Parkinson's disease is clinically characterized by four main features:
|Resting tremor (shaking back and forth when the limb is relaxed) |
|Bradykinesia (slowness of movement) |
|Rigidity (stiffness, or resistance of the limb to passive movement when the limb is
|Postural instability (poor balance). |
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, 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.
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
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:
|Slowness of voluntary movements, especially in the
initiation of such movements as walking or rolling over in bed. |
|Decreased facial expression, monotonous speech and decreased
eye blinking. |
|A shuffling gait with poor arm swing and stooped posture. |
|Unsteady balance; difficulty rising from a sitting position.
|Continuous "pill-rolling" motion of the thumb and
|Abnormal tone or stiffness in the trunk and extremities.|
|Swallowing problems in later stages.|
|Difficulty bending arms or legs|
Unstable, stooped, or slumped-over posture
|Loss of balance|
|Gait (walking pattern) changes|
|Difficulty beginning to walk|
|Difficulty initiating any voluntary movement|
|Small steps followed by the need to run to maintain balance|
|Freezing of movement when the movement is stopped, inability
to resume - movement|
|Muscle aches and pains (myalgia)|
|Shaking, tremors (varying degrees, may not be present)|
|Characteristically occur at rest, may occur at any time|
|May become severe enough to interfere with activities|
|May be worse when tired, excited, or stressed|
|Finger-thumb rubbing (pill-rolling tremor) may be present|
Changes in facial expression
|Reduced ability to show facial expressions "mask"
appearance to face|
|May be unable to close mouth|
|Reduced rate of blinking|
Loss of fine motor skills
|Difficulty writing, may be small and illegible|
|Difficulty with any activity that requires small movements|
|Movement, uncontrolled - slow|
|Decline in intellectual function (may occur, can be severe)|
|A 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:
|Muscle function/feeling loss|
|Anxiety, stress, and tension|
Next Topic: Hoehn and Yahr Staging of Parkinson's Disease
[Parkinson's Disease Home]
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