Parkinson's disease

Alternative names:

paralysis agitans; shaking palsy

Symptoms:

• muscle rigidity
  • stiffness
  • difficulty bending arms or legs

• unstable, stooped, or slumped-over posture
• loss of balance
• gait (walking pattern) changes
• shuffling walk
• slow movements
• 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
  • staring
  • may be unable to close mouth
  • reduced rate of blinking

• voice/speech changes
  • slow speech
  • low-volume voice
  • monotone
  • difficulty speaking

• loss of fine motor skills
  • difficulty writing, may be small and illegible
  • difficulty eating
  • difficulty with any activity that requires small movements
  • movement, uncontrolled - slow

• frequent falls
• 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:

• depression
• confusion
• dementia
• seborrhea (skin)
• muscle function/feeling loss
• muscle atrophy
• memory loss
• drooling
• anxiety, stress, and tension

Signs and tests:

The health care provider may be able to diagnose Parkinson's disease based on the symptoms and physical examination. However, the symptoms may be difficult to assess, particularly in the elderly. For example, the tremor may not appear when the person is sitting quietly with arms in the lap. The posture changes may be similar to osteoporosis or other changes associated with aging. Lack of facial expression may be a sign of depression.

An examination may show "cogwheel" rigidity (the movements are jerky and stiff), tremors of the Parkinson's type, and difficulty initiating or completing voluntary movements. Reflexes are essentially normal.

Tests are not usually specific for Parkinson's, but they may be required to rule out other disorders that cause similar symptoms.