Parkinson’s Disease is a progressive neurological disorder that affects the many people who have been diagnosed. Motor symptoms of the disease are those that affect motor functioning or movement, and are characteristic of the disease’s effects on the body.
Parkinson’s Disease is highly variable, and not every patient with the disease will experience all the symptoms. Different patients will have different combinations of symptoms as well as severity of symptoms.
Several other neurological conditions mimic Parkinson’s Disease, which may make diagnosis difficult. A diagnosis is made by a neurologist and is generally based on clinical assessment of the main motor symptoms. Typically, there is a gradual progression of motor and non-motor symptoms. Relief of motor symptoms is often treated with levodopa therapy. Treatments are more successful the earlier the symptoms are diagnosed. Therefore, if you have any of the symptoms, it is important to see your primary care physician and a neurologist who is a movement disorder specialist as soon as Parkinson’s Disease is suspected. TOP
Motor Symptoms
Tremors: Tremors are a rhythmic shaking in hands, arms, legs or chin. Tremors can be worse for some people at rest or while relaxing, hence the name, resting tremor. Others experience active tremor, which means that they experience more shaking while doing something like trying to drink a cup of coffee or eating with a utensil. You may a rub your thumb and forefinger back-and-forth. This is known as “a pill-rolling tremor”. Tremors generally begin on one side of the body, and over time may spread to both sides of the body.
Rigidity: Painful muscle and joint stiffness, often in arms, legs, neck or back muscles occurs. Frozen shoulder or a ratcheting movement of a joint is often a first sign of Parkinson’s Disease. Reduced manual dexterity, like tying shoelaces, buttoning buttons, can occur. If someone has back pain prior to having Parkinson’s, the disease can exacerbate the condition because the muscles tighten down with Parkinson’s Disease.
Bradykinesia, Akinesia, and Hypokinesia: Is the gradual loss and slowing down of spontaneous movement, reduction of movement, slowness & in some cases complete lack of movement. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk. Hyperkinesia refers to loss of momentum or force in movement. Small or cramped handwriting, called Micrographia, comes under this category.
Freezing: The inability to initiate movement occurs when starting to walk, in cramped spaces or in doorways. You may feel your feet are attached to the ground.
Postural Instability: Your posture may become stooped, or you may have balance problems as a result of Parkinson’s Disease. Balance problems caused by a loss of reflexes that stabilize the upright position can occur. This particular problem can lead to problems with walking, making turns while walking; stride length, and falling over backward. Orthostatic hypotension may happen, when standing up from a seated position or even just standing in place. This causes your blood pressure to drop precipitously. A drop in blood pressure may cause the person to lose consciousness.
Loss of Automatic Movements. You may have a decreased ability to perform unconscious movements, including blinking, smiling, swallowing of saliva or swinging your arms when you walk. TOP
Other Non – Motor Symptoms of Parkinson’s Disease
In addition to these primary motor symptoms, there are secondary non-motor symptoms that can occur in people with Parkinson’s Disease, including a shuffling gait (rhythm of walking), abnormally small or cramped handwriting, a mask-like expression, or speech difficulties. There are many non-motor symptoms that people with Parkinson’s experience, including depression, difficulty swallowing or chewing, urinary problems, constipation, skin problems, sleep problems, pain, leg cramps, or restless legs, and cognitive problems, such as memory problems or slow thinking.
It’s important to realize that non-motor symptoms are common and can be more troublesome and disabling than motor symptoms. That’s why you should watch for these symptoms and discuss early changes with your doctor. Research shows that people develop some non-motor symptoms, like depression, sleep problems and loss of smell, years before they get a Parkinson’s diagnosis.
Dysarthria Speech Changes. You may begin to speak softly, quickly, slur words or hesitate before talking. Your speech may be more monotone rather than with usual inflections.
Micrographia Writing Changes. It may become difficult to write clearly and your writing may appear small.
Drooling (sialorrhea) It is common to have pooling of saliva because of swallowing issues. Forward leaning upper torso posture can exacerbate this problem. Keeping your mouth closed will reduce the saliva accumulation. Also, sugarless hard candy or gum can help. Botulinum toxin (Botox®) injections can be administered to control drooling (sialorrhea) reducing excess saliva production, resulting in symptoms of dry mouth.
