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Parkinson's Disease

Also called: Paralysis agitans, Shaking palsy

Parkinson's disease is a disorder that affects nerve cells, or neurons, in a part of the brain that controls muscle movement. In Parkinson's, neurons that make a chemical called dopamine die or do not work properly. Dopamine normally sends signals that help coordinate your movements. No one knows what damages these cells. Symptoms of Parkinson's disease may include

  • Trembling of hands, arms, legs, jaw and face
  • Stiffness of the arms, legs and trunk
  • Slowness of movement
  • Poor balance and coordination

As symptoms get worse, people with the disease may have trouble walking, talking or doing simple tasks. They may also have problems such as depression, sleep problems or trouble chewing, swallowing or speaking.

Parkinson's usually begins around age 60, but it can start earlier. It is more common in men than in women. There is no cure for Parkinson's disease. A variety of medicines sometimes help symptoms dramatically.

Symptoms

The diagnosis of PD depends upon the presence of one or more of the four most common motor symptoms of the disease, which are: resting tremor, bradykinesia, rigidity and postural instability.

In addition, there are other secondary and nonmotor symptoms that affect many people and are increasingly recognized by doctors as important to treating Parkinsonís.

Each person with Parkinson's will experience these symptoms differently. For example, many people experience tremor as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly, and in others it does not.

Find out more by reading below†about:

  • Primary Motor Symptoms
  • Secondary Motor Symptoms
  • Nonmotor Symptoms
  • Coping with Symptoms

Primary Motor Symptoms

Resting Tremor: About 70 percent of people with Parkinsonís experience a slight tremor in the early stage of the disease - either in the hand or foot on one side of the body, or less commonly in the jaw or face. The tremor appears as a "beating" or oscillating movement. Because the Parkinson's tremor usually appears when a person's muscles are relaxed, it is called "resting tremor." This means that the affected body part trembles when it is not doing work, and it usually subsides when a person begins an action. The tremor often spreads to the other side of the body as the disease progresses, but remains most apparent on the original side of occurrence.

Bradykinesia (Slow Movement): Bradykinesia is the phenomenon of a person experiencing slow movements. In addition to slow movements, a person with bradykinesia will probably also have incomplete movement, difficulty initiating movements and sudden stopping of ongoing movement. People who have bradykinesia may walk with short, shuffling steps (this is called festination). Bradykinesia and rigidity can occur in the facial muscles, reducing a person's range of facial expressions and resulting in a "mask-like" appearance.

Rigidity: Rigidity, also called increased muscle tone, means stiffness or inflexibility of the muscles. Muscles normally stretch when they move, and then relax when they are at rest. In rigidity, the muscle tone of an affected limb is always stiff and does not relax, sometimes resulting in a decreased range of motion. For example, a person who has rigidity may not be able to swing his or her arms when walking because the muscles are too tight. Rigidity can cause pain and cramping.

Postural Instability (Impaired Balance and Coordination): People with Parkinson's disease often experience instability when standing or impaired balance and coordination. These symptoms, combined with other symptoms such as bradykinesia, increase the chance of falling. People with balance problems may have difficulty making turns or abrupt movements. They may go through periods of "freezing," which is when a person feels stuck to the ground and finds it difficult to start walking. The slowness and incompleteness of movement can also affect speaking and swallowing.

Secondary Motor Symptoms

The secondary motor symptoms include those below, but not all people with Parkinsonís will experience all of these. †

  • Stooped posture, a tendency to lean forward
  • Dystonia
  • Fatigue
  • Impaired fine motor dexterity and motor coordination
  • Impaired gross motor coordination
  • Poverty of movement (decreased arm swing)
  • Akathisia
  • Speech problems, such as softness of voice or slurred speech caused by lack of muscle control
  • Loss of facial expression, or "masking"
  • Micrographia (small, cramped handwriting)
  • Difficulty swallowing
  • Sexual dysfunction
  • Drooling (See Q&A booklet, page 22)
  • Nonmotor Symptoms

    Nonmotor symptoms of Parkinsonís, such as sleep problems and depression, can be, for many people, as troublesome as the primary movement symptoms of the disease.

    The following is a list of nonmotor symptoms of Parkinson's disease. To read more about nonmotor symptoms, read our fact sheet, PD: More than a Movement Disorder or check the Living with PD section of the website to learn more about living well with different aspects of PD.

    • Dementia or confusion
    • Sleep disturbances
    • Constipation
    • Skin problems
    • Depression
    • Fear or anxiety
    • Memory difficulties and slowed thinking
    • Urinary problems
    • Fatigue and aching
    • Loss of energy
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