Parkinson's Disease

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The initial signs of Parkinson's are often quite subtle; they include lack of facial expression, slow movement, and a tendency to speak softly and monotonously. Confusion of these symptoms with the signs of normal aging often contributes to underdiagnosis, misdiagnosis, and lack of treatment in the elderly. Diagnosing the condition is primarily a matter of clinical judgment and the process of elimination, since there's currently no unequivocal neurodiagnostic test.

Most symptoms involve some aberration of normal movement, resulting from the garbling of chemical signals between cells that happens when dopamine-producing cells die. Symptoms vary in kind and intensity from person to person and may grow progressively worse over a couple of decades. The common symptoms include:

  • A resting tremor, so called because it's a shaking that typically happens when the muscles are relaxed and subsides when the person begins to make an intentional motion. A tremor can affect all parts of the body, but it commonly involves movements of the thumb across the fingers ("pill rolling"), flexion and extension of the arm, and rotating of the forearm. Usually, the tremor is absent during sleep.
  • Stiffness or rigidity of the muscles, resulting in decreased ability to move. When a joint of a Parkinson's patient is moved, there is resistance to the movement. "Lead pipe" rigidity is a form of increased tone that is particularly prominent in Parkinson's and can result in muscle stiffness, fatigue, and weakness. "Cogwheel" rigidity occurs when there is also a tremor and is characterized by a "stop and go" effect during a range of motion maneuver.
  • A slow shuffling gait and general slowness of movement (bradykinesia)
  • Decreased range of facial expression
  • Impaired balance
  • A reduction in automatic movements, such as blinking, swallowing, arm swing, and facial expression
  • Loss of fine motor skills, such as cutting food, buttoning clothes, and fastening jewelry
  • A decrease in speech volume

Other possible symptoms include difficulty getting up from a seated position or turning over in bed; decrease in walking arm swing on one or both sides; mild dragging of one foot; disordered sleep, and constipation. Dementia frequently—though not always—develops as time goes on. Depression is often seen in people with Parkinson's, possibly a result of the loss of dopamine.

Stages of Parkinson's disease

Developing an objective tool that would allow doctors to judge the severity of a patient's Parkinson's disease has been difficult. The classification most widely used to stage disease severity is the Hoehn and Yahr Scale. This system puts symptoms into five stages:

  • Stage 1: The symptoms are mild and on one side of the body only; one limb may show a tremor.
  • Stage 2: Symptoms are still fairly mild but appear on both sides of the body.
  • Stage 3: By this time, the patient is moving quite slowly and with difficulty; has trouble keeping his balance.
  • Stage 4: Symptoms are severe enough that the patient can't live alone. He can still walk, but muscles are rigid, and movements are very slow.
  • Stage 5: The patient can no longer stand and requires nursing care.

Last reviewed on 04/11/2006

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