User:Awatson723/Parkinson's disease

Signs and symptoms

Main article: Signs and symptoms of Parkinson's disease

Parkinson's disease is characterized by a range of symptoms, with the most recognizable ones being movement (motor) related. These include tremor, bradykinesia (slowness of movement), rigidity, and a shuffling or stooped gait [37]. In addition to these motor symptoms, there are non-motor symptoms that may also be present, such as autonomic dysfunction (dysautonomia), neuropsychiatric problems (mood, cognition, behavior, or thought alterations), sensory abnormalities (especially altered sense of smell), and sleep difficulties. Some patients may experience non-motor symptoms prior to the onset of motor symptoms, including constipation, anosmia, and REM Behavior Disorder (rapid eye movement sleep behavior disorder). As the disease progresses, symptoms such as dementia, psychosis, orthostasis (abnormal drop in blood pressure upon standing), and more severe falls tend to occur [37]. Dysphagia (difficulty swallowing) can also develop at any time during the course of Parkinson's and affects more than 80% of patients [38][39].

Four motor symptoms are considered as cardinal signs in Parkinson's disease: tremor, bradykinesia, rigidity, and postural instability [37].

The most common presenting sign of Parkinson's disease is a coarse, slow tremor of the hand at rest, which disappears during voluntary movement of the affected arm and in the deeper stages of sleep. Initially, it usually affects only one hand and later progresses to involve both hands [37]. The frequency of the tremor in Parkinson's disease is typically between 4 and 6 hertz (cycles per second). A characteristic feature of the tremor is pill-rolling, where the index finger and thumb tend to touch and perform a circular movement, resembling the manual technique used to make pills [37][40].

Bradykinesia is caused by disturbances in motor planning of movement initiation and is associated with difficulties throughout the entire movement process, from planning to execution. It manifests as a slowness of movement and is the most disabling symptom of Parkinson's disease, affecting everyday tasks such as dressing, feeding, and bathing. Individuals with Parkinson's disease often struggle to perform two independent motor activities simultaneously and may experience worsening of symptoms due to emotional stress or concurrent illnesses. Interestingly, people with Parkinson's disease can sometimes ride a bicycle or climb stairs more easily than walk on level ground. While physicians can often observe bradykinesia, a formal assessment requires individuals to perform repetitive movements with their fingers and feet [41].

In parkinsonism, rigidity or hypokinesia can be uniform, known as lead-pipe rigidity, or ratcheted, known as cogwheel rigidity [22][37][42][43]. Cogwheel rigidity is thought to arise from the combination of tremor and increased muscle tone [44]. Rigidity may be accompanied by joint pain, which can be an early manifestation of the disease [37]. In the early stages of Parkinson's disease, rigidity is usually asymmetrical and primarily affects the neck and shoulder muscles before involving the muscles of the face and extremities [45]. As the disease progresses, rigidity tends to affect the entire body, severely limiting mobility.

Postural instability is a common feature in the later stages of Parkinson's disease, leading to impaired balance and an increased risk of falls [46]. These falls can result in bone fractures, loss of confidence, and reduced mobility [47]

Summary of Revisions Made


 * Clarified that Parkinson's disease is characterized by a range of symptoms.
 * Added a mention of non-motor symptoms, including autonomic dysfunction, neuropsychiatric problems, sensory abnormalities, and sleep difficulties.
 * Included specific examples of non-motor symptoms that may precede motor symptoms.
 * Reorganized the sentence discussing the progression of symptoms as the disease advances.
 * Clarified the definition of the cardinal signs of Parkinson's disease.
 * Revised the description of the hand tremor to emphasize its occurrence at rest and disappearance during voluntary movement.
 * Clarified that tremor frequency is between 4 and 6 hertz.
 * Added an explanation of the term "pill-rolling" and its resemblance to the manual technique of making pills.
 * Clarified the cause of bradykinesia and its impact on daily activities.
 * Added information about the ability of individuals with Parkinson's disease to perform certain motor activities more easily than walking.
 * Clarified the assessment of bradykinesia and the need for repetitive movements.
 * Provided additional details about rigidity, including uniform and cogwheel rigidity.
 * Clarified the association of rigidity with joint pain and its distribution in the early stages of the disease.
 * Expanded on the consequences of postural instability, including falls, fractures, loss of confidence, and reduced mobility.