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Parkinson Disease (cont.)

Parkinson Disease Symptoms

The 3 key signs of Parkinson disease are tremor (shaking) at rest, rigidity, and slowness in the initiation of movement (called bradykinesia). Of these features, 2 are required to make the diagnosis. Postural instability is the fourth key sign, but it happens late in the disease, usually after having PD 8 years or more.

  • Tremor at rest

    • Tremor usually begins in one arm and may start and stop.

    • As with most tremors, it worsens when under stress and improves during rest or sleep.

    • After several months to a few years, both arms may become affected, but the beginning asymmetry (lopsidedness) is often maintained.

    • PD tremor may also involve the tongue, lips, or chin.

    • The characteristic PD tremor is present and most prominent with the limb at rest.

    • The tremor may appear as a pill-rolling motion of the hand or a simple oscillation of the hand or arm.

  • Rigidity

    • Rigidity refers to an increase in resistance to someone else moving your joint.

    • The resistance can be either smooth (lead-pipe) or start and stop (cog wheeling). (Cog wheeling is thought to be a tremor rather than rigidity.)

    • Having someone else flex and extend your relaxed wrists tests for rigidity.

    • Rigidity can be made more obvious with voluntary movement in the opposite limb.

  • Bradykinesia

    • Bradykinesia refers to slowness of movement but also includes a lessening of unplanned movements and decreased size of movement.

    • Bradykinesia is also expressed as micrographia (small handwriting), hypomimia (decreased facial expression), decreased blink rate, and hypophonia (soft speech).

  • Postural instability

    • Postural instability refers to imbalance and loss of reflexes used to keep you upright.

    • This symptom is an important milestone, because it is not easy to treat and a common source of disability in late disease.

  • Other symptoms

    • You may experience freezing when starting to walk (start-hesitation), during turning, or crossing a threshold such as going through a doorway.

    • Flexed postures of neck, trunk, and limbs may occur.

    • Altered mental status generally occurs late in PD and affects 15-30% of people with PD.

    • Short-term memory and visio-spacial function may be impaired.

    • The onset of PD is typically lopsided, with the most common initial finding being an asymmetric rest tremor in one arm. About 20% of people first experience clumsiness in 1 hand.

    • Over time, you will notice symptoms related to progressive bradykinesia, rigidity, and problems with walking (called gait disturbances).

  • The initial symptoms of PD may be nonspecific and include fatigue and depression.

    • Some people experience a subtle decrease in dexterity and may notice a lack of coordination with activities such as golf, dressing, or climbing stairs.

    • Some people complain of aching or tightness in the calf or shoulder region.

    • The first affected arm may not swing fully when walking, and the foot on the same side may scrape the floor.

    • Over time, posture becomes progressively flexed and your stride becomes shorter leading to a shuffling gait.

    • Decreased swallowing may lead to excess saliva and ultimately drooling.

    • Symptoms of problems with your involuntary nervous system are common and may include constipation, sweating abnormalities, and sexual dysfunction.

    • Sleep disturbances are also common.

  • The best clinical predictors of a diagnosis of PD are asymmetry, the presence of rest tremor, and a good response to dopamine replacement therapy.



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Parkinson Disease »

Parkinson disease (Parkinson's disease, PD) is a progressive neurodegenerative disorder associated with a loss of dopaminergic nigrostriatal neurons.

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