The Reasons Behind Your Unexplained Temperature Changes    

Dysregulation of temperature as a non-motor symptom of PD

Our bodies are programmed to keep our internal temperature at a near-constant point, using very complex mechanisms. Parkinson’s disease (PD) can unfortunately interfere with this regulation, and it can significantly affect quality of life when these mechanisms don’t work well. Without proper temperature regulation, a person may feel that they are too hot or too cold. They may sweat too little or too much. 

Although dysregulation of temperature is not as well-known as other non-motor symptoms in PD, such as constipation or sleep disorders, it is actually very common, and can also be a pre-motor symptom of PD, developing years before motor symptoms. In general, temperature dysregulation in PD is under-studied and under-reported as a non-motor symptom.

Why does impaired temperature regulation occur in Parkinson’s disease?

There are two areas of the nervous system that control temperature – the hypothalamus and the autonomic nervous system, and both can be affected in PD. The hypothalamus is a region deep in the brain that plays a critical role in maintaining the balance of many different functions of the body, including heart rate, hunger, and temperature. The hypothalamus receives information from receptors that detect temperature located throughout the body, as well as from other regions of the brain, and uses this information to regulate body temperature. When the body is exposed to cold temperatures, the hypothalamus triggers several responses that help to conserve heat, such as shivering and constriction of blood vessels in the skin. When the body is exposed to heat, the hypothalamus triggers sweating and dilation of blood vessels in the skin to promote heat loss.

In addition to the hypothalamus, the autonomic nervous system, or the nerves located throughout the body that control automatic body functions, are also responsible for temperature regulation by regulating blood flow to the skin which affects heat exchange with the environment.

Damage to the autonomic nervous system contributes to many of the well-known non-motor symptoms of PD including:

• constipation
• urinary dysfunction
• sexual dysfunction      
• blood pressure dysregulation

Both systems can be affected in PD. Lewy bodies, containing the abnormal accumulation of alpha-synuclein which is the pathological hallmark of PD, can be found in many brain areas of people with PD, including the hypothalamus. In addition, damage to the autonomic nervous system, with reduced innervation of blood vessels and sweat glands, is also common in PD. Together these changes can impair regulation of temperature in people with PD.

Why is impaired temperature regulation a problem?

Dysregulation of temperature or impaired thermoregulation in PD can have several consequences.

A person with Parkinson’s disease may experience:

• Cold intolerance
  • Over-constriction of blood vessels can cause cold hands and feet which can be uncomfortable.
• Heat intolerance
  • Feeling more uncomfortable than most in hot weather.

Heat intolerance is often related to impairments in sweating. Both too much or too little sweating can occur in PD, and both can be problematic. Too much sweating can occur unpredictably throughout the day but can also be particularly prominent at night. A person with PD may report that their clothes and bed sheets are soaked during the night. This can be particularly problematic as it can interfere with sleep, and those with PD often have sleep disturbances to begin with. Excessive sweating can also occur as an OFF phenomenon or as part of an episode of dyskinesias.

An inadequate sweating response can also occur, with too little sweat produced. This is typically less bothersome for a person with PD than too much sweating, but can be more dangerous, as it can lead to overheating since the purpose of sweating is to remove heat from the skin surface as the sweat evaporates. Heat stroke and other heat-related illnesses can result.

Managing Body Temperature with Parkinson’s Disease    

Lifestyle modifications

There are several strategies that can be employed to help individuals with PD manage their body temperature. One approach is to avoid extreme temperatures and to dress appropriately for the weather. For example, during hot weather, individuals with Parkinson’s disease should wear loose-fitting, breathable clothing, and stay in air-conditioned environments as much as possible.

Lifestyles modifications for those who are often hot and/or who sweat too much can include:

• Taking cool or lukewarm showers.
• Drinking ample water.
• Using moisture-wicking and cooling sheets, pajamas, clothing, and socks. These products are made of materials that absorb more water and dry faster than standard fabrics and can be helpful for some people with excessive sweating.
• Avoiding sweat triggers including spicy foods, caffeine, and alcohol.

For individuals with low body temperatures:

• During cold weather, dress in layers and wear warm clothing to help conserve heat. Your base layer should be snug fitting, and made of a moisture-wicking material, not cotton.
• Limit time outdoors in cold temperatures.
• Drink hot beverages like tea.
• Use hand warmers if gloves are not sufficient.

Other Treatments for Managing Body Temperature

Tips for Choosing the Right Treatments & Medications

Medications to Avoid or Change

Oral anti-cholinergic medications should be avoided by people with impaired sweating but may be beneficial for those with excessive sweating. Oral anti-cholinergic medications have many side effects, so the positive and negative effects of the medications must be weighed.

Excessive sweating, if it occurs as an OFF phenomenon or during episodes of severe dyskinesia, may improve with adjustment of PD medications.

Medications and Treatments to Consider

Topical glycopyrrolate is a gel containing an anti-cholinergic medication that can be applied to the skin in areas that are typically sweaty. A topical medication is thought to have fewer side effects than an oral pill whose impact is more widespread in the body.

Botulinum toxin injections could be considered for the control of excessive sweating in particular areas such as under the arms, on the palms, and around the hairline.

Prescription-strength anti-perspirants can be used under the arms and in other sweaty areas such as the soles of the feet.

Dealing with Uncomfortable Changes in Temperature

As we have explored throughout this article, is not uncommon to experience changes in your body temperature while having Parkinson’s disease. Therefore, it is important to discuss this symptom with your doctor, as there are lifestyle modifications and other therapies that may be beneficial in helping to manage this symptom.

Tips and Takeaways:

• Our bodies are programmed to keep our internal temperature at a near-constant point, and Parkinson’s disease can interfere with these mechanisms. 
• PD can result in heat or cold intolerance, also known as temperature dysregulation.
• Either too much or too little sweating can also be problematic in people with PD.
• Talk with your doctor about any concerns that you have with temperature regulation, as there are potential treatments available to improve your quality of life.