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Parkinson's disease

Description

An in-depth report on the causes, diagnosis, and treatment of Parkinson's Disease

Symptoms

Parkinson's disease (PD) symptoms often start with tremor, which may occur in the following ways:

• Tremors may first be only occasional, starting in one finger and spreading over time to involve the whole arm. The tremor is often rhythmic, 4 to 5 cycles per second, and frequently causes an action of the thumb and fingers known as pill rolling.
• Tremors can occur when the limb is at rest or when it is held up in a stiff unsupported position. They usually disappear briefly during movement and do not occur during sleep.
• Tremors can also eventually occur in the head, lips, tongue, and feet. Symptoms can occur on one or both sides of the body. In one study, 44% of patients reported experiencing internal tremors lasting less than half an hour, but occurring several times a week.

In younger patients tremor is usually predominant and often suggests a less aggressive form of the disease. Some evidence suggests that tremor in PD may occur from mechanisms in the brain that are different from those that cause other PD symptoms.

Motion and Motor Impairment

A number of PD symptoms involve motor impairment caused by the abnormalities in the brain that regulate movement:

• Slowness of motion ( bradykinesia ) is one of the classic symptoms of Parkinson's disease. Patients may eventually develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady. After a number of years, muscles may freeze up or stall, usually when a patient is making a turn or passing through narrow spaces, such as a doorway.
• Intestinal motility (the ability to swallow, digest, and eliminate) may slow down, causing eating problems and constipation.
• Muscles may become rigid ( akinesia ). This symptom often begins in the legs and neck. Muscle rigidity in the face can produce a mask-like, staring appearance.
• Motor abnormalities that limit action in the hand may develop in late stages. Handwriting, for instance, often becomes diminutive.
• Normally spontaneous muscle movements, such as blinking, may need to be done consciously.

Other Symptoms of Parkinson's Disease

The traditional view of Parkinson's disease is shifting to reflect growing awareness that it is much more than a motor disease. Many non-motor components and their treatments are now under study. The following symptoms should be carefully monitored by doctors and caregivers:

• Depression is the most common psychiatric problem associated with PD, affecting about 40% of patients. Because depression is a common problem in older people, it is likely not to be recognized as a symptom.
• Anxiety affects about 30% of patients.
• Dementia and paranoia are more common than previously understood.
• Compulsive behavior -- patients with PD may have a significant tendency (up to 20%, as compared to 2% in the general population) to engage in compulsive problem gambling and sexual behaviors.
• Orthostatic hypotension -- some patients experience a sudden drop in blood pressure when they stand. This can cause dizziness and fainting.
• Changes in sensations of temperature, hot flashes, and excessive sweating.
• Daytime sleepiness and other sleep disorders are common.

• Review Date: 3/30/2007
• Reviewed By: A.D.A.M. Editorial Team: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (5/22/2006).

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