Parkinson's Disease - Diagnosis

Symptoms

Tremors

Parkinson's disease (PD) symptoms often start with tremor, which may occur in the following ways:

• Tremors may be only occasional at first, starting in one finger and spreading over time to involve the whole arm. The tremor is often rhythmic, 4 - 5 cycles per second, and frequently causes an action of the thumb and fingers known as pill rolling.
• Tremors can occur when the limb is at rest or when it is held up in a stiff unsupported position. They usually disappear briefly during movement and do not occur during sleep.
• Tremors can also eventually occur in the head, lips, tongue, and feet. Symptoms can occur on one or both sides of the body.

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About a quarter of patients with Parkinson’s do not develop tremor.

Motion and Motor Impairment

A number of PD symptoms involve motor impairment caused by the abnormalities in the brain nerves that regulate movement:

• Slowness of motion, particularly when initiating any movement (a condition called akinesia or bradykinesia), is one of the classic symptoms of Parkinson's disease.
• Patients may eventually develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady. After a number of years, muscles may freeze up or stall, usually when a patient is making a turn or passing through narrow spaces, such as a doorway. Patients' posture can be unstable and there is an increased risk for falls.
• Intestinal motility (the ability to swallow, digest, and eliminate) may slow down, causing eating problems and constipation.
• Muscles may become rigid. This symptom often begins in the legs and neck. Muscle rigidity in the face can produce a mask-like, staring appearance.
• Motor abnormalities that limit action in the hand may develop in late stages. Handwriting, for instance, often becomes small.
• Normally spontaneous muscle movements, such as blinking, may need to be done consciously.
• Patients may develop speech problems, including soft voice or slurred speech.

Other Symptoms of Parkinson's Disease

Parkinson’s disease also causes non-motor symptoms including sleep problems, gastrointestinal and urinary disorders, sexual dysfunction, decreased sense of smell, and depression and anxiety. [See Complications section of this report.]

Sialorrhea (drooling) is a common and bothersome symptom for those with Parkinson's disease. It can cause chapped skin and lips around the mouth, dehydration, an unpleasant odor, and social embarrassment.

Review Date: 06/18/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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