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Parkinson's Disease

What Are The Signs And Symptoms Of Parkinson's Disease?

Monday, April 23, 2012 - 15:01

Contributing Author: Guy Slowik FRCS

Parkinson's disease has classic signs and symptoms, but they do not all appear at the same time or to the same degree. Some people are more troubled by one than another. The condition can vary significantly between individuals, for example how the disease progresses, and how well someone responds to the drugs, etc. Therefore, people with PD should never compare themselves with others who have PD.

These Are The Four Major Signs Of PD:

  • Tremor. In about 70 percent of people with PD, this is the earliest symptom to appear. It is a tremor that occurs in a limb when it is at rest. The tremor starts in one arm or leg on one side of the body and can progress to include the other side of the body. It usually remains more pronounced on one side of the body. Although socially distressing, the tremor does not usually interfere with activities of daily life, and it tends to disappear with voluntary movement (picking up a cup, for example). Often, medications do not completely control tremor. Fatigue, emotional stress, and worrying about the tremor can make it worse in the short term.
  • Rigidity. This describes increased tone or stiffness in the muscles when they are at rest. Joints may sometimes feel locked. The lack of mobility often causes muscle fatigue and ache. Rigidity usually responds well to treatment.
  • Slowness of movement. This condition is called bradykinesia. Fine movements become clumsy, for example, doing up buttons. Typically, it is often hard to begin a movement, for example, getting up from a chair, or there may be an abrupt stopping of ongoing movement such as when turning corners or going through doorways. This symptom is the most disabling, but it responds well to treatment.
  • Impaired balance. Normally, reflexes allow us to make rapid adjustments to changes in the body's center of gravity when standing or walking. These reflexes become impaired in people with PD who may eventually be at risk for falls. Medication may help, but rehabilitation therapy is most valuable.

Symptoms:

There are also a number of symptoms associated with PD. Not all people will experience them to the same degree. They include:

  • A changed facial expression. Because the facial muscles that normally create expression don't move as well, people with PD sometimes appear to look uninterested or sad when they are not. This is known as hypomimia.
  • A soft voice. This is known as hypophonia. People with PD may have difficulty being heard, particularly on the phone. In addition, the rhythm of the voice can be affected, and words may be spoken in a monotone.
  • Small, cramped handwriting. Writing may be normal size for the first few words and then will trail off and get smaller. This is known as micrographia.
  • Pain. Painful stiffness, for example affecting the shoulder or calves, is a common early feature of PD. Painful cramps can also affect some people, sometimes as a result of too much medication and sometimes too little. The physician will want to know when the cramps occur in relationship to the timing of the drugs. Successful treatment of PD symptoms can lead to improved mobility, but can sometimes aggravate existing arthritis.
  • Fatigue. Everyday tasks take longer to complete when one has PD. It is hard to do two things at once. Sleep may also be disturbed. When combined, these problems often contribute to the tiredness experienced by many. It also takes a while for people with PD to learn to pace themselves to avoid reaching the end of a day without feeling exhausted. Some people experience a noticable benefit in their symptoms after a good nap or a sleep.
  • Depression. Research indicates that up to 50 percent of patients with PD can experience a period of depression during their illness. Depression in PD is caused by disturbed brain chemistry, and it can be triggered or made worse by stressful situations in life. Depression may occur at any time during the illness. But if depression is present when the person is first diagnosed with PD, it sometimes gets better on its own when PD symptoms start to improve with treatment.

    Depression may, however, need some treatment itself. The most important first step is for the person with PD to be able to admit to being depressed and seek appropriate help. Today's antidepressants are safe and well tolerated, and most can be taken very successfully with antiparkinson drug therapy. There may be mild side effects early in treatment (dry mouth, dizziness, drowsiness), but these usually disappear with time. Full benefit from treatment for depression can take from four to six weeks. Patience, determination, and family support are needed while the right dose level is achieved.

  • Constipation. PD and the drugs used for its treatment contribute to constipation. Severe constipation can lead to a medical emergency. If constipation continues to be a problem, it is important to seek medical help.

Intellectually, people with PD usually remain normal. But because speech and everyday tasks take longer to execute, it may appear that they lack comprehension or understanding - when actually they know exactly what they want to do but are unable to process their thoughts or actions in a timely manner. Some 30 percent of patients with PD, however, do develop dementia - the loss of cognitive and intellectual functions without impairment of perception or consciousness. Dementia can also lead to disorientation, a flattened mood, impaired memory, judgment, and intellect.

Parkinson's Disease