Parkinson's Disease Symptoms

(Also Known As: Parkinsons Disease Symptoms, Parkinson’s Symptoms, Shaking Palsy Symptoms, Paralysis Agitans Symptoms)

(Reviewed by: Paul Peterson, Licensed Therapist)

What are the symptoms of Parkinson’s disease? The Four cardinal symptoms or characteristics of Parkinson’s disease:

  • Rigidity of the musculature body as manifested by stiffness of the limbs and trunk.
  • Involuntary tremors as manifested by trembling in hands, arms, legs, jaw, and face, even if the patient is resting.
  • Bradykinesia or slowing of physical movement. In some extreme cases it develops into akinesia, the serious difficulty in initiating movement.
  • Postural instability, or impaired balance and coordination.5

Early symptoms of PD are subtle and occur gradually. The onset of the disease progresses more quickly in some people than in others and as this comes about, the tremors, which is the most distressing symptoms, begins to affect daily activities. Other indicators of the disease include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.6

The primary symptoms of Parkinson’s disease are due to the decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine, which is produced in the dopaminergic neurons of the brain. Secondary symptoms, on the other hand, may include high level cognitive dysfunction and subtle language problems. Parkinson’s disease also may result from drug toxicity, head trauma and injury, or as complications of other medical disorders. 7

The onsets of the motor symptoms are as follows:

  • Tremor: Typically unilateral at onset and normally a 4–6 Hz tremor. It is maximal when the limb is at rest, and decreased with voluntary movement.
  • Rigidity: Manifested as stiffness; increased muscle tone. Together with a resting tremor, this produces a ratchety, cogwheel rigidity when the limb is passively moved.
  • Akinesia/bradykinesia: Manifested as the absence or slowness of bodily movements respectively. Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude.
  • Postural instability: Manifested as failure of postural reflexes which leads to impaired sense of balance and thus consequently falls or collapses.

Other symptoms include:

Gait and posture disturbances:

  • Shuffling gait: Patient walks with short steps, with feet barely leaving the ground, generating an audible shuffling noise. Small obstacles tend to cause the patient to trip.
  • Turning en bloc: PD patients are unable to perform the normal twisting of the neck and trunk and pivoting on the toes. Instead, their movements are limited to multiple small steps to accomplish a turn because their necks and trunks are rigid.
  • Decreased arm-swing.
  • Stooped, forward-flexed posture. In acute forms, the head and upper shoulders may be bent at a right angle relative to the trunk which is a condition known as Camptocormia.
  • Festination: This condition is a combination of stooped posture, imbalance, and short steps. As a result, the gait occurs increasingly faster, often ending in a fall.
  • Gait freezing: Gait freezing is a manifestation of akinesia and thus characterized by an inability to move. The feet may get even more stiff in tight spaces or when attempting to initiate gait.
  • Dystonia (in about 20% of cases): This condition is a condition of an abnormal, sustained, painful twisting muscle contractions, often affecting the foot and ankle, particularly the flexion of toes and inversion of the foot, subsequently interfering with gait.

Speech and swallowing disturbances:

  • Hypophonia: This condition is also known as soft speech, because the speech quality tends to be soft, hoarse, and monotonous. Patients often complain that their tongue is heavy or have stuttered speech.
  • Monotonic speech.
  • Festinating speech: Unlike hypophonia, this condition is manifested as excessively rapid, soft and poorly-intelligible speech.
  • Drooling: This is most likely caused by a weak, infrequent swallow and stooped posture.
  • Dysphagia: This condition is manifested as the impaired ability to swallow or the inability to swallow due to rigidity of the mastication and esophageal muscles. Moreover, this can lead to aspiration pneumonia.

Other motor symptoms:

  • Fatigue
  • Hypomimia or masked faces, with infrequent blinking
  • Difficulty rolling in bed or rising from a seated position
  • Micrographia or small, cramped handwriting.
  • Impaired fine motor dexterity and motor coordination as manifested by impaired gross motor coordination and akathisia or the inability to sit still. 8

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