Key takeaways
- Mental health conditions like depression and anxiety, as well as cognitive changes, are common in advanced Parkinson’s disease, affecting a significant majority of individuals.
- Several factors can contribute to mental health challenges, such as changes in brain chemistry, medication effects, reduced independence, caregiver strain, and social isolation.
- Various support options are available, including helplines, support groups, therapy, education, and focusing on general health. These support options can help individuals with advanced Parkinson’s and their caregivers navigate mental health concerns.
Parkinson’s disease (PD) is a progressive condition that affects the nervous system. While it’s best-known for causing movement-related symptoms, Parkinson’s can also affect areas of the brain involved in mood, sleep, attention, and learning.
Parkinson’s changes how certain brain chemicals (neurotransmitters), such as dopamine, acetylcholine, and serotonin, work. As levels of these chemicals decrease, movement may become slower or more difficult, and symptoms like tremors, muscle stiffness, and balance issues can appear.
Movement changes are often the most visible signs of Parkinson’s, but the condition affects much more than motor function.
Some people, especially in later stages of the disease, also experience emotional and cognitive challenges that can affect daily life and overall well-being.
Mental health conditions are common among people living with advanced Parkinson’s disease.
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Depression and anxiety are among the most common mood-related health conditions in Parkinson’s. A 2023 review found that up to 60% of people with advanced Parkinson’s experience symptoms of depression.
Cognitive changes, while not considered a mental health condition, are also common in Parkinson’s disease.
According to the American Parkinson Disease Association (APDA), about 25% of people experience mild cognitive impairment (MCI), which can involve noticeable changes in memory and thinking. For some people, these changes may appear earlier in the course of the disease.
Why mental health symptoms may increase as Parkinson’s advances
Parkinson’s disease affects the neurotransmitters in the brain that regulate mood, thoughts, and emotions. As levels of these neurotransmitters change over time, people may notice shifts in how they think, feel, and behave.
Brain chemistry is only part of the picture. Living with a progressive, chronic condition can also place an emotional strain on a person over time.
Managing symptoms, adjusting to changes in independence, and navigating daily challenges may lead to feelings such as frustration, anger, overwhelm, and hopelessness.
Not everyone living with Parkinson’s disease develops mental health concerns. However, several mental health and cognitive changes are more common with this condition, especially as it progresses.
Mild cognitive impairment (MCI) and dementia
MCI involves changes in memory and thinking that go beyond typical aging but are not severe enough to be classified as dementia.
Some people with Parkinson’s go on to develop Parkinson’s disease dementia, while others may develop other types of dementia related to advanced aging rather than Parkinson’s itself.
Depression
Depression involves ongoing feelings of low mood or loss of interest that can affect daily life. Symptoms may include changes in appetite or weight, difficulty concentrating, sleep problems, and lack of self-motivation.
Anxiety
Anxiety involves feelings of worry, fear, or unease. When these feelings are persistent, difficult to control, or interfere with everyday activities, they may be related to an anxiety disorder.
Psychosis
Some people with Parkinson’s may experience psychosis, which involves changes in how reality is perceived. These symptoms can include hallucinations, such as seeing or hearing things that aren’t there, or delusions, which are fixed beliefs that don’t align with reality.
In Parkinson’s disease, hallucinations are far more common than delusions. Psychosis symptoms are most often linked to side effects of dopaminergic medications, rather than being a direct feature of Parkinson’s itself. These side effects are more likely to occur after many years of treatment or when medications are used at higher doses.
Not everyone who takes dopaminergic medications will experience hallucinations or delusions. If these symptoms develop, a healthcare professional may adjust medications to help manage them.
Behavior and personality changes
Parkinson’s disease can also affect how a person expresses themselves, which may look like changes in behavior or personality. These changes aren’t always related to mood disorders, cognitive decline, or psychosis.
For example, Parkinson’s can affect speech and facial expression. Some people develop a softer voice, rapid or less clear speech, or reduced facial movement, sometimes called a “masked” facial expression. A person’s voice may sound flat or apathetic even when they’re not feeling depressed.
Parkinson’s may also affect motivation, impulse control, or social engagement. These changes can interfere with communication and relationships, especially if others misinterpret them as emotional withdrawal or personality change rather than symptoms of the condition.
