Parkinson's disease natural history, complications and prognosis: Difference between revisions

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{{Parkinson's disease}}
{{Parkinson's disease}}


{{CMG}}
{{CMG}} {{AE}} {{Fs}}


==Overview==
==Overview==
The most common initiating [[Symptom|symptoms]] in [[Parkinson's disease|PD]] are slowness of movement ([[bradykinesia]]), shaking hands while they are at rest (resting [[tremor]]) and [[muscle]] stiffness (rigidity). These [[Symptom|symptoms]] usually starts unilaterally and the severity of them remains higher in the side of onset. [[Complications]] that can develop as a result of Parkinson disease include [[tremor]], rigidity, [[bradykinesia]], [[gait]] problems, [[cognitive]] dysfunction and [[dementia]], [[psychosis]] and [[Hallucination|hallucinations]], [[Mood disorder|mood disorders]] including [[depression]], [[anxiety]], and [[apathy]]/[[abulia]], [[sleep]] disturbances, [[fatigue]], [[olfactory]] dysfunction, [[pain]], [[autonomic dysfunction]] including [[orthostatic hypotension]][[constipation|, constipation]], [[dysphagia]], [[urinary]] and [[Sexual dysfunction|sexual]] problems. In one of the studies regarding [[Parkinson|PD]] [[prognosis]], it was seen that the percent of dead or severely disabled patients is 25 percent within 5 years, 67 percent within 5 to 9 years and 80 percent within 10 to 14 years of disease onset. It was also shown that disability will occurs mostly in 3 to 7 years of disease onset.


==Natural History==
== Natural History, Complications, and Prognosis ==


==Complications==
===Natural History===
==Prognosis==
* The most common initiating [[Symptom|symptoms]] in [[Parkinson's disease|PD]] are slowness of movement ([[bradykinesia]]), shaking hands while they are at rest (resting [[tremor]]) and [[muscle]] stiffness (rigidity).<ref name="pmid26865518" />
In one of the studies regarding [[Parkinson|PD]] [[prognosis]], it was seen that the percent of dead or severely disabled patients is 25 percent within 5 years, 67 percent within 5 to 9 years and 80 percent within 10 to 14 years of disease onset.(16_35) It was also shown that disability will occurs mostly in 3 to 7 years of disease onset.(150)
* These [[Symptom|symptoms]] usually starts unilaterally and the severity of them remains higher in the side of onset.<ref name="pmid1564476">{{cite journal |vauthors=Hughes AJ, Daniel SE, Kilford L, Lees AJ |title=Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases |journal=J. Neurol. Neurosurg. Psychiatry |volume=55 |issue=3 |pages=181–4 |date=March 1992 |pmid=1564476 |pmc=1014720 |doi= |url=}}</ref>
 
* In the course of the disease patients may experience motor and nonmotor symptoms:
===== Motor symptoms =====
* Tremor: [[Tremor]] is the most common [[symptom]] in Parkinson disease and can be the presenting sign in 70 to 80 percent of patients.<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref>
*This [[symptom]] starts unilaterally mostly in [[hand]] and then progress to the other side of the body. It can also involve [[Leg|legs]], [[jaw]], [[lips]] and [[tongue]].<ref name="pmid7276968">{{cite journal |vauthors=Findley LJ, Gresty MA, Halmagyi GM |title=Tremor, the cogwheel phenomenon and clonus in Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=44 |issue=6 |pages=534–46 |date=June 1981 |pmid=7276968 |pmc=491035 |doi= |url=}}</ref><ref name="pmid5463541">{{cite journal |vauthors=Scott RM, Brody JA, Schwab RS, Cooper IS |title=Progression of unilateral tremor and rigidity in Parkinson's disease |journal=Neurology |volume=20 |issue=7 |pages=710–4 |date=July 1970 |pmid=5463541 |doi= |url=}}</ref><ref name="pmid2296262">{{cite journal |vauthors=Hunker CJ, Abbs JH |title=Uniform frequency of parkinsonian resting tremor in the lips, jaw, tongue, and index finger |journal=Mov. Disord. |volume=5 |issue=1 |pages=71–7 |date=1990 |pmid=2296262 |doi=10.1002/mds.870050117 |url=}}</ref>
*[[Parkinson's disease|PD]] [[tremor]] frequency is 3 to 7 Hz.<ref name="pmid7276968">{{cite journal |vauthors=Findley LJ, Gresty MA, Halmagyi GM |title=Tremor, the cogwheel phenomenon and clonus in Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=44 |issue=6 |pages=534–46 |date=June 1981 |pmid=7276968 |pmc=491035 |doi= |url=}}</ref>
*There is a [[symptom]] called re-emergent tremor in some of the [[Parkinson's disease|PD]] patients. It manifests by postural tremor that starts after several seconds and can make it difficult to differentiate [[Parkinson's disease|PD]] from [[essential tremor]].<ref name="pmid10519872">{{cite journal |vauthors=Jankovic J, Schwartz KS, Ondo W |title=Re-emergent tremor of Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=5 |pages=646–50 |date=November 1999 |pmid=10519872 |pmc=1736624 |doi= |url=}}</ref><ref name="pmid11594921">{{cite journal |vauthors=Louis ED, Levy G, Côte LJ, Mejia H, Fahn S, Marder K |title=Clinical correlates of action tremor in Parkinson disease |journal=Arch. Neurol. |volume=58 |issue=10 |pages=1630–4 |date=October 2001 |pmid=11594921 |doi= |url=}}</ref>
 
