Parkinson's Disease

Symptoms of Parkinson's Disease

Parkinson's Disease Symptoms

Parkinson's disease is a fairly common neurological condition that affects over half a million Americans.  It is uncommon before age 40, and it is most likely to begin after the age of 60. Parkinson’s disease symptoms can be managed with both medical and surgical treatment options. The condition is characterized by a collection of uniquely distinguishing symptoms that affect movement along with a number of other aspects of daily life.

Common Symptoms of Parkinson's Disease 

Tremors

The tremors of Parkinson’s disease, often described as “pill-rolling,” are slow frequency tremors (4-5Hz) with high amplitude often occurring first in one hand and subsequently spreading to the other side of the body, usually remaining asymmetrical. The tremors usually affect the hands and arms, although they can also involve the chin or the legs.

Parkinson's disease tremors are noted to be resting tremors.

If you have a hand tremor, for example, the tremor should only happen when you are not engaging your hand in any type of action. Once you deliberately move your hand to reach for a utensil or to shake someone's hand, the tremor should briefly stop while you are using your hand. 

Stiffness and Rigidity 

Parkinson's disease commonly causes stiffness throughout the body. Like the tremors, the stiffness often begins in one side, typically on the same side of the tremor, but subsequently affects both sides of the body.

Masked Face

One of the telltale signs of Parkinson's disease is a lack of animated facial expression.

If you have early Parkinson’s disease, you might not notice the changes in your own facial expression. Your masked face can make it appear as if you are not interested in what others are doing or saying. Your friends and family members may finally begin to understand your blank facial expression after you explain to them that you have been diagnosed with Parkinson's disease. 

Decreased Blinking 

One of the common symptoms of Parkinson's disease is decreased blinking. If you have Parkinson's disease, diminished blinking can make you look as if you are staring at someone or something. The reduced blinking may also make your eyes feel dry. 

Shuffling Gait

People living with Parkinson's disease often walk distinctively slowly, with a trademark sluggish shuffling of the feet and a tendency to keep the legs relatively straight, rather than bending them while walking. When someone with Parkinson’s disease walks, the feet remain closer to the ground instead of the usual lifting off the ground.

Slow Movements/Bradykinesia 

Most people with Parkinson's disease move slowly. This begins early in the course of the disease, but like most of the symptoms, it is often not strikingly noticeable until after a diagnosis has been made, when an "aha" moment suddenly explains years of gradually slowing physical activity.

Speech Characteristics of Parkinson's Disease

Speech problems are common in patients with Parkinson’s disease and are characterized by a weak, sometimes nasal or monotonous voice with imprecise articulation. The speech can be slow in some patients, but fast in others.

Sleep Problems 

The majority of people living with Parkinson's disease experience trouble sleeping. This can range from trouble falling asleep, to trouble staying asleep, to sleepiness during the daytime. Restless leg syndrome, a condition characterized by an urge to move the legs is associated with an unpleasant sensation occurring mostly at nighttime. REM sleep disorder, a an condition in which people act out their dreams, are also common.

The sleep problems caused by Parkinson’s disease ultimately result in a sense of fatigue. 

Balance Problems 

Most of the time, Parkinson's disease interferes with balance. This can make it difficult to participate in physical exercise, and as the disease progresses, it becomes a challenge to remain standing without leaning on something for support. 

Less Common Symptoms of Parkinson's Disease 

Fluctuating Emotions 

Some people with Parkinson's disease, especially late-stage Parkinson's disease, experience emotions that change very quickly. Sadness is the emotion most prevalent among people living with Parkinson's disease. 

Freezing 

Parkinson's disease may cause episodic "freezing" of muscles. This usually involves the muscles already the most rigid, but freezing is more severe than the usual rigidity, and it does not affect everyone who is living with the condition. 

Apathy 

Apathy is a lack of interest in anything. While most people who have Parkinson’s disease display a masked face, which gives the appearance of apathy, sometimes Parkinson’s disease actually causes apathy.

In fact, apathy may be one of the earliest symptoms of the disease.

Unexplained Crying 

Parkinson's disease can produce bouts of tearfulness. These are usually mild and unexplained episodes of weeping that come on unexpectedly, and they can be quite embarrassing.

Small Handwriting 

The micrographia of Parkinson’s disease is distinct. If you have micrographia as a result of Parkinson’s disease, your writing is most likely tiny, yet clear and sharp. The letters and words become smaller and smaller as you proceed to write additional sentences, and the words typically begin to curve or angle down along the page after several sentences or paragraphs.

Stooped Posture 

A trademark hunched-over posture can affect some people living with Parkinson’s disease. Most of the time, this begins late in the course of the illness.

Low Blood Pressure/Blood Pressure Fluctuations

Often described as dysautonomia, this unsettling problem affects a small minority of people living with Parkinson's disease. Dysautonomia causes fluctuations in blood pressure, predominantly causing unexpected and sudden episodes of low blood pressure. Symptoms include lightheadedness, dizziness, and loss of balance. 

Swallowing Problems 

Sometimes, the slowing of muscle movements in Parkinson’s disease can interfere with normal action of the swallowing muscles, making it challenging to chew, swallow, and eat.

