How to recognise Parkinson’s disease

Parkinson’s disease is a progressive neurological condition. Would you know the signs and symptoms of Parkinson’s?

Parkinson’s disease (Pd) is a progressive neurological condition which is characterised by both motor (movement) and non-motor symptoms. It is important to remember that presentation of symptoms is unique to each person with Parkinson’s (PWP).

Provisional medical diagnosis is based on four cardinal symptoms:

  • Tremor
  • Bradykinesia
  • Muscle rigidity
  • Postural instability

It should be noted that although this is the most commonly identified symptom it is not present in all cases (30 per cent of PWP will not experience tremor) and tremor is present in other conditions.

Tremor is related to the imbalance of dopamine and acetylcholine and in particular to the action of acetylcholine, hence tremor may not be the most responsive symptom to dopamine therapy.

The classic Pd tremor is described as a ‘resting’ tremor i.e. it is apparent when the limb is at rest. The Parkinson’s tremor is regular and rhythmic and occurs at the rate of four to six times per second.

Initially tremor may affect a unilateral limb, however, with progression of the disease tremor may become bilateral. A classic tremor presentation in Pd involves the thumb and first finger and is known as ‘a pill rolling tremor’.

While resting tremor is typical of Pd in some cases ‘action’ tremor is present (initiated by active movements). This can be challenging in routine daily activities e.g. eating, drinking and writing.

Tremor may be exacerbated by stress and this is possibly due to the influence of adrenaline causing a further neurotransmitter imbalance.

Bradykinesia literally means ‘slow movement’. The general effect is that it takes longer and requires more effort to complete daily tasks. Slowness and difficulty in initiating and executing automatic repetitive movements is commonly experienced. These actions include writing, fastening buttons, turning over in bed and walking. These difficulties are exacerbated when dual tasking is involved i.e. walking and talking.

Bradykinesia is also apparent in decreased eye blink and may lead to changes in swallowing and speech.

Muscle Rigidity
Muscle rigidity refers to the resistance felt in muscles when they are passively moved. This can be described as ‘lead pipe’ rigidity when the resistance is consistent. ‘Cogwheel’ rigidity is the term used when the resistance to passive movements has a regular jerking characteristic. Muscle rigidity as with all Pd symptoms first presents as unilateral however with progression becomes bilateral. Muscle rigidity accounts for the neck and shoulder pain sometimes experienced early in the disease process.

Postural Instability
Postural changes are evident as forward flexed or stooped posture. The ability to maintain posture and balance may be affected in Pd. This symptom may appear later and is often the cause of falls because the ability to correct one’s balance is compromised. This may lead to unsteadiness when walking, turning or standing.

Other Symptoms
There are many other symptoms which add to the complete presentation and are considered in the diagnostic process. These can be as challenging as the four major symptoms.

Akinesia is a term used to describe absence or impairment of movement. This may result in freezing of gait which is the sudden onset inability to move while walking. This often happens in confined spaces e.g. doorways or on turning.

Anosmia refers to a decrease/loss of sense of smell which often precedes a diagnosis of Pd.

Anxiety is a common phenomenon in Pd and can aggravate motor symptoms.

Constipation, a common symptom, is due to the reduced motility of the bowels and may be aggravated by a reduction in physical activity and the introduction of Parkinson’s medications.

Depression is commonly associated with Pd. This may be attributed to the initial diagnosis of Pd (reactive depression) or may be related to a chemical imbalance within the brain (endogenous depression). The latter may develop several years following diagnosis.

Fatigue, which is not relieved by resting, is a commonly described early symptom that may be associated with a variety of causes. Disturbed sleep pattern caused by changes in bed mobility, restless legs, urinary frequency and/or leg cramping will result in daytime fatigue.

Festination of speech describes the changes to fluency. This can be described as a stuttering-like speech pattern.

Gait changes are associated with walking and posture. Stride length and height become smaller leading to the typical ‘shuffling’ gait. Flexed posture is due to a shifting forward of the centre of gravity combined with muscle rigidity.

Impotence is frequently reported.

Loss of motivation is frequently described by family and friends as a gradual early symptom.

Masked facial expression is due to increased muscle rigidity and impairment of automatic facial responses. This is compounded by a decreased eye blink rate and may be misinterpreted as boredom or depression.

Micrographia refers to changes in handwriting, primarily cursive. This becomes smaller in height and the written words may be unclear by the end of the sentence.

Microphonia describes decreased volume of speech. Often PWP may not be aware of the gradual reduction in volume.

Postural hypotension refers to a lowering of blood pressure especially on standing or rising from the lying position. This can result in unsteadiness, dizziness and falls.

Sialorrhea describes excessive saliva and is often related to a decreased frequency in swallowing and poor mouth closure.

Sweating may be excessive or diminished. Some people find they become more sensitive to changes in temperature.

The symptoms listed above reflect some of the changes associated with Pd. Not everyone affected by Pd will experience all of these symptoms.

For further information please contact your state organisation: Freecall 1800 644 189

Parkinson’s Australia (08) 9346 7373
New South Wales (02) 9767 7881
Victoria (03) 9551 1122
Queensland (07) 3209 1588
Australian Capital Territory (02) 6290 1984
South Australia (08) 8357 8909
Western Australia (08) 9346 7373
Tasmania (03) 6224 4028