may make swallowing difficult – hence less food intake and increased chances of under-nutrition of the patient – but also because it increases the possibility of aspiration pneumonia.

How does dysphagia occur?

The act of swallowing can be divided into 3 phases – oral, pharyngeal and esophageal. Parkinson’s disease patients usually have problems with the first 2 stages of swallowing, which means that their dysphagia is of the oropharyngeal type. Weak tongue or cheek muscles make moving food around in the mouth difficult and can hamper chewing. Along with that, the weak throat muscles cannot sufficiently move the food towards the esophagus.

Causes of Dysphagia in Parkinson’s Disease

A number of factors may contribute to swallowing problems in Parkinson’s disease.

1. Motor impairment of the throat muscles as a result of Parkinson’s disease.
2. Dysphagia can be made worse by lack of saliva or dry mouth. This is common in Parkinson’s disease patients, frequently related to anticholinergics medication. Refer to Parkinson’s Disease Drugs.
3. Since Parkinson’s disease is more common in the elderly, associated features such as poor dentition can play a role.

Diagnosis of dysphagia in Parkinson’s Disease

When a person with Parkinson’s disease has problems with swallowing, a proper history and examination of the patient will help to determine the severity of dysphagia and evaluate the risk of aspiration. This is usually done by the doctor as well as a speech-language pathologist. Certain tests may also be done such as :

1. Video-fluoroscopy.
2. Endoscopy.
3. Barium swallow.

Complications of dysphagia in Parkinson’s Disease

• Food and saliva which cannot be swallowed may collect in the mouth or back of the throat and cause choking, coughing or drooling.
• Aspiration pneumonia – due to food or liquids being inhaled into the lungs.
• Weight loss – this can be an indicator of the severity and duration of dysphagia.
• Malnutrition.
• Shorter survival time in a patient with Parkinson’s disease.
• Apart from the physical problems faced due to dysphagia, certain psychosocial problems may also occur. Difficulty in swallowing can make patients dread meal times. The fear of choking is very real in some people. There is less enjoyment of food, especially due to the adjustments needed regarding the type of food that can be easily swallowed. Social adjustments, such as avoiding guests during meal times or going out to dinner can take its toll, both on the patient as well as the care-giver.

Treatment of dysphagia in Parkinson’s Disease

• Intensive swallowing therapy by a speech-language pathologist can help to overcome the weakness in the swallowing apparatus by strengthening exercises or compensatory maneuvers.
• Sitting up straight and keeping the head slightly forward while eating may help.
• Modifications in diet, such as eating soft and pureed food can help.
• Gastric feeding tube in end stages of the disease may become necessary.

Physiotherapy and a home exercise program for Parkinson’s patients do help to prevent this muscle atrophy to a certain extent. Apart from muscle atrophy, some amount of cerebral or brain atrophy is also to be expected in people suffering from Parkinson’s disease, which is in excess to that found in normal people, taking into account the age of the patient in both circumstances.

Signs and Symptoms of Atrophy in Parkinson’s Disease

Muscle Atrophy

The muscles of the body may look small and show decrease in bulk. There will be loss of tone and weakness in the muscles. There may be difficulty in standing and walking when the leg muscles are involved or generalized weakness of the body may be present. Muscle twitching or spasms, often painful, may occur especially in the legs.

Cerebral Atrophy

Dementia and decreased cerebral function may occur as a result of cerebral atrophy, where the brain cells and tissues gradually decrease and cause the brain to shrink. There may be associated problems with speech and vision too.

Diagnosis of Atrophy in Parkinson’s Disease

Diagnosis can be made by taking the history and by examination of the patient.

CT scan or MRI can help in diagnosis, both for muscle as well cerebral atrophy.

Treatment of Atrophy in Parkinson’s Disease

Since the main cause of muscle atrophy in Parkinson’s disease is restricted movement and reduced physical activity, these issues have to be addressed aggressively for prevention as well as treatment of atrophy. Because of their symptoms of rigidity or lack of muscle co-ordination, people with Parkinson’s disease tend to avoid physical activities.

They have to be motivated to do simple aerobic exercises such as walking, cycling or swimming if their condition permits. Aquatic exercises which are performed in a warm pool help to improve muscle tone. Exercises to involve full range of movement of the body, especially the arms and legs, should be encouraged. Yoga and Tai chi exercises help to improve muscle tone and improve strength in the muscles.

For the bedridden patient or in those who cannot undertake these forms of exercise, a physiotherapist could help with other forms of passive exercises and limb movements. Many patients find benefit with massage therapy although this is not as effective as rehabilitation physiotherapy treatments.

In addition, good nutrition is very important in improving muscle bulk and reversing or preventing some amount of muscle atrophy. A reduced protein intake will speed up the loss of muscle bulk and in Parkinson’s patient with a poor diet, this will exacerbate the problem of muscle atrophy.

Adequate treatment of Parkinson’s disease itself as well as certain drug treatment may be of some help to relieve symptoms of cerebral atrophy. However stopping this form of atrophy with conservative measures is unlikely.

