Dizziness is a commonly reported non-motor symptom for individuals living with Parkinson’s disease (PD). While PD is primarily recognized for motor symptoms like tremor and rigidity, feelings of lightheadedness, unsteadiness, or faintness are frequently experienced. These sensations, broadly defined as dizziness, significantly impact daily life and increase the risk of falling. Dizziness is highly prevalent, reported in almost half of patients, even in the early stages of the disease. This symptom stems from a combination of underlying disease-related changes and medication side effects, rather than being a direct result of the movement disorder itself. Understanding the specific causes is the first step toward effective management.
The Connection to Autonomic Dysfunction
The most common physiological cause of dizziness in PD is neurogenic orthostatic hypotension (nOH). This condition arises because PD affects the autonomic nervous system, which controls involuntary functions like heart rate and blood pressure. When a healthy person stands up, the autonomic nervous system releases norepinephrine to constrict blood vessels, preventing blood from pooling and ensuring flow to the brain. In people with PD, the disease process can damage the nerves that release norepinephrine, leading to a diminished response. As a result, when changing posture from lying down or sitting to standing, blood pressure can drop significantly. This sudden reduction in blood flow to the brain causes lightheadedness, wooziness, or feeling faint. This orthostatic dizziness is often temporary, lasting seconds to minutes, and is particularly noticeable when getting out of bed or standing up quickly.
Dizziness Triggered by Medication
Dizziness and lightheadedness can be a direct consequence of the medications used to manage PD motor symptoms. The primary treatment involves dopaminergic drugs, such as Levodopa and dopamine agonists, which increase dopamine activity in the brain. A known side effect of these medications is that they can cause or worsen low blood pressure, known as orthostatic hypotension. These drug-induced changes can exacerbate existing blood pressure regulation issues caused by autonomic dysfunction. The introduction or adjustment of a dopaminergic drug can trigger dizziness symptoms, especially in the initial weeks of treatment. Patients should communicate any dizziness or lightheadedness that occurs after taking medication to a healthcare provider. Adjusting the timing or dosage, rather than stopping the medication, is often the necessary step to alleviate this side effect.
Differentiating Balance Issues from Vertigo
The term “dizziness” is broad and describes several distinct sensations, making accurate description important for diagnosis. True vertigo is a specific sensation where a person feels a false sense of spinning or whirling, as if the room or they themselves are rotating. While true vertigo can occur in PD, often due to age-related inner ear issues, it is less frequent than other forms of dizziness. The most common sensations are lightheadedness (linked to blood pressure changes) or a feeling of general unsteadiness. This unsteadiness, or imbalance, is a core motor symptom of PD known as postural instability. It is caused by progressive degeneration in the basal ganglia, the part of the brain that controls movement and balance. This feeling of being off-balance while walking is often misinterpreted as dizziness, even though it relates to impaired movement control, not blood flow.
Practical Management Strategies
Non-pharmacological and lifestyle adjustments can help mitigate lightheadedness caused by orthostatic hypotension.
Lifestyle Adjustments for Management
- Increase fluid intake, aiming for six to eight glasses of water daily, to boost blood volume.
- A higher salt intake, sometimes through salt tablets, can help raise blood pressure, but this must be done after consulting a physician.
- Rise slowly and deliberately from a sitting or lying position to allow the body time to adjust blood pressure.
- Wear compression stockings or abdominal binders to help prevent blood from pooling in the legs and abdomen.
- Eat smaller, more frequent meals, as large carbohydrate-heavy meals can cause a temporary drop in blood pressure.
Ongoing communication with the medical team is necessary to ensure any contributing medications are appropriately managed.