* Rigidity: Rigidity in [[Parkinson's disease|PD]] in very common and can be seen in 75 to 90 percent of patients.<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |doi=10.1212/WNL.0000000000002461 |url=}}</ref><ref name="pmid8420197">{{cite journal |vauthors=Hughes AJ, Daniel SE, Lees AJ |title=The clinical features of Parkinson's disease in 100 histologically proven cases |journal=Adv Neurol |volume=60 |issue= |pages=595–9 |date=1993 |pmid=8420197 |doi= |url=}}</ref>
*It commonly starts in the same side as the [[tremor]]. [[Parkinson's disease|PD]] patients have increased resistance to passive movement of their [[joint]] and sometimes it’s known as cogwheel rigidity because of the ratchety pattern of resistance and relaxation. Some evidences suggest that superimposition of [[tremor]] on increased [[muscle tone]] creates this kind of rigidity.<ref name="pmid9827589">{{cite journal |vauthors=Deuschl G, Bain P, Brin M |title=Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee |journal=Mov. Disord. |volume=13 Suppl 3 |issue= |pages=2–23 |date=1998 |pmid=9827589 |doi= |url=}}</ref><ref name="pmid13928399">{{cite journal |vauthors=LANCE JW, SCHWAB RS, PETERSON EA |title=Action tremor and the cogwheel phenomenon in Parkinson's disease |journal=Brain |volume=86 |issue= |pages=95–110 |date=March 1963 |pmid=13928399 |doi= |url=}}</ref>
 
* Bradykinesia: [[Bradykinesia]] or slowness of movement, is seen in 80 percent of [[Parkinson's disease|PD]] patients.<ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref>
* Postural instability: [[Gait]] and postural problems can be the main cause of disability in [[Parkinson's disease|PD]] patients and commonly doesn’t response well to [[Dopamine|dopaminergic]] treatment.<ref name="pmid2720700">{{cite journal |vauthors=Koller WC, Glatt S, Vetere-Overfield B, Hassanein R |title=Falls and Parkinson's disease |journal=Clin Neuropharmacol |volume=12 |issue=2 |pages=98–105 |date=April 1989 |pmid=2720700 |doi= |url=}}</ref><ref name="pmid18519873">{{cite journal |vauthors=Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ |title=Determinants of disability and quality of life in mild to moderate Parkinson disease |journal=Neurology |volume=70 |issue=23 |pages=2241–7 |date=June 2008 |pmid=18519873 |doi=10.1212/01.wnl.0000313835.33830.80 |url=}}</ref>
 
===== Nonmotor symptoms =====
* [[Cognitive]] dysfunction and [[dementia]]: Cognitive impairment can occur in the [[Parkinson's disease|PD]] but in some ways it’s different from [[Alzheimer's disease|Alzheimer]] disease. Language dysfunction and [[memory]] deficit is less prominent while [[Executive dysfunction|executive]] and visuospatial dysfunction is more prominent in [[Parkinson's disease|PD]].<ref name="pmid22814541">{{cite journal |vauthors=Svenningsson P, Westman E, Ballard C, Aarsland D |title=Cognitive impairment in patients with Parkinson's disease: diagnosis, biomarkers, and treatment |journal=Lancet Neurol |volume=11 |issue=8 |pages=697–707 |date=August 2012 |pmid=22814541 |doi=10.1016/S1474-4422(12)70152-7 |url=}}</ref><ref name="pmid16247051">{{cite journal |vauthors=Muslimovic D, Post B, Speelman JD, Schmand B |title=Cognitive profile of patients with newly diagnosed Parkinson disease |journal=Neurology |volume=65 |issue=8 |pages=1239–45 |date=October 2005 |pmid=16247051 |doi=10.1212/01.wnl.0000180516.69442.95 |url=}}</ref><ref name="pmid2006002">{{cite journal |vauthors=Levin BE, Llabre MM, Reisman S, Weiner WJ, Sanchez-Ramos J, Singer C, Brown MC |title=Visuospatial impairment in Parkinson's disease |journal=Neurology |volume=41 |issue=3 |pages=365–9 |date=March 1991 |pmid=2006002 |doi= |url=}}</ref><ref name="pmid8215961">{{cite journal |vauthors=Stern Y, Richards M, Sano M, Mayeux R |title=Comparison of cognitive changes in patients with Alzheimer's and Parkinson's disease |journal=Arch. Neurol. |volume=50 |issue=10 |pages=1040–5 |date=October 1993 |pmid=8215961 |doi= |url=}}</ref><ref name="pmid17542011">{{cite journal |vauthors=Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, Broe GA, Cummings J, Dickson DW, Gauthier S, Goldman J, Goetz C, Korczyn A, Lees A, Levy R, Litvan I, McKeith I, Olanow W, Poewe W, Quinn N, Sampaio C, Tolosa E, Dubois B |title=Clinical diagnostic criteria for dementia associated with Parkinson's disease |journal=Mov. Disord. |volume=22 |issue=12 |pages=1689–707; quiz 1837 |date=September 2007 |pmid=17542011 |doi=10.1002/mds.21507 |url=}}</ref>
*Parkinson’s diseases [[memory]] deficits are in the area of retrieval of learned information. [[Aphasia]], [[apraxia]] and sever [[memory loss]] are uncommon in [[Parkinson's disease|PD]].<ref name="pmid15372593">{{cite journal |vauthors=Hobson P, Meara J |title=Risk and incidence of dementia in a cohort of older subjects with Parkinson's disease in the United Kingdom |journal=Mov. Disord. |volume=19 |issue=9 |pages=1043–9 |date=September 2004 |pmid=15372593 |doi=10.1002/mds.20216 |url=}}</ref><ref name="pmid11274306">{{cite journal |vauthors=Aarsland D, Andersen K, Larsen JP, Lolk A, Nielsen H, Kragh-Sørensen P |title=Risk of dementia in Parkinson's disease: a community-based, prospective study |journal=Neurology |volume=56 |issue=6 |pages=730–6 |date=March 2001 |pmid=11274306 |doi= |url=}}</ref><ref name="pmid20855849">{{cite journal |vauthors=Aarsland D, Bronnick K, Williams-Gray C, Weintraub D, Marder K, Kulisevsky J, Burn D, Barone P, Pagonabarraga J, Allcock L, Santangelo G, Foltynie T, Janvin C, Larsen JP, Barker RA, Emre M |title=Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis |journal=Neurology |volume=75 |issue=12 |pages=1062–9 |date=September 2010 |pmid=20855849 |pmc=2942065 |doi=10.1212/WNL.0b013e3181f39d0e |url=}}</ref><ref name="pmid15247534">{{cite journal |vauthors=Emre M |title=Dementia in Parkinson's disease: cause and treatment |journal=Curr. Opin. Neurol. |volume=17 |issue=4 |pages=399–404 |date=August 2004 |pmid=15247534 |doi= |url=}}</ref>
 