Types of Skin Problems in Parkinson’s Disease

• Oily skin. There is excessive oiliness of the skin on the face, especially on the forehead and on the sides of the nose, making the skin look greasy and shiny.
• Dandruff. The scalp may become oily, resulting in greasy hair and dandruff.
• Seborrheic dermatitis. Inflammation of the skin may occur, causing the skin to become red and itchy, with a tendency to flake.
• Dry skin. In some cases there is extreme dryness of the skin due to too little perspiration.
• Excessive sweating. Too much perspiration can be a distressing symptom.
• Night sweats are quite common in patients with Parkinson’s disease.

Causes of Skin Problems in Parkinson’s Disease

Skin problems may occur as a result of Parkinson’s disease and improper functioning of the autonomic nervous system, or sometimes as a side effect of anti-Parkinson drugs.

• The sebaceous glands in the skin produce sebaceous matter or sebum, which help to protect the skin and keep it supple. Excessive production of sebum may occur in Parkinson’s disease and the areas that contain more sebaceous glands, such as on the forehead, beside the nose, and scalp are more severely affected. This causes oily skin and dandruff and in extreme cases the skin may become red, inflamed and itchy. Heat may exacerbate this problem.
• In Parkinson’s disease, sweat glands may produce too little or too much sweat, causing problems of dry skin or excessive perspiration. Anti-Parkinson drugs also have side effects causing too much sweating (with medicines such as levodopa), or too little sweating (due to anticholinergics).

Treatment of Skin Problems in Parkinson’s Disease

• For oily and greasy skin, standard treatments, such as using a neutral soap (unscented glycerin soap) and washing the skin twice daily with warm water and rinsing with cold water, do help. It is preferable to use gels since they are water based, than creams which are oil based. In more severe cases, a cream containing sulfur and salicylic acid may give better results.
• Various lotions and shampoos are available for treatment of dandruff. Selenium or selenium sulfide containing products may give good results.
• Seborrheic dermatitis may need treatment with lotions containing a steroid such as adrenocorticotrophic hormone, or a ketoconazole containing cream. Coal tar shampoo may be effective for forehead and eyebrows.
• Taking lukewarm showers, wearing light cotton clothes in summer, and drinking plenty of water and liquids are helpful in combating the effects of excessive perspiration. Excessive sweating may sometimes be due to side effects of anti-Parkinson drugs such as levodopa or can occur during the “wearing off” period of levodopa treatment -adjusting the dose, using a controlled release levodopa preparation, or COMT inhibitors may help. Beta-blockers, anticholinergics, or use of astringents containing glutaraldehyde also help in some cases.
• Too little perspiration may be helped by reducing the dose of anti-Parkinson medicines such as anticholinergics.

Types of Eye Problems in Parkinson’s Disease

• Blurred vision or difficulty in focusing may be due to difficulty in moving the eyes or due to the side effects of Parkinson’s drug therapy, especially anticholinergics. This problem may occur on starting treatment with anticholinergics, but normally improves over time. It may also occur with long-term treatment with anticholinergics or after some dose adjustments.
• Double vision usually occurs in Parkinson’s disease due to problems in moving the eyes in alignment from side to side, such as when reading. This occurs as a result of impaired coordination and fatigue of the muscles moving the eyeballs.
• Excessive tearing (lachrymation) of the eyes.
• Dry eyes is caused by reduced blinking of the eyes.
• Difficulty in moving the eyes may be manifested in two ways : (i) difficulty in starting a movement of the eyes or (ii) problem with moving the eyes quickly when following a fast moving object. Instead of moving smoothly, the eyes move in a slow and jerky way. Driving a vehicle may pose difficulties.
• Sensitivity to contrast – there may be difficulty in seeing in dim light, or making out light colored objects against a light background, or difficulty in reading fine print.
• Color vision may be affected for differentiating between slight color differences, especially for shades of blue or blue-green.
• Problem with visuo-spatial orientation or depth perception – the person may have difficulty in assessing the distance between objects and may need to reach out to touch the sides of the wall or objects while walking through a narrow place. This may create problems while walking or driving.
• Glaucoma and anti-Parkinson’s medication – levodopa and anticholinergics should be used with caution in patients with glaucoma.
• Some patients with Parkinson’s disease cannot judge the speed of moving objects, which may be dangerous if driving or trying to cross the street.
• Hallucinations and illusions or visual misinterpretations are more likely to occur in those people who have had Parkinson’s disease for a long time. It may be due to the disease itself or due to anti-Parkinson drugs.
• Blepharospasm or involuntary spasm of the eyelids.

Treatment of Eye Problems in Parkinson’s Disease

• Blurred vision – modification of anticholinergic medicine dose and adjustments in power if wearing glasses.
• Double vision – improves with anti-Parkinson medicines and by resting the eye.
• Dry eyes – using artificial tear drops and avoiding dry, hot and smoky places.
• Difficulty in moving the eyes – usually improves with anti-Parkinson drugs.
• Sensitivity to contrast – improves with treatment by levodopa.
• Color vision – problem may improve with anti-Parkinson medicines.
• Hallucinations – reducing the dose of anti-Parkinson drugs and use of neuroleptics such as clozapine and quetapine.