brain, spinal cord, and nerve disorders
Parkinson Disease (PD)
Symptoms of Parkinson Disease
Usually, Parkinson disease begins subtly and progresses gradually. The first symptom is Tremors in about two thirds of people Problems with movement or a reduced sense of smell in most of the others Tremorstypically have the following characteristics: Are coarse and rhythmic Usually occur in one hand while the hand is at rest (a resting tremor) Often involve the hand moving as if it is rolling small objects around (called pill-rolling) Decrease when the hand is moving purposefully and disappear completely during sleep May be worsened by emotional stress or fatigue May eventually progress to the other hand, the arms, and the legs May also affect the jaws, tongue, forehead, and eyelids and, to a lesser degree, the voice In some people, a tremor never develops. Sometimes the tremor becomes less obvious as the disease progresses and muscles become stiffer. Parkinson disease typically also causes the following symptoms: Stiffness (rigidity):Muscles become stiff, making movement difficult. When a doctor tries to bend the person's forearm back or straighten it out, the arm resists being moved and, when it moves, it starts and stops, as it is being ratcheted (called cogwheel rigidity). Slowed movements:Movements become slow and smaller and are difficult to initiate. Thus, people tend to move less. When they move less, moving becomes more difficult because joints become stiff and muscles weaken. Difficulty maintaining balance and posture:Posture becomes stooped, and balance is difficult to maintain. Thus, people tend to topple forward or backward. Because movements are slow, people often cannot move their hands quickly enough to break a fall. These problems tend to develop later in the disease. Walking becomes difficult, especially taking the first step. Once started, people often shuffle, taking short steps, keeping their arms bent at the waist, and swinging their arms little or not at all. While walking, some people have difficulty stopping or turning. When the disease is advanced, some people suddenly stop walking because they feel as if their feet are glued to the ground (called freezing). Other people unintentionally and gradually quicken their steps, breaking into a stumbling run to avoid falling. This symptom is called festination. Stiffness and decreased mobility can contribute to muscle ache and fatigue. Having stiff muscles interferes with many movements: turning over in bed, getting in or out of a car, and standing up from a deep chair. Usual daily tasks (such as dressing, combing the hair, eating, and brushing the teeth) take longer. Because people often have difficulty controlling the small muscles of the hands, daily tasks, such as buttoning a shirt and tying shoelaces, become increasingly difficult. Most people with Parkinson disease have shaky, tiny handwriting (micrographia) because initiating and sustaining each stroke of the pen is difficult. People may mistakenly think of these symptoms as weakness. However, strength and sensation are usually normal. The face becomes less expressive (masklike) because the facial muscles that control expression do not move as much as they normally would. This lack of expression may be mistaken for depression, or it may cause depression to be overlooked. (Depression is common among people with Parkinson disease.) Eventually, the face can take on a blank stare with the mouth open, and the eyes may not blink often. Often, people drool or choke because the muscles in the face and throat are stiff, making swallowing difficult. People often speak softly in a monotone and may stutter because they have difficulty articulating words. Parkinson disease also causes other symptoms: including Insomnia and Excessive Daytime Sleepiness (EDS) , are common, often because people need to urinate frequently or because symptoms worsen during the night, making turning over in bed difficult. may occur. Urination may be difficult to start and to maintain (called urinary hesitancy). People may have a compelling need to urinate (urgency). Urinary Incontinence in Adults is common. Difficulty Swallowing None Constipation in Adults None may occur when a person stands up ( Dizziness or Light-Headedness When Standing Up ). ( Seborrheic Dermatitis ) develop often on the scalp and face and occasionally in other areas. Loss of Smell None Dementia With Lewy Bodies and Parkinson Disease Dementia None Depression None Hallucinations, delusions,andparanoiacan occur, particularly if dementia develops. People may see or hear things that are not there (hallucinations) or firmly hold certain beliefs despite clear evidence that contradicts them (delusions). They may become mistrustful and think other people intend them harm (paranoia). These symptoms are considered psychotic symptoms because they represent loss of contact with reality. Psychotic symptoms are the most common reason people with Parkinson disease are put in an institution. Having these symptoms increases the risk of dying. Mental symptoms, including psychotic symptoms, may be caused by Parkinson disease or by a drug used to treat it. The drugs used to treat Parkinson disease (see table Drugs Used to Treat Parkinson Disease ) can also cause problems, such as obsessive-compulsive behavior or difficulty controlling urges, resulting, for example, in compulsive gambling or collecting. 