Several factors may contribute to mental health challenges and cognitive changes as Parkinson’s disease progresses. These influences often overlap and can affect people differently over time.
Changes in brain chemistry
Parkinson’s disease affects brain cells that produce important chemical messengers. As these cells decline, levels of certain neurotransmitters change. These shifts can affect how the brain regulates mood, emotions, and thinking, which may contribute to mental health symptoms.
Medication effects
Medications play a crucial role in managing Parkinson’s symptoms by helping rebalance brain chemicals. For some people, however, these medications may also affect mood, thinking, or behavior, leading to mental health-related side effects.
Sleep problems
Parkinson’s disease is also associated with a range of sleep problems that can affect overall mental and emotional well-being. These may include insomnia, frequent nighttime awakenings, and conditions such as restless leg syndrome.
When sleep is disrupted or not restorative, it can have downstream effects. Ongoing sleep deprivation may increase the risk of cognitive decline and can worsen symptoms of depression and anxiety. Over time, lack of sleep may make it harder to manage both the physical and non-motor symptoms of Parkinson’s disease.
Reduced independence and mobility
Living with a progressive condition like Parkinson’s can place emotional strain on a person over time. Mobility challenges and changes in independence can be frustrating or overwhelming, which may affect mental well-being.
Social isolation
As symptoms progress, some people with Parkinson’s may withdraw from social activities. Feeling self-conscious about mobility changes or needing assistance with everyday tasks can make social situations harder to navigate.
Social isolation itself can also affect mental health. Reduced social engagement may increase the risk of anxiety and depression, and mental health conditions like depression can further increase the risk of isolation.
Caregiver strain
Mental health challenges can also affect caregivers. A 2023 review found that caregivers of people with Parkinson’s are more likely than the general population to experience anxiety and depression. Many caregivers report feelings of distress, guilt, helplessness, and frustration.
Caregiver strain can affect both the caregiver and the person living with Parkinson’s. Some people with Parkinson’s may feel guilt or worry about the burden they place on their caregiver, which can affect their own emotional well-being. At the same time, ongoing stress and fatigue can make it harder for caregivers to provide consistent support without additional help.
Recognizing caregiver strain and seeking support for caregivers may benefit the mental health and quality of life for everyone involved.
Support services are available in various forms.
Helplines
Helplines offer phone or text-based support and can help you connect with mental health services in your area. These services are available whether you’re in crisis or simply need someone to talk to.
- SAMHSA National Helpline: 1-800-662-4357
- Suicide Prevention & Crisis Service: 988
Support groups
Support groups can provide connection, understanding, and shared experiences with others who are living with Parkinson’s disease or caring for someone who is.
Therapy
Mental health professionals, such as counselors, psychologists, or therapists, can help diagnose and treat mental health conditions. They can also teach you new coping skills and tools to help manage stress, mood changes, and emotional challenges.
Helpful resources for finding therapy include:
Education
Learning as much as you can about mental health concerns related to Parkinson’s disease can be empowering. Understanding what’s happening and why may help you feel more prepared and involved in your care.
Focusing on general health
Prioritizing your overall health can support both physical and mental well-being. Even when you live with advanced Parkinson’s, focusing on sleep, nutrition, physical activity (as able), and social connection may help support your emotional health and well-being.
There’s never a wrong time to seek help for mental health concerns. If you experience new, sudden, or concerning symptoms, or if you aren’t sure whether what you’re feeling is typical, it’s OK to call your doctor or seek urgent care.
You may want to seek immediate medical help if you or a loved one notices any of the following mental health-related symptoms in Parkinson’s disease:
- suicidal thoughts or actions
- thoughts or behaviors of self-harm or harm to others
- severe hallucinations or delusions
- violent or unsafe behavior
- severe confusion or disorientation
- prolonged sleep deprivation
- rapid or significant changes in mood or personality
Parkinson’s disease affects more than just your motor function. Changes in your brain chemistry, along with the challenges of living with a progressive condition, can affect your emotional and mental well-being.
Depression and anxiety are common in Parkinson’s, but help is available. Support groups, helplines, and mental health professionals can help people with Parkinson’s and their caregivers navigate these challenges and find meaningful support.