| Symptoms
Parkinson
disease affects movement (motor symptoms). Typical other
symptoms include disorders of mood, behavior, thinking,
and sensation (non-motor symptoms). Individual patients'
symptoms may be quite dissimilar and progression of the
disease is also distinctly individual.
Motor
symptoms
The
cardinal symptoms are:
-tremor: normally 4-7 Hz tremor, maximal when the limb
is at rest, and decreased with voluntary movement. It
is typically unilateral at onset. This is the most apparent
and well-known symptom, though an estimated 30% of patients
have little perceptible tremor; these are classified as
akinetic-rigid.
-rigidity: stiffness; increased muscle tone. In combination
with a resting tremor, this produces a ratchety, "cogwheel"
rigidity when the limb is passively moved.
-bradykinesia/akinesia: respectively, slowness or absence
of movement. Rapid, repetitive movements produce a dysrhythmic
and decremental loss of amplitude. Also "dysdiadokinesia",
which is the loss of ability to perform rapid alternating
movements
-postural instability: failure of postural reflexes, which
leads to impaired balance and falls.
Other
motor symptoms include:
-Gait and posture disturbances:
-Shuffling: gait is characterized by short steps, with
feet barely leaving the ground, producing an audible shuffling
noise. Small obstacles tend to trip the patient
-Decreased arm swing: a form of bradykinesia
-Turning "en bloc": rather than the usual twisting
of the neck and trunk and pivoting on the toes, PD patients
keep their neck and trunk rigid, requiring multiple small
steps to accomplish a turn.
-Stooped, forward-flexed posture. In severe forms, the
head and upper shoulders may be bent at a right angle
relative to the trunk (camptocormia).
-Festination: a combination of stooped posture, imbalance,
and short steps. It leads to a gait that gets progressively
faster and faster, often ending in a fall.
-Gait freezing: "freezing" is another word for
akinesia, the inability to move. Gait freezing is characterized
by inability to move the feet, especially in tight, cluttered
spaces or when initiating gait.
-Dystonia (in about 20% of cases): abnormal, sustained,
painful twisting muscle contractions, usually affecting
the foot and ankle, characterized by toe flexion and foot
inversion, interfering with gait. However, dystonia can
be quite generalized, involving a majority of skeletal
muscles; such episodes are acutely painful and completely
disabling.
-Speech and swallowing disturbances
-Hypophonia: soft speech. Speech quality tends to be soft,
hoarse, and monotonous. Some people with Parkinson's disease
claim that their tongue is "heavy" or have cluttered
speech.
-Festinating speech: excessively rapid, soft, poorly-intelligible
speech.
-Drooling: most likely caused by a weak, infrequent swallow
and stooped posture.
-Non-motor causes of speech/language disturbance in both
expressive and receptive language: these include decreased
verbal fluency and cognitive disturbance especially related
to comprehension of emotional content of speech and of
facial expression.
-Dysphagia: impaired ability to swallow. Can lead to aspiration,
pneumonia.
- Other motor symptoms:
-fatigue (up to 50% of cases);
-masked faces (a mask-like face also known as hypomimia),
with infrequent blinking;
-difficulty rolling in bed or rising from a seated position;
-micrographia (small, cramped handwriting);
-impaired fine motor dexterity and motor coordination;
-impaired gross motor coordination;
-Poverty of movement: overall loss of accessory movements,
such as decreased arm swing when walking, as well as spontaneous
movement.
Non-motor
symptoms
Mood
disturbances
-Estimated prevalence rates of depression vary widely
according to the population sampled and methodology used.
Reviews of depression estimate its occurrence in anywhere
from 20-80% of cases. Estimates from community samples
tend to find lower rates than from specialist centres.
Most studies use self-report questionnaires such as the
Beck Depression Inventory, which may overinflate scores
due to physical symptoms. Studies using diagnostic interviews
by trained psychiatrists also report lower rates of depression.
-More generally, there is an increased risk for any individual
with depression to go on to develop Parkinson's disease
at a later date.
-70% of individuals with Parkinson's disease diagnosed
with pre-existing depression go on to develop anxiety.
90% of Parkinson's disease patients with pre-existing
anxiety subsequently develop depression; apathy or abulia.
Cognitive
disturbances
-slowed reaction time; both voluntary and involuntary
motor responses are significantly slowed.
-executive dysfunction, characterized by difficulties
in: differential allocation of attention, impulse control,
set shifting, prioritizing, evaluating the salience of
ambient data, interpreting social cues, and subjective
time awareness. This complex is present to some degree
in most Parkinson's patients; it may progress to:
-dementia: a later development in approximately 20-40%
of all patients, typically starting with slowing of thought
and progressing to difficulties with abstract thought,
memory, and behavioral regulation. Hallucinations, delusions
and paranoia may develop.
-short term memory loss; procedural memory is more impaired
than declarative memory. Prompting elicits improved recall.
-medication effects: some of the above cognitive disturbances
are improved by dopaminergic medications, while others
are actually worsened.
Sleep
disturbances
-Excessive daytime somnolence
-Initial, intermediate, and terminal insomnia
-Disturbances in REM sleep: disturbingly vivid dreams,
and REM Sleep Disorder, characterized by acting out of
dream content - can occur years prior to diagnosis
Sensation
disturbances
-impaired visual contrast sensitivity, spatial reasoning,
colour discrimination, convergence insufficiency (characterized
by double vision) and oculomotor control
-dizziness and fainting; usually attributable orthostatic
hypotension, a failure of the autonomous nervous system
to adjust blood pressure in response to changes in body
position
-impaired proprioception (the awareness of bodily position
in three-dimensional space)
-reduction or loss of sense of smell (microsmia or anosmia)
- can occur years prior to diagnosis,
-pain: neuropathic, muscle, joints, and tendons, attributable
to tension, dystonia, rigidity, joint stiffness, and injuries
associated with attempts at accommodation
Autonomic
disturbances
-oily skin and seborrheic dermatitis
-urinary incontinence, typically in later disease progression
-nocturia (getting up in the night to pass urine) - up
to 60% of cases
-constipation and gastric dysmotility that is severe enough
to endanger comfort and even health
-altered sexual function: characterized by profound impairment
of sexual arousal, behavior, orgasm, and drive is found
in mid and late Parkinson disease. Current data addresses
male sexual function almost exclusively
-weight loss, which is significant over a period of ten
years - 8% of body weight lost compared with 1% in a control
group.
|