Parkinson’s disease

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Central nervous system

Substantia nigra

Paralysis agitans; Shaking palsy

The disorder may affect one or both sides of the body. How much function is lost can vary.

Symptoms may be mild at first. For instance, the patient may have a mild tremor or a slight feeling that one leg or foot is stiff and dragging.

Symptoms include:

• Automatic movements (such as blinking) slow or stop
• Constipation
• Difficulty swallowing
• Drooling
• Impaired balance and walking
• Lack of expression in the face (mask-like appearance)
• Muscle aches and pains
• Movement problems
  • Difficulty starting or continuing movement, such as starting to walk or getting out of a chair
  • Loss of small or fine hand movements; writing may become small and difficult to read; eating becomes difficult
  • Slowed movements
  • Stooped position
• Rigid or stiff muscles, often beginning in the legs
• Shaking, tremors
  • Tremors usually occur in the limbs at rest, or when the arm or leg is held out
  • Tremors go away during movement
  • Over time, tremor can be seen in the head, lips, tongue, and feet
  • May be worse when tired, excited, or stressed
  • Finger-thumb rubbing (pill-rolling tremor) may be present
• Slowed, quieter speech and monotone voice

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Other symptoms:

• Anxiety, stress, and tension
• Confusion
• Dementia
• Depression
• Fainting
• Hallucinations
• Memory loss

The health care provider may be able to diagnose Parkinson's disease based on your symptoms and a physical examination. However, the symptoms can be difficult to assess, particularly in the elderly. The signs (tremor, change in muscle tone, problems walking, unsteady posture) become more clear as the illness progresses.

An examination may show:

• Difficulty starting or finishing voluntary movements
• Jerky, stiff movements
• Muscle atrophy
• Parkinson's tremors
• Variation in heart rate

Reflexes should be normal.

Tests may be needed to rule out other disorders that cause similar symptoms.

Review Date: 05/06/2011
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Daniel Kantor, MD, Medical Director of Neurologique, Ponte Vedra, FL and President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network (10/4/2010).

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).