Parkinson?s disease

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Substantia nigra and Parkinson's disease

Central nervous system

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 initiating any voluntary movement
- Difficulty beginning to walk
- Difficulty getting up from a chair
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 or speech changes
- Slow speech
- Low volume
- 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
- Uncontrolled, slow movement
Frequent falls
Decline in intellectual function (may occur, can be severe)
A variety of gastrointestinal symptoms, mainly constipation.

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Note: Initial symptoms may be mild and nonspecific, for instance, a mild tremor or a slight feeling that one leg or foot is stiff and dragging.

Additional symptoms that may be associated with this disease:

Depression
Confusion
Dementia
Seborrhea (oily skin)
Loss of muscle function or feeling
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 (jerky, stiff movements), 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. See also essential tremor.

References:

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders;2003: 713-720.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:1612-1618.