Symptoms of Parkinson's Disease
Parkinson’s disease is a complex condition with many potential symptoms, which can be different for each person. The main motor symptoms of Parkinson’s disease affect physical movement. Along with motor symptoms, the disease can have non-motor symptoms, ranging from depression and anxiety to hallucinations, memory problems and dementia.
The motor symptoms of Parkinson’s disease refer to those that affect the body’s movement. They are grouped into primary motor symptoms and secondary motor symptoms. Primary motor symptoms, which include Primary motor symptoms include resting tremor, bradykinesia (slowness of movement), rigidity, and postural instability, are important for diagnosing the disease.
Akinesia in Parkinson’s can take many forms. Usually, it involves a patient failing to make a movement or making a much smaller version of the movement. Akinesia is sometimes referred to as “freezing” in patients with Parkinson’s disease and is usually a symptom of advanced Parkinson’s disease. These are two types of akinesia: the movement can be so slow and small that it cannot be seen, or the time to initiate the movement can be very long.
Bradykinesia, a defining feature of Parkinson’s, involves a general reduction of spontaneous movement, which can give the appearance of abnormal stillness and a decrease in facial expressiveness. Patients may have difficulty executing repetitive movements and performing everyday tasks, such as buttoning a shirt or brushing their teeth. They also may walk with short, shuffling steps.
Dyskinesia refers to uncontrolled, involuntary movements that can affect the arms, legs, head, or the whole body. Dyskinesia is common in Parkinson’s patients and is associated with long-term use of levodopa, a medication that increases levels of dopamine in the brain. The severity of dyskinesia can vary widely among individuals, and younger patients have a greater risk of developing the symptom.
Dystonia, or abnormal muscle tone, is characterized by involuntary repetitive twisting and sustained muscle contractions, which result in abnormal movements and postures. The symptoms usually begin in one body region, such as the neck, face, vocal cords, arm, or leg, and then may spread to other parts of the body. In some instances, secondary dystonia may arise as a result of levodopa treatment in Parkinson’s patients.
Gait and Balance Problems
One of the most debilitating effects of Parkinson’s disease is the loss of coordination and control in body movements, which in many cases leads to severe walking disabilities. Although gait symptoms can vary among patients, there are some commonly observed movements. These include a tendency to lean or stoop forward while walking, dragging and shuffling of feet, and a decreased arm swing.
Rigidity includes stiffness or inflexibility of the muscles of the neck, shoulders, trunk, and limbs. It causes the affected muscles to remain stiff and not relaxed, decreasing the range of motions. Rigidity can be uncomfortable or even painful. A person with rigidity and bradykinesia cannot swing their arms while walking. It can occur on one or both sides of the body.
A tremor is an involuntary, uncontrollable muscle contraction, which manifests as shaking in body parts, most commonly the hands. There are two types: resting and action. Resting tremors are the most common form associated with Parkinson’s. They occur when the muscles are relaxed and still, such as when the patient is lying in a bed or when their hands are resting on their lap.
The non-motor symptoms of Parkinson’s disease do not affect movement, coordination, or physical tasks, but they can be more difficult to manage and more disabling than motor symptoms. Research has shown that people develop some non-motor symptoms years before they are diagnosed with Parkinson’s.
Cognitive impairment is a common non-motor symptom of Parkinson’s and is characterized by predominant executive function deficits, attention difficulties, visuospatial dysfunction, slowed thinking, difficulties in word-finding, and difficulties in learning and remembering information. The characteristics of cognitive impairment in Parkinson’s patients can be variable, both in terms of what cognitive domains are impaired and the timing of onset and rate of progression.
Depression is a mood disorder in which mixed feelings of sadness, loss, and hopelessness are experienced, interfering with quality of life. Depression can have different causes, including psychological, biological, and environmental. In people with Parkinson’s disease, the principal cause of depression is thought to be an imbalance in certain neurotransmitters that regulate mood.
Micrographia, or small handwriting, is a common sign of Parkinson’s disease. Patients often notice the difference in their handwriting themselves, and a neurologist can confirm the diagnosis by the size of the handwriting in a writing test. Software that measures the size, speed, fluency, and duration of writing is available to provide accurate measurement of writing characteristics.
The period when levodopa has a positive effect on Parkinson’s symptoms is called on-time. Once the medication stops working, a so-called off-episode starts, where symptoms recur. Ideally, levodopa should be given in a way that prevents off-episodes between doses. The problem is that with prolonged use, the body’s ability to convert levodopa into dopamine decreases lowering the medication’s efficacy.
Psychosis results in patients experiencing hallucinations and/or delusions. Hallucinations mean that people see, hear, or feel things that do not exist, and can happen at any time a person is awake, including daytime. Delusions are illogical or irrational views that are not based on reality. They may include, for example, accusations of marital infidelity or fear of being poisoned by medications or food.
Pseudobulbar affect (PBA) is a condition characterized by frequent, uncontrollable outbursts of crying or laughing that do not match how the person actually feels. It can affect people with Parkinson’s disease as well as those with brain injury or other neurological conditions. The sudden outbursts seen in PBA may be frequent and occur at any time with the affected person’s mood appearing normal between episodes.
Most sleep problems in Parkinson’s patients can be broken down into one of three categories: trouble falling asleep, trouble staying asleep or getting restful sleep, or falling asleep at the wrong times. Several Parkinson’s symptoms can lead to difficulty falling asleep and can lead to insomnia. Excessive daytime sleepiness is also common in Parkinson’s and can affect a patient’s quality of life.