October 26, 2026

@michaelokun

Parkinson’s is more than movement: The emotional ONs and OFFs we may be missing. This important review by Sousa and colleagues resonates deeply with me because it highlights something I have witnessed repeatedly in caring for people with Parkinson’s disease: sometimes the most disabling fluctuations are not the ones we can see. We spend enormous amounts of time measuring tremor, stiffness, dyskinesia, and walking, yet we may miss the anxiety, sadness, apathy, fatigue, and difficulty thinking that can emerge as Parkinson’s medications wear off. Equally important, when dopamine levels rise, some people experience dramatic changes in mood, energy, impulsivity, and behavior. These neuropsychiatric fluctuations can occur even when movement seems relatively unchanged, and their impact on quality of life can be profound. What particularly resonates with me is the authors’ call to recognize these fluctuations earlier, ask better questions, and tailor treatments to the whole person rather than simply their motor symptoms. We still need better tools and stronger clinical trials, but this review reminds us of a fundamental principle of Parkinson’s care: we are not just treating movement; we are treating a person whose emotions, motivation, thinking, and sense of self matter every bit as much. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.70771