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Parkinson's Disease HOL-emblem1-web.GIF (3556 bytes)


Parkinson's disease is clinically characterized by four main features:
bulletResting tremor (shaking back and forth when the limb is relaxed)
bulletBradykinesia (slowness of movement)
bulletRigidity (stiffness, or resistance of the limb to passive movement when the limb is relaxed)
bulletPostural instability (poor balance).

Tremor. The tremor associated with Parkinson's disease has a characteristic appearance. Typically, the tremor takes the form of a rhythmic back-and-forth motion of the thumb and forefinger at three beats per second. This is sometimes called "pill rolling." Tremor usually begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. In three out of four patients, the tremor may affect only one part or side of the body, especially during the early stages of the disease. Later it may become more general. Tremor is rarely disabling and it usually disappears during sleep or improves with intentional movement.
Rigidity. Rigidity, or a resistance to movement, affects most parkinsonian patients. All of our muscles have an opposing muscle. When we try to move a muscle, it becomes active, and the opposing muscle relaxes. In Parkinson's disease, this delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the patient's arm, which will move only in ratchet-like or short, jerky movements. This is known as "cogwheel" rigidity.
Bradykinesia. Bradykinesia is the slowing down and loss of spontaneous and automatic movement. It is particularly frustrating because it is unpredictable. One moment the patient can move easily. The next moment he or she may need help. This may well be the most disabling and distressing symptom of the disease because the patient cannot rapidly perform routine movements. Activities once performed quickly and easil, such as washing or dressing, may take several hours.
Postural instability. Postural instability, or impaired balance and coordination, causes patients to develop a forward or backward lean and to fall easily. When bumped from the front or when starting to walk, patients with a backward lean have a tendency to step back wards, which is known as retropulsion. Postural instability can cause patients to have a stooped posture in which the head is bowed and the shoulders are drooped. As the disease progresses, walking may be affected. Patients may halt in mid-stride and "freeze" in place, possibly even toppling over. Or patients may walk with a series of quick, small steps as if hurrying forward to keep balance. This is known as festination.

Resting tremor, bradykinesia, and rigidity are relatively early signs of Parkinson's disease. It is often apparent in the first-affected extremity. Postural instability is a late symptom typically emerging ten or more years into the disease. Other common signs include shuffling gait, stooped posture, difficulty with fine coordinated movements, and micrographia (small handwriting). Secondary features include autonomic dysfunction (constipation, sweating), cognitive symptoms (dementia), affective disturbances (depression), and sensory complaints including pain in muscles.

The symptoms of Parkinson's disease include:
bulletSlowness of voluntary movements, especially in the initiation of such movements as walking or rolling over in bed.
bulletDecreased facial expression, monotonous speech and decreased eye blinking.
bulletA shuffling gait with poor arm swing and stooped posture.
bulletUnsteady balance; difficulty rising from a sitting position.
bulletContinuous "pill-rolling" motion of the thumb and forefinger.
bulletAbnormal tone or stiffness in the trunk and extremities.
bulletSwallowing problems in later stages.

Muscle rigidity
bulletDifficulty bending arms or legs

Unstable, stooped, or slumped-over posture
bulletLoss of balance
bulletGait (walking pattern) changes
bulletShuffling walk

Slow movements
bulletDifficulty beginning to walk
bulletDifficulty initiating any voluntary movement
bulletSmall steps followed by the need to run to maintain balance
bulletFreezing of movement when the movement is stopped, inability to resume - movement
bulletMuscle aches and pains (myalgia)
bulletShaking, tremors (varying degrees, may not be present)
bulletCharacteristically occur at rest, may occur at any time
bulletMay become severe enough to interfere with activities
bulletMay be worse when tired, excited, or stressed
bulletFinger-thumb rubbing (pill-rolling tremor) may be present

Changes in facial expression
bulletReduced ability to show facial expressions "mask" appearance to face
bulletMay be unable to close mouth
bulletReduced rate of blinking

Voice/speech changes
bulletSlow speech
bulletLow-volume voice
bulletDifficulty speaking

Loss of fine motor skills
bulletDifficulty writing, may be small and illegible
bulletDifficulty eating
bulletDifficulty with any activity that requires small movements
bulletMovement, uncontrolled - slow
bulletFrequent falls
bulletDecline in intellectual function (may occur, can be severe)
bulletA variety of gastrointestinal symptoms, mainly constipation.

Note: Initial symptoms may be mild and nonspecific (mild tremor, slight feeling that one leg/foot is stiff and dragging, and so on).

Additional symptoms that may be associated with this disease:
bulletSeborrhea (skin)
bulletMuscle function/feeling loss
bulletMuscle atrophy
bulletMemory loss
bulletAnxiety, stress, and tension

Next Topic: Hoehn and Yahr Staging of Parkinson's Disease


[Parkinson's Disease Home]

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