Hallucinations 

Parkinson's disease can cause hallucinations. These hallucinations are typically visual. Auditory (hearing voices), olfactory and tactile hallucinations also can occur in Parkinson's Disease, but are less common. Some of the medications used to treat Parkinson's disease are known to cause hallucinations as a side effect. But Parkinson's disease itself can cause hallucinations, although it is not a frequent symptom and does not affect everyone who has Parkinson’s disease. 

Forgetfulness 

Parkinson’s disease can be associated with a type of dementia, called subcortical dementia. That is characterized by difficulties with decision making, multi-tasking, changes in personality and overall slowness of thinking. The dementia tends to occur late on the course of the disease.

Dry Skin

If you have Parkinson's disease, you may have dry, flaky skin and dryness of your scalp. 

Pain 

About 54-60 percent of those living with Parkinson's disease experience pain. Persistent stiffness and muscle rigidity is often the root of the pain. The pain associated with Parkinson's disease is muscle pain that happens in the absence of any obvious injury.

Constipation and Urinary Retention

The slow muscle movements typical of Parkinson's disease can cause the muscles of the bowels or bladder to slow down, resulting in constipation or urinary retention.

Health Problems Similar to Parkinson's Disease 

There are a number of illnesses that can easily be mistaken for Parkinson's disease because they produce similar symptoms. 

Benign Essential Tremor

Benign essential tremor is a common condition often confused with Parkinson’s disease. It is characterized by rapid tremors of the hands, arms, head or voice, ussually affecting both sides of the body equally, that worsen with anxiety. Unlike the tremors of Parkinson's disease, the tremors of benign essential tremor do not improve with action, and in fact, typically worsen with activity. 

Parkinsonism 

Parkinsonism is a group of neurological diseases that causes motor problems similar to Parkinson’s disease. Medications such as antipsychotics, repeated head trauma, strokes, toxins as well as certain neurodegenerative disorders such as progressive supranuclear palsy and multisystem atrophy, are some of the causes of this condition. Some of these conditions tend to progress more rapidly, do not respond well to levodopa therapy and have other associated symptoms such as early falling, early dementia, more severe dysautonomia

Lewy Body Dementia 

This type of dementia is characterized by forgetfulness, lack of insight, hallucinations, and some motor symptoms that are similar to the symptoms of Parkinson’s disease. The major difference between Parkinson’s disease and Lewy body dementia is that motor symptoms and physical symptoms are more prominent in Parkinson’s disease, while memory and behavioral symptoms are much more prominent in Lewy body dementia. At the late stage of each of these conditions, the symptoms may overlap considerably.

Major Depression

Extreme depression can cause slowness of movements, a masked face, apathy, sadness, and sleep disturbances that resemble the symptoms of Parkinson’s disease. However, depression does not cause tremors, shuffling gait or muscle rigidity that are trademarks of Parkinson’s disease.

Side Effects of Antipsychotic Medications 

A few antipsychotic medications are known to cause tremors and stiffness that are very similar to the symptoms of Parkinson’s disease. These medications must be carefully adjusted in order to manage the illness for which they are intended while minimizing the Parkinsonian side effects.

Creutzfeld-Jacob Disease

This is a rare disease that causes involuntary muscle jerks called myoclonus and profound dementia. Sometimes it causes blindness. This illness can be caused by an unusual infectious agent that is transmitted through contact with the brain or spinal cord contents of an infected individual or animal. The muscle jerks are intense and erratic, in contrast to the rhythmic tremors of Parkinson’s disease. Also, differently from Parkinson's, the dementia is rapidly progressive and can prevent you from being able to move and speak.

Infectious Encephalitis 

Encephalitis is inflammation or infection of the brain, and it can be fatal. Viral encephalitis has been known to cause Parkinsonism among survivors.

When to See the Doctor

If you experience any symptoms such as tremors, stiffness, trouble with balance, forgetfulness, or trouble sleeping, you should make an appointment to see your doctor. These symptoms may or may not be Parkinson’s disease, but they are manageable. Parkinson’s disease is treatable, and early treatment is the best way to prevent the symptoms from interfering with your life.

A Word From Verywell

Parkinson’s disease is a noteworthy medical condition in that it is one of the few medical ailments that tends to preferentially affect people who are highly educated, productively employed, and who do not smoke. The reasons for this trend are not completely well understood by medical researchers yet. If you have Parkinson’s disease, you should rest assured knowing that treatment for your medical condition is effective and is also advancing at a rapid pace. Parkinson’s disease certainly presents some disruption to your life, but fortunately, it is not fatal and people living with Parkinson’s disease are known to live long, healthy, and productive lives.

 

Sources:

Ozturk EA, Gundogdu I, Kocer B, Comoglu S, Cakci A. Chronic pain in Parkinson's disease: Frequency, characteristics, independent factors, and relationship with health-related quality of lifeJournal of Back and Musculoskeletal Rehabilitation. 2016.

Ylikoski A, Martikainen K, Sieminski M, Partinen M. Sleeping difficulties and health-related quality of life in Parkinson's disease. Acta Neurologica Scandinavica. 2016.

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