* Psychosis and hallucinations: [[Psychosis]], especially [[Visual hallucinations|visual hallucination]] occurs in [[Parkinson's disease|PD]] patients who are under treatment.<ref name="pmid11004314">{{cite journal |vauthors= |title=Hallucinations in Parkinson's disease. prevalence, phenomenology and risk factors. Fenelon G* mahieux F, huon R, Ziegler M. Brain 2000;123:733-745 |journal=Am. J. Ophthalmol. |volume=130 |issue=2 |pages=261–2 |date=August 2000 |pmid=11004314 |doi= |url=}}</ref><ref name="pmid8970453">{{cite journal |vauthors=Sanchez-Ramos JR, Ortoll R, Paulson GW |title=Visual hallucinations associated with Parkinson disease |journal=Arch. Neurol. |volume=53 |issue=12 |pages=1265–8 |date=December 1996 |pmid=8970453 |doi= |url=}}</ref><ref name="pmid22674352">{{cite journal |vauthors=Lee AH, Weintraub D |title=Psychosis in Parkinson's disease without dementia: common and comorbid with other non-motor symptoms |journal=Mov. Disord. |volume=27 |issue=7 |pages=858–63 |date=June 2012 |pmid=22674352 |pmc=3511789 |doi=10.1002/mds.25003 |url=}}</ref>
*All of the antiparkinsonism drugs can cause this but [[Dopamine agonist|dopamine agonists]] are the most common cause.<ref name="pmid2061539">{{cite journal |vauthors=Cummings JL |title=Behavioral complications of drug treatment of Parkinson's disease |journal=J Am Geriatr Soc |volume=39 |issue=7 |pages=708–16 |date=July 1991 |pmid=2061539 |doi= |url=}}</ref>
*Severity and [[prevalence]] of these [[hallucinations]] increase over time but can resolve when [[Parkinson's disease|PD]] medications are discontinued.<ref name="pmid15642908">{{cite journal |vauthors=Goetz CG, Wuu J, Curgian LM, Leurgans S |title=Hallucinations and sleep disorders in PD: six-year prospective longitudinal study |journal=Neurology |volume=64 |issue=1 |pages=81–6 |date=January 2005 |pmid=15642908 |doi=10.1212/01.WNL.0000148479.10865.FE |url=}}</ref><ref name="pmid3888135">{{cite journal |vauthors=Friedman JH |title='Drug holidays' in the treatment of Parkinson's disease. A brief review |journal=Arch. Intern. Med. |volume=145 |issue=5 |pages=913–5 |date=May 1985 |pmid=3888135 |doi= |url=}}</ref>
 
