The nurse notes that a client with Parkinson's disease has a flat facial expression, speaks softly, and shows little emotion. Which non-motor symptom does this suggest?

Rationale: A. Cognitive impairment in Parkinson’s disease typically presents as memory deficits, executive dysfunction, or difficulty with problem-solving, not primarily as a flat affect or reduced speech. While cognitive changes can occur, the client’s symptoms reflect emotional and affective changes rather than cognition. B. Anxiety may present as restlessness, excessive worry, or agitation, which differs from a flat affect, soft speech, and reduced emotional expression. The observed signs are not indicative of anxiety. C. A flat facial expression (masked facies), soft speech (hypophonia), and reduced emotional expression are classic non-motor symptoms of depression in Parkinson’s disease. Depression is common in PD due to dopamine depletion in mesolimbic and mesocortical pathways, affecting mood and affect. Recognizing these subtle non-motor signs is critical, as depression significantly impacts quality of life and functional outcomes. D. Bradyphrenia refers to slowed thought processes, manifesting as delayed responses and mental processing. Although it may coexist with PD depression, it does not specifically explain flat affect or soft speech. The client’s presentation is more indicative of affective rather than cognitive slowing.