Abnormal Sweating Among Parkinson’s PatientsBy: Neal Hermanowicz, MD
Although many of us think of Parkinson’s disease as a medical disorder that causes shaking of the limbs, stiffness and slowness of movement, it can also cause other troubling problems that are less commonly known to be due to this illness. For example, problems with sleep are very common, affecting by some estimates 80 percent or more of people with Parkinson’s disease. A ruddy, red skin rash, often on the face or scalp, is another frequent but under recognized problem that accompanies Parkinson’s disease.
Other common symptoms that are not generally associated with Parkinson’s disease include problems that arise from malfunction of the autonomic nervous system. The autonomic nervous system plays an important role in maintaining several body functions that generally occur automatically with little or no conscious thought or awareness. Saliva production, as well as the bladder and bowels, are controlled to a great extent by components of the autonomic nervous system. When these nerves do not function properly, the result can be excessive saliva with drooling or dryness of the mouth, an over active bladder—urgency and frequency of urination, sometimes associated with incontinence—and constipation. The majority of people with Parkinson’s disease have one of these.
Disturbances of the autonomic nervous system can also produce changes in the appearance and temperature of the skin of the hands and feet, resulting in fingers and toes that are red and cold. Blood pressure regulation also is controlled partly via the autonomic nervous system. When there is a disturbance of the autonomic nervous system, people may notice symptoms of abnormally low blood pressure, especially with changes of posture, such as going from a seated to standing position. Extremes of Sweating
Abnormal sweating is another problem attributable to autonomic nervous system disturbance, and a symptom that I certainly hear about from many of my patients. This has been recognized by Parkinson’s physician specialists for some time. Both extremes of sweating can occur in Parkinson’s—too much sweating (also known as hyperhydrosis in medical jargon) as well as an abnormal reduction in the ability to sweat (hypohydrosis). Excessive sweating can literally drench one’s clothes, pajamas or nightgown. Although too little sweating doesn’t sound so bad, remember we cool ourselves by the evaporation of sweat from the skin. People who sweat too little may feel uncomfortably warm when everyone else feels the temperature is fine, and in a desert climate this can be downright dangerous. The Magnitude of the Problem
Although abnormal sweating has been recognized as a symptom of Parkinson’s disease for quite some time, it was just recently that this was looked at in a more formal fashion to determine just how commonly this occurs. A group in England undertook a study to identify the magnitude of this problem among people with Parkinson’s disease and their results have just been published in the journal Movement Disorders.
In this study, Dr. Niall Quinn and his colleagues in London and Nijmege, The Netherlands, used a formal questionnaire to ask 77 patients and 40 of their spouses about problems with sweating. In this study, 49 of the 77 people with Parkinson’s disease (64 percent) were found to have some problems with sweating, whereas only 5 of the 40 (12 percent) spouses identified sweating issues. Of the people with Parkinson’s disease who experienced a problem sweating, excessive sweating was more commonly reported than too little sweating.
In this study, the subjects reported that sweating problems seemed to occur most commonly in the “off” state, when medications had worn off, or in the “on” state, when medications allowed them to be mobile, and they experienced dyskinesias, or involuntary movements.
Abnormal sweating and other problems arising from the autonomic nervous system have been previously believed to be more common among people who have had Parkinson’s disease for a longer time, or more common among people who have more severe tremor, stiffness and slowness, but Quinn and his colleagues did not find this to be the case. They found no correlation of sweating abnormality to the length of time someone has had Parkinson’s disease, nor to the severity of disease. Quinn and colleagues also did not find any connection between sweating and the types of medication used to treat Parkinson’s symptoms. They did find that people with sweating problems were more likely to have other problems also arising from the autonomic system, like constipation and overactive bladder.