Swallowing Difficulties (Dysphagia) may occur due to rigidity and loss of muscle coordination. You may develop difficulties with swallowing as your condition progresses. Swallowing problems range from inability to swallow pills, eating a steak, chicken, hard breads or other foods that require proper chewing. There is potential risk of aspiration pneumonia, caused when saliva, liquids or food is breathed into the lungs instead of being swallowed into the esophagus and stomach. Swallowing problems can be addressed with swallowing exercises by a licensed speech language pathologist, some dietary changes and precutting food to a smaller bite size.
Chewing and Eating Problems. Late-stage Parkinson’s Disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition. Xerostomia, Dry Mouth, can occur in late-stage Parkinson’s Disease with excessively dry cheeks that may stick to your teeth
Smell dysfunction. You may experience problems with your sense of smell and have difficulty identifying certain odors or the difference between odors. Loss of smell is a symptom of Parkinson’s Disease that is caused by the loss of neurons in the olfactory bulb, a pathological process as a result of alpha synuclein in the brain.
Cognitive Changes such as problems with focused attention and planning, slowing of thought, language and memory difficulties, personality changes, and / or dementia may develop. You may experience cognitive problems (dementia) and thinking. Not everyone with Parkinson’s Disease develops dementia. These usually occur in the later stages of Parkinson’s Disease.
Double Vision & Dry Eyes Research has shown that visual symptoms are extraordinarily common in people living with Parkinson’s. Visual symptoms may occur due to changes in the front of the eye due to dry eye, changes in the retina (the part of our eyes that senses light), or changes in how our eyes move together. Visual symptoms related to Parkinson’s can be specific: eyes can feel dry, gritty/sandy, and may burn or have redness. You may experience crusting on the lashes, lids that stick together in the morning, sensitivity to light, or dry eye.
Depression and Emotional Changes. You may experience depression sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson’s Disease. You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms.
Sleep Disorders: People diagnosed with Parkinson’s disease often have sleep problems. This includes waking up frequently throughout the night, waking up early or falling asleep during the day. People may also experience rapid eye movement REM sleep behavior disorder, which involves acting out your dreams. Rem Sleep Disorder includes vivid dreams acted out physically and hallucinations, falling out of bed, striking a bed partner, etc.
Hypersomnia: also known as Excessive Daytime Sleepiness is experienced by over half of Parkinson’s patients. This condition is made worse by the medications used to treat the disease.
Bladder problems. Parkinson’s Disease may cause bladder problems, including being unable to control urine or having difficulty urinating.
Constipation. Many people with Parkinson’s Disease develop constipation due to a slower digestive tract.
Blood pressure changes. You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure (orthostatic hypotension).
Fatigue. Many people with Parkinson’s Disease lose energy and experience fatigue, especially later in the day.
Sexual Dysfunction. Some people with Parkinson’s Disease notice a decrease or a hyper increase in sexual desire or performance. This can be linked to depression, anxiety, fatigue or a reaction to medications.
Dystonia: A sustained or repetitive muscle twisting, spasm or cramp in a particular part of the body may lead to a turned in foot, tented hand, twisted trunk, etc. This can be brought on by depression, anxiety reaction to medications, stress or fatigue.
Unexplained Weight Loss: Weight loss is more common and may be due to increased energy expenditure due to tremor or dyskinesia, fatigue, especially with dopamine agonists, Mirapex and Requip. Your Neurologist may need to review and change your medication.
Excessive Sweating: especially of hands and feet, with no or little exercise one third of people with Parkinson’s experience it.
Numbness & Tingling: such as neuropathy can occur in the feet or hands.
Masked Face exhibiting a faraway look on your face.
Impulsive Control Disorders such as binge eating, excessive shopping or gambling are usually a side effect of medications. TOP
Dental Health
There are a number of reasons that poor dental health may occur in people with Parkinson’s, including tremor, dementia, hand strength, dry mouth etc. Of course poor dental health may lead to cavities, gum disease, bad breath and mouth pain. Visiting your dentist twice a year and addressing any issues you may have is important.