* [[Mood disorder|Mood disorders]] including [[depression]], [[anxiety]], and [[apathy]]/[[abulia]]:
** Depression: Mild to moderate [[depression]] is very common in [[Parkinson's disease|PD]] and can be seen in 50 percent of [[Parkinson's disease|PD]] patients.<ref name="pmid10486397">{{cite journal |vauthors=Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, Cummings JL |title=Range of neuropsychiatric disturbances in patients with Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=4 |pages=492–6 |date=October 1999 |pmid=10486397 |pmc=1736593 |doi= |url=}}</ref><ref name="pmid17581943">{{cite journal |vauthors=Ravina B, Camicioli R, Como PG, Marsh L, Jankovic J, Weintraub D, Elm J |title=The impact of depressive symptoms in early Parkinson disease |journal=Neurology |volume=69 |issue=4 |pages=342–7 |date=July 2007 |pmid=17581943 |pmc=2031220 |doi=10.1212/01.wnl.0000268695.63392.10 |url=}}</ref><ref name="pmid8639068">{{cite journal |vauthors=Tandberg E, Larsen JP, Aarsland D, Cummings JL |title=The occurrence of depression in Parkinson's disease. A community-based study |journal=Arch. Neurol. |volume=53 |issue=2 |pages=175–9 |date=February 1996 |pmid=8639068 |doi= |url=}}</ref> these patients can present with [[anhedonia]], [[sadness]], guilt and feeling of worthlessness.<ref name="pmid3701347">{{cite journal |vauthors=Gotham AM, Brown RG, Marsden CD |title=Depression in Parkinson's disease: a quantitative and qualitative analysis |journal=J. Neurol. Neurosurg. Psychiatry |volume=49 |issue=4 |pages=381–9 |date=April 1986 |pmid=3701347 |pmc=1028762 |doi= |url=}}</ref>
** Anxiety: Anxiety, especially [[generalized anxiety disorder]] and [[social phobia]] is common in [[Parkinson's disease|PD]] and can be seen in more than 30 percent of patients.<ref name="pmid10486397">{{cite journal |vauthors=Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, Cummings JL |title=Range of neuropsychiatric disturbances in patients with Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=4 |pages=492–6 |date=October 1999 |pmid=10486397 |pmc=1736593 |doi= |url=}}</ref><ref name="pmid27125963">{{cite journal |vauthors=Broen MP, Narayen NE, Kuijf ML, Dissanayaka NN, Leentjens AF |title=Prevalence of anxiety in Parkinson's disease: A systematic review and meta-analysis |journal=Mov. Disord. |volume=31 |issue=8 |pages=1125–33 |date=August 2016 |pmid=27125963 |doi=10.1002/mds.26643 |url=}}</ref> [[Anxiety]] is usually combined by [[depression]].<ref name="pmid26711668">{{cite journal |vauthors=Wee N, Kandiah N, Acharyya S, Chander RJ, Ng A, Au WL, Tan LC |title=Depression and anxiety are co-morbid but dissociable in mild Parkinson's disease: A prospective longitudinal study of patterns and predictors |journal=Parkinsonism Relat. Disord. |volume=23 |issue= |pages=50–6 |date=February 2016 |pmid=26711668 |doi=10.1016/j.parkreldis.2015.12.001 |url=}}</ref>
** Apathy and abulia: [[Apathy]] and [[abulia]] are characterized by lack of motivation, [[speech]], emotional and motor function. The [[pathophysiology]] behind this [[symptom]] is involvement of [[frontal lobe]] in [[Parkinson's disease|PD]] patients.<ref name="pmid20669264">{{cite journal |vauthors=Reijnders JS, Scholtissen B, Weber WE, Aalten P, Verhey FR, Leentjens AF |title=Neuroanatomical correlates of apathy in Parkinson's disease: A magnetic resonance imaging study using voxel-based morphometry |journal=Mov. Disord. |volume=25 |issue=14 |pages=2318–25 |date=October 2010 |pmid=20669264 |doi=10.1002/mds.23268 |url=}}</ref><ref name="pmid22895582">{{cite journal |vauthors=Robert G, Le Jeune F, Lozachmeur C, Drapier S, Dondaine T, Péron J, Travers D, Sauleau P, Millet B, Vérin M, Drapier D |title=Apathy in patients with Parkinson disease without dementia or depression: a PET study |journal=Neurology |volume=79 |issue=11 |pages=1155–60 |date=September 2012 |pmid=22895582 |doi=10.1212/WNL.0b013e3182698c75 |url=}}</ref>
 
