Parkinson's Disease:

Symptoms of Parkinson's disease

Dr. James Parkinson discovered a disease he identified as “shaky palsy” in 1817. It was not until 1960 that changes in the brains of Parkinson's patients were discovered, making it possible to develop medication for the condition.

There are primary levels of Parkinson's disease and secondary levels. Not everyone with the disease experiences all of the symptoms and the progression of the disease is different from person to person. Most people who get Parkinson's are over 60, but there have recently been more cases in younger men and women.

Most of the symptoms of the disease have to do with motor skills, but pain and lack of energy are also symptoms of the disease.

Symptoms of Parkinson's Disease
Primary Symptoms	Bradykinesia – slowness in voluntary movement such as standing up, walking, and sitting down. This happens because of delayed transmission signals from the brain to the muscles. Tremors – often occur in the hands, fingers, forearms, foot, mouth, or chin. Typically, tremors take place when the limbs are at rest as opposed to when there is movement. Rigidity – otherwise known as stiff muscles, often produce muscle pain that is increased during movement. Poor Balance – happens because of the loss of reflexes that help posture. This causes unsteady balance which oftentimes leads to a fall. Parkinson's Gait – a common walk of somebody with Parkinson's disease. It includes shuffling, head down, shoulders drooped, lack of arm swing, and leaning backwards or forwards unnaturally. Initiating walking is difficult and freezing mid-stride is common.
Secondary Symptoms	Constipation Difficulty swallowing; saliva and food that get caught in the mouth or in the back of the throat may cause choking, coughing, or drooling Excessive salivation Excessive sweating Loss of bowel and/or bladder control Loss of intellectual capacity Psychosocial: anxiety, depression, isolation Scaling, dry skin on the face or scalp Slow response to questions Small cramped handwriting Soft, whispery voice

There are many secondary symptoms associated with Parkinson's disease. Patients do not typically experience all the symptoms, and the intensity of each symptom varies from person to person

Diagnosis and treatment of Parkinson's disease

How is Parkinson's disease diagnosed?

There are not lab tests to definitively diagnose Parkinson's disease. A systematic neurological exam will include testing your reflexes and observing things like muscle strength throughout your body, coordination, balance, and other details of movement. You may be given tests to exclude the possibility of other disorders. These tests include blood tests, urine tests, CT scans, or MRI scans. Although none of these tests actually diagnose Parkinson's disease, they may reveal the presence of some other conditions that could be responsible for the symptoms.

Treatment of Parkinson’s disease

There is no cure for Parkinson’s disease; however, there are certain medications available to treat the symptoms of the disease. A surgical treatment, known as Deep Brain Stimulation (DBS) is sometimes used to help reduce the severity of muscle rigidity and bradykinesia, and physical therapy is often recommended.

However, if you have been diagnosed with Parkinson’s, you can help keep yourself as healthy and safe as possible by taking certain precautions.

Alleviating Parkinson’s-related problems and symptoms

General tips for mobility and comfort

• Before starting an exercise regime, you should always check with your doctor.
• Cut foods into smaller portions to avoid choking and to encourage digestion.
• For upset stomachs linked to medication, try eating an oatmeal cookie when taking it.
• Exercise your face and jaw whenever possible.
• Practice bending, stretching, and breathing exercises.
• Try exercising in bed; it may be easier than on the floor.
• Build your walking skills, even if that means having to hold onto something.
• Try exercising in the water; it is easier on the joints.

Ways to improve your safety when living with Parkinson’s

• Use grab bars in the tub and shower.
• Use a bath chair or stool in the shower.
• Keep your floors smooth but not slippery.
• Store supplies in easy to reach cabinets.
• Make sure stairwells are lit.
• Get nightlights for bathrooms and hallways.
• Keep walking areas free of clutter.
• Wear low heeled, comfortable shoes when walking around. Avoid walking in slippery socks and slippers.
• Make sure carpets are fully tacked to the ground.

The relationship between Parkinson's disease and dementia

Parkinson’s patients who experience hallucinations and more severe motor control problems are at risk for dementia. According to Dr. Jean Hubble of Ohio State University, dementia is a “cognitive impairment of sufficient magnitude to hinder daily activities or diminish the quality of the patient's life.” Approximately 20% of people with Parkinson’s disease will develop dementia, usually after the age of 70. In general, there is a 10 to 15 year lag time between a Parkinson’s diagnosis and the onset of dementia, which typically occurs years after the motor skills begin to be affected.

Signs of dementia in Parkinson’s patients include:

There are two types of dementia found in Parkinson’s patients, both involving Lewy bodies, or protein deposits in the nerve cells. The first one develops when Lewy bodies occupy the brain and the brain stem, which occurs in about 25% of the cases. The more common type of dementia, accounting for the remaining 75%, is caused by Lewy bodies in the brainstem and Alzheimer’s-type changes in the brain. For both types of dementia, medications may help improve early symptoms.

Indications that the dementia may be caused by something other than Parkinson’s include agitation, delusions, language difficulties, and early onset of symptoms. If these factors are present, your physician can test for other possible causes, such as a Vitamin B-12 deficiency or an underactive thyroid gland. Depression is also common in Parkinson’s patients and can mimic dementia by causing similar symptoms. For this reason, anti-depressant drugs often help.

References and resources about Parkinson's disease

Parkinson's Disease Foundation – Includes several interesting features, including 'Ask the Expert' for specific questions and answers about the disease; and ‘Parkinson's Community' to help you find regional, national and internet groups and support organizations. (Parkinson's Disease Foundation)

Parkinson's Disease Patient Information – Provides information about Parkinson's disease, current events, publication and video, fellowships and grants. (American Parkinson's Disease Association)

Medline Plus: Parkinson's Disease – A resource list of online articles and publications about Parkinson's including links to information about current research, specific medication and treatment regimens, support organizations and general information. (National Library of Medicine / National Institutes of Health)

Tracking Dementia in Parkinson's Disease – Outlines a study that found Parkinson's disease patients with dementia can lose their mental abilities at almost the same rate as people with Alzheimer's disease. (Web MD)

Cognitive Impairment and Dementia in Parkinson's Disease – Discusses cognitive decline and dementia in Parkinson's disease patients. Reports on the effectiveness of some medications for dementia and cognitive impairment. (Parkinson's Association of the Rockies)

Gina Kemp, M.A., and John Dorsey contributed to this article. Last modified on: 12/19/07.