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Parkinson's Disease Symptoms

The 3 key signs of Parkinson's 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.
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  • 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.