* Sleep disturbances: Sleep disorders is seen in 55 to 80 percent of [[Parkinson's disease|PD]] patients in early or late stages of the disease.<ref name="pmid9827612">{{cite journal |vauthors=Tandberg E, Larsen JP, Karlsen K |title=A community-based study of sleep disorders in patients with Parkinson's disease |journal=Mov. Disord. |volume=13 |issue=6 |pages=895–9 |date=November 1998 |pmid=9827612 |doi=10.1002/mds.870130606 |url=}}</ref><ref name="pmid14592234">{{cite journal |vauthors=Oerlemans WG, de Weerd AW |title=The prevalence of sleep disorders in patients with Parkinson's disease. A self-reported, community-based survey |journal=Sleep Med. |volume=3 |issue=2 |pages=147–9 |date=March 2002 |pmid=14592234 |doi= |url=}}</ref> approximately 40 percent of [[Parkinson's disease|PD]] patients take medicine for sleep cause [[insomnia]] is as common as 60 percent in them.<ref name="pmid9827612">{{cite journal |vauthors=Tandberg E, Larsen JP, Karlsen K |title=A community-based study of sleep disorders in patients with Parkinson's disease |journal=Mov. Disord. |volume=13 |issue=6 |pages=895–9 |date=November 1998 |pmid=9827612 |doi=10.1002/mds.870130606 |url=}}</ref><ref name="pmid14592234">{{cite journal |vauthors=Oerlemans WG, de Weerd AW |title=The prevalence of sleep disorders in patients with Parkinson's disease. A self-reported, community-based survey |journal=Sleep Med. |volume=3 |issue=2 |pages=147–9 |date=March 2002 |pmid=14592234 |doi= |url=}}</ref><ref name="pmid17098844">{{cite journal |vauthors=Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP |title=Insomnia in Parkinson's disease: frequency and progression over time |journal=J. Neurol. Neurosurg. Psychiatry |volume=78 |issue=5 |pages=476–9 |date=May 2007 |pmid=17098844 |pmc=2117851 |doi=10.1136/jnnp.2006.100370 |url=}}</ref>
*The most common cause of [[insomnia]] and frequent awakening during sleep include [[nocturia]], [[cramp]], [[pain]], [[Nightmare|nightmares]] and [[tremor]].<ref name="pmid17098844">{{cite journal |vauthors=Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP |title=Insomnia in Parkinson's disease: frequency and progression over time |journal=J. Neurol. Neurosurg. Psychiatry |volume=78 |issue=5 |pages=476–9 |date=May 2007 |pmid=17098844 |pmc=2117851 |doi=10.1136/jnnp.2006.100370 |url=}}</ref><ref name="pmid12210875">{{cite journal |vauthors=Kumar S, Bhatia M, Behari M |title=Sleep disorders in Parkinson's disease |journal=Mov. Disord. |volume=17 |issue=4 |pages=775–81 |date=July 2002 |pmid=12210875 |doi=10.1002/mds.10167 |url=}}</ref><ref name="pmid3233589">{{cite journal |vauthors=Lees AJ, Blackburn NA, Campbell VL |title=The nighttime problems of Parkinson's disease |journal=Clin Neuropharmacol |volume=11 |issue=6 |pages=512–9 |date=December 1988 |pmid=3233589 |doi= |url=}}</ref><ref name="pmid24796235">{{cite journal |vauthors=Schrempf W, Brandt MD, Storch A, Reichmann H |title=Sleep disorders in Parkinson's disease |journal=J Parkinsons Dis |volume=4 |issue=2 |pages=211–21 |date=2014 |pmid=24796235 |doi=10.3233/JPD-130301 |url=}}</ref><ref name="pmid2246656">{{cite journal |vauthors=Askenasy JJ, Yahr MD |title=Parkinsonian tremor loses its alternating aspect during non-REM sleep and is inhibited by REM sleep |journal=J. Neurol. Neurosurg. Psychiatry |volume=53 |issue=9 |pages=749–53 |date=September 1990 |pmid=2246656 |pmc=1014251 |doi= |url=}}</ref>
*Another sleep disorder which can be seen in these patients is REM sleep behavior disorder (RBD), characterized by vigorous movement because of increased [[muscle tone]].<ref name="pmid21832215">{{cite journal |vauthors=Sixel-Döring F, Trautmann E, Mollenhauer B, Trenkwalder C |title=Associated factors for REM sleep behavior disorder in Parkinson disease |journal=Neurology |volume=77 |issue=11 |pages=1048–54 |date=September 2011 |pmid=21832215 |doi=10.1212/WNL.0b013e31822e560e |url=}}</ref><ref name="pmid11902423">{{cite journal |vauthors=Schenck CH, Mahowald MW |title=REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP |journal=Sleep |volume=25 |issue=2 |pages=120–38 |date=March 2002 |pmid=11902423 |doi= |url=}}</ref>
* Fatigue: The prevalence of [[fatigue]] in [[Parkinson's disease|PD]] patients is 33 to 58 percent<ref name="pmid8369103">{{cite journal |vauthors=van Hilten JJ, Weggeman M, van der Velde EA, Kerkhof GA, van Dijk JG, Roos RA |title=Sleep, excessive daytime sleepiness and fatigue in Parkinson's disease |journal=J Neural Transm Park Dis Dement Sect |volume=5 |issue=3 |pages=235–44 |date=1993 |pmid=8369103 |doi= |url=}}</ref><ref name="pmid8413960">{{cite journal |vauthors=Friedman J, Friedman H |title=Fatigue in Parkinson's disease |journal=Neurology |volume=43 |issue=10 |pages=2016–8 |date=October 1993 |pmid=8413960 |doi= |url=}}</ref><ref name="pmid10091615">{{cite journal |vauthors=Karlsen K, Larsen JP, Tandberg E, Jørgensen K |title=Fatigue in patients with Parkinson's disease |journal=Mov. Disord. |volume=14 |issue=2 |pages=237–41 |date=March 1999 |pmid=10091615 |doi= |url=}}</ref>
*It’s mostly associated with [[depression]] and excessive day time somnolence but can occur as an isolate problem too.<ref name="pmid10091615">{{cite journal |vauthors=Karlsen K, Larsen JP, Tandberg E, Jørgensen K |title=Fatigue in patients with Parkinson's disease |journal=Mov. Disord. |volume=14 |issue=2 |pages=237–41 |date=March 1999 |pmid=10091615 |doi= |url=}}</ref><ref name="pmid8413960">{{cite journal |vauthors=Friedman J, Friedman H |title=Fatigue in Parkinson's disease |journal=Neurology |volume=43 |issue=10 |pages=2016–8 |date=October 1993 |pmid=8413960 |doi= |url=}}</ref><ref name="pmid15557510">{{cite journal |vauthors=Alves G, Wentzel-Larsen T, Larsen JP |title=Is fatigue an independent and persistent symptom in patients with Parkinson disease? |journal=Neurology |volume=63 |issue=10 |pages=1908–11 |date=November 2004 |pmid=15557510 |doi= |url=}}</ref>
* Olfactory dysfunction: Deficits in [[odor]] identification and discrimination are common in [[Parkinson's disease|PD]] and can happen even before the motor symptoms of the disease.<ref name="pmid11215591">{{cite journal |vauthors=Tissingh G, Berendse HW, Bergmans P, DeWaard R, Drukarch B, Stoof JC, Wolters EC |title=Loss of olfaction in de novo and treated Parkinson's disease: possible implications for early diagnosis |journal=Mov. Disord. |volume=16 |issue=1 |pages=41–6 |date=January 2001 |pmid=11215591 |doi= |url=}}</ref><ref name="pmid15293269">{{cite journal |vauthors=Ponsen MM, Stoffers D, Booij J, van Eck-Smit BL, Wolters ECh, Berendse HW |title=Idiopathic hyposmia as a preclinical sign of Parkinson's disease |journal=Ann. Neurol. |volume=56 |issue=2 |pages=173–81 |date=August 2004 |pmid=15293269 |doi=10.1002/ana.20160 |url=}}</ref><ref name="pmid18067173">{{cite journal |vauthors=Ross GW, Petrovitch H, Abbott RD, Tanner CM, Popper J, Masaki K, Launer L, White LR |title=Association of olfactory dysfunction with risk for future Parkinson's disease |journal=Ann. Neurol. |volume=63 |issue=2 |pages=167–73 |date=February 2008 |pmid=18067173 |doi=10.1002/ana.21291 |url=}}</ref>
* Pain: 46 percent of PD patients experience [[pain]] as a sense of lancinating, burning or tingling. The pain can be generalized or localized and can happen in different body areas like [[face]], [[joints]] and [[genitals]].<ref name="pmid3504231">{{cite journal |vauthors=Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC |title=Pain in Parkinson's disease |journal=Mov. Disord. |volume=1 |issue=1 |pages=45–9 |date=1986 |pmid=3504231 |doi=10.1002/mds.870010106 |url=}}</ref><ref name="pmid8909426">{{cite journal |vauthors=Hillen ME, Sage JI |title=Nonmotor fluctuations in patients with Parkinson's disease |journal=Neurology |volume=47 |issue=5 |pages=1180–3 |date=November 1996 |pmid=8909426 |doi= |url=}}</ref><ref name="pmid8813222">{{cite journal |vauthors=Ford B, Louis ED, Greene P, Fahn S |title=Oral and genital pain syndromes in Parkinson's disease |journal=Mov. Disord. |volume=11 |issue=4 |pages=421–6 |date=July 1996 |pmid=8813222 |doi=10.1002/mds.870110411 |url=}}</ref>
 
* Autonomic dysfunction: [[Autonomic dysfunction]] includes [[orthostatic hypotension]], [[constipation]], [[dysphagia]], [[urinary]] and [[Sexual dysfunction|sexual]] problems.<ref name="pmid17646625">{{cite journal |vauthors=Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ |title=Patient-reported autonomic symptoms in Parkinson disease |journal=Neurology |volume=69 |issue=4 |pages=333–41 |date=July 2007 |pmid=17646625 |doi=10.1212/01.wnl.0000266593.50534.e8 |url=}}</ref><ref name="pmid22942216">{{cite journal |vauthors=Asahina M, Vichayanrat E, Low DA, Iodice V, Mathias CJ |title=Autonomic dysfunction in parkinsonian disorders: assessment and pathophysiology |journal=J. Neurol. Neurosurg. Psychiatry |volume=84 |issue=6 |pages=674–80 |date=June 2013 |pmid=22942216 |doi=10.1136/jnnp-2012-303135 |url=}}</ref>
*Urinary [[Symptom|symptoms]] is mostly cause by reduced bladder capacity due to detresor muscle contraction and manifest as [[Urinary frequency|frequency]], [[Urinary urgency|urgency]] and [[urge incontinence]].<ref name="pmid10925088">{{cite journal |vauthors=Lemack GE, Dewey RB, Roehrborn CG, O'Suilleabhain PE, Zimmern PE |title=Questionnaire-based assessment of bladder dysfunction in patients with mild to moderate Parkinson's disease |journal=Urology |volume=56 |issue=2 |pages=250–4 |date=August 2000 |pmid=10925088 |doi= |url=}}</ref><ref name="pmid11025724">{{cite journal |vauthors=Araki I, Kitahara M, Oida T, Kuno S |title=Voiding dysfunction and Parkinson's disease: urodynamic abnormalities and urinary symptoms |journal=J. Urol. |volume=164 |issue=5 |pages=1640–3 |date=November 2000 |pmid=11025724 |doi= |url=}}</ref>
*[[Sexual dysfunction]] in men manifest with [[erection]] dysfunction and in women with [[Vagina|vaginal]] tightness and lack of [[orgasm]].<ref name="pmid2272026">{{cite journal |vauthors=Koller WC, Vetere-Overfield B, Williamson A, Busenbark K, Nash J, Parrish D |title=Sexual dysfunction in Parkinson's disease |journal=Clin Neuropharmacol |volume=13 |issue=5 |pages=461–3 |date=October 1990 |pmid=2272026 |doi= |url=}}</ref><ref name="pmid1592069">{{cite journal |vauthors=Singer C, Weiner WJ, Sanchez-Ramos JR |title=Autonomic dysfunction in men with Parkinson's disease |journal=Eur. Neurol. |volume=32 |issue=3 |pages=134–40 |date=1992 |pmid=1592069 |doi=10.1159/000116810 |url=}}</ref>
 
===Complications===
*[[Complications]] that can develop as a result of Parkinson disease, may be equal to disease [[symptoms]] such as:
**[[Tremor]]<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref>
**Rigidity<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |doi=10.1212/WNL.0000000000002461 |url=}}</ref><ref name="pmid8420197">{{cite journal |vauthors=Hughes AJ, Daniel SE, Lees AJ |title=The clinical features of Parkinson's disease in 100 histologically proven cases |journal=Adv Neurol |volume=60 |issue= |pages=595–9 |date=1993 |pmid=8420197 |doi= |url=}}</ref>
**[[Bradykinesia]]<ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref>
**[[Gait]] problems<ref name="pmid2720700">{{cite journal |vauthors=Koller WC, Glatt S, Vetere-Overfield B, Hassanein R |title=Falls and Parkinson's disease |journal=Clin Neuropharmacol |volume=12 |issue=2 |pages=98–105 |date=April 1989 |pmid=2720700 |doi= |url=}}</ref><ref name="pmid18519873">{{cite journal |vauthors=Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ |title=Determinants of disability and quality of life in mild to moderate Parkinson disease |journal=Neurology |volume=70 |issue=23 |pages=2241–7 |date=June 2008 |pmid=18519873 |doi=10.1212/01.wnl.0000313835.33830.80 |url=}}</ref>
**[[Cognitive]] dysfunction and [[dementia]]<ref name="pmid22814541">{{cite journal |vauthors=Svenningsson P, Westman E, Ballard C, Aarsland D |title=Cognitive impairment in patients with Parkinson's disease: diagnosis, biomarkers, and treatment |journal=Lancet Neurol |volume=11 |issue=8 |pages=697–707 |date=August 2012 |pmid=22814541 |doi=10.1016/S1474-4422(12)70152-7 |url=}}</ref><ref name="pmid16247051">{{cite journal |vauthors=Muslimovic D, Post B, Speelman JD, Schmand B |title=Cognitive profile of patients with newly diagnosed Parkinson disease |journal=Neurology |volume=65 |issue=8 |pages=1239–45 |date=October 2005 |pmid=16247051 |doi=10.1212/01.wnl.0000180516.69442.95 |url=}}</ref><ref name="pmid2006002">{{cite journal |vauthors=Levin BE, Llabre MM, Reisman S, Weiner WJ, Sanchez-Ramos J, Singer C, Brown MC |title=Visuospatial impairment in Parkinson's disease |journal=Neurology |volume=41 |issue=3 |pages=365–9 |date=March 1991 |pmid=2006002 |doi= |url=}}</ref><ref name="pmid8215961">{{cite journal |vauthors=Stern Y, Richards M, Sano M, Mayeux R |title=Comparison of cognitive changes in patients with Alzheimer's and Parkinson's disease |journal=Arch. Neurol. |volume=50 |issue=10 |pages=1040–5 |date=October 1993 |pmid=8215961 |doi= |url=}}</ref><ref name="pmid17542011">{{cite journal |vauthors=Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, Broe GA, Cummings J, Dickson DW, Gauthier S, Goldman J, Goetz C, Korczyn A, Lees A, Levy R, Litvan I, McKeith I, Olanow W, Poewe W, Quinn N, Sampaio C, Tolosa E, Dubois B |title=Clinical diagnostic criteria for dementia associated with Parkinson's disease |journal=Mov. Disord. |volume=22 |issue=12 |pages=1689–707; quiz 1837 |date=September 2007 |pmid=17542011 |doi=10.1002/mds.21507 |url=}}</ref>
**[[Psychosis]] and [[Hallucination|hallucinations]]<ref name="pmid11004314">{{cite journal |vauthors= |title=Hallucinations in Parkinson's disease. prevalence, phenomenology and risk factors. Fenelon G* mahieux F, huon R, Ziegler M. Brain 2000;123:733-745 |journal=Am. J. Ophthalmol. |volume=130 |issue=2 |pages=261–2 |date=August 2000 |pmid=11004314 |doi= |url=}}</ref><ref name="pmid8970453">{{cite journal |vauthors=Sanchez-Ramos JR, Ortoll R, Paulson GW |title=Visual hallucinations associated with Parkinson disease |journal=Arch. Neurol. |volume=53 |issue=12 |pages=1265–8 |date=December 1996 |pmid=8970453 |doi= |url=}}</ref><ref name="pmid22674352">{{cite journal |vauthors=Lee AH, Weintraub D |title=Psychosis in Parkinson's disease without dementia: common and comorbid with other non-motor symptoms |journal=Mov. Disord. |volume=27 |issue=7 |pages=858–63 |date=June 2012 |pmid=22674352 |pmc=3511789 |doi=10.1002/mds.25003 |url=}}</ref>
**[[Mood disorder|Mood disorders]] including [[depression]], [[anxiety]], and [[apathy]]/[[abulia]]<ref name="pmid10486397">{{cite journal |vauthors=Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, Cummings JL |title=Range of neuropsychiatric disturbances in patients with Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=4 |pages=492–6 |date=October 1999 |pmid=10486397 |pmc=1736593 |doi= |url=}}</ref><ref name="pmid17581943">{{cite journal |vauthors=Ravina B, Camicioli R, Como PG, Marsh L, Jankovic J, Weintraub D, Elm J |title=The impact of depressive symptoms in early Parkinson disease |journal=Neurology |volume=69 |issue=4 |pages=342–7 |date=July 2007 |pmid=17581943 |pmc=2031220 |doi=10.1212/01.wnl.0000268695.63392.10 |url=}}</ref><ref name="pmid8639068">{{cite journal |vauthors=Tandberg E, Larsen JP, Aarsland D, Cummings JL |title=The occurrence of depression in Parkinson's disease. A community-based study |journal=Arch. Neurol. |volume=53 |issue=2 |pages=175–9 |date=February 1996 |pmid=8639068 |doi= |url=}}</ref><ref name="pmid27125963">{{cite journal |vauthors=Broen MP, Narayen NE, Kuijf ML, Dissanayaka NN, Leentjens AF |title=Prevalence of anxiety in Parkinson's disease: A systematic review and meta-analysis |journal=Mov. Disord. |volume=31 |issue=8 |pages=1125–33 |date=August 2016 |pmid=27125963 |doi=10.1002/mds.26643 |url=}}</ref><ref name="pmid20669264">{{cite journal |vauthors=Reijnders JS, Scholtissen B, Weber WE, Aalten P, Verhey FR, Leentjens AF |title=Neuroanatomical correlates of apathy in Parkinson's disease: A magnetic resonance imaging study using voxel-based morphometry |journal=Mov. Disord. |volume=25 |issue=14 |pages=2318–25 |date=October 2010 |pmid=20669264 |doi=10.1002/mds.23268 |url=}}</ref><ref name="pmid22895582">{{cite journal |vauthors=Robert G, Le Jeune F, Lozachmeur C, Drapier S, Dondaine T, Péron J, Travers D, Sauleau P, Millet B, Vérin M, Drapier D |title=Apathy in patients with Parkinson disease without dementia or depression: a PET study |journal=Neurology |volume=79 |issue=11 |pages=1155–60 |date=September 2012 |pmid=22895582 |doi=10.1212/WNL.0b013e3182698c75 |url=}}</ref>
**Sleep disturbances<ref name="pmid9827612">{{cite journal |vauthors=Tandberg E, Larsen JP, Karlsen K |title=A community-based study of sleep disorders in patients with Parkinson's disease |journal=Mov. Disord. |volume=13 |issue=6 |pages=895–9 |date=November 1998 |pmid=9827612 |doi=10.1002/mds.870130606 |url=}}</ref><ref name="pmid14592234">{{cite journal |vauthors=Oerlemans WG, de Weerd AW |title=The prevalence of sleep disorders in patients with Parkinson's disease. A self-reported, community-based survey |journal=Sleep Med. |volume=3 |issue=2 |pages=147–9 |date=March 2002 |pmid=14592234 |doi= |url=}}</ref>
**[[Fatigue]]<ref name="pmid8369103">{{cite journal |vauthors=van Hilten JJ, Weggeman M, van der Velde EA, Kerkhof GA, van Dijk JG, Roos RA |title=Sleep, excessive daytime sleepiness and fatigue in Parkinson's disease |journal=J Neural Transm Park Dis Dement Sect |volume=5 |issue=3 |pages=235–44 |date=1993 |pmid=8369103 |doi= |url=}}</ref><ref name="pmid8413960">{{cite journal |vauthors=Friedman J, Friedman H |title=Fatigue in Parkinson's disease |journal=Neurology |volume=43 |issue=10 |pages=2016–8 |date=October 1993 |pmid=8413960 |doi= |url=}}</ref><ref name="pmid10091615">{{cite journal |vauthors=Karlsen K, Larsen JP, Tandberg E, Jørgensen K |title=Fatigue in patients with Parkinson's disease |journal=Mov. Disord. |volume=14 |issue=2 |pages=237–41 |date=March 1999 |pmid=10091615 |doi= |url=}}</ref>
**[[Olfactory]] dysfunction<ref name="pmid11215591">{{cite journal |vauthors=Tissingh G, Berendse HW, Bergmans P, DeWaard R, Drukarch B, Stoof JC, Wolters EC |title=Loss of olfaction in de novo and treated Parkinson's disease: possible implications for early diagnosis |journal=Mov. Disord. |volume=16 |issue=1 |pages=41–6 |date=January 2001 |pmid=11215591 |doi= |url=}}</ref>
**Pain<ref name="pmid3504231">{{cite journal |vauthors=Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC |title=Pain in Parkinson's disease |journal=Mov. Disord. |volume=1 |issue=1 |pages=45–9 |date=1986 |pmid=3504231 |doi=10.1002/mds.870010106 |url=}}</ref><ref name="pmid8909426">{{cite journal |vauthors=Hillen ME, Sage JI |title=Nonmotor fluctuations in patients with Parkinson's disease |journal=Neurology |volume=47 |issue=5 |pages=1180–3 |date=November 1996 |pmid=8909426 |doi= |url=}}</ref><ref name="pmid8813222">{{cite journal |vauthors=Ford B, Louis ED, Greene P, Fahn S |title=Oral and genital pain syndromes in Parkinson's disease |journal=Mov. Disord. |volume=11 |issue=4 |pages=421–6 |date=July 1996 |pmid=8813222 |doi=10.1002/mds.870110411 |url=}}</ref>
**[[Autonomic dysfunction]] including [[orthostatic hypotension]]
**[[constipation]]
**[[dysphagia]]
**[[urinary]] and [[Sexual dysfunction|sexual]] problems.<ref name="pmid17646625">{{cite journal |vauthors=Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ |title=Patient-reported autonomic symptoms in Parkinson disease |journal=Neurology |volume=69 |issue=4 |pages=333–41 |date=July 2007 |pmid=17646625 |doi=10.1212/01.wnl.0000266593.50534.e8 |url=}}</ref><ref name="pmid22942216">{{cite journal |vauthors=Asahina M, Vichayanrat E, Low DA, Iodice V, Mathias CJ |title=Autonomic dysfunction in parkinsonian disorders: assessment and pathophysiology |journal=J. Neurol. Neurosurg. Psychiatry |volume=84 |issue=6 |pages=674–80 |date=June 2013 |pmid=22942216 |doi=10.1136/jnnp-2012-303135 |url=}}</ref>.
 
====Prognosis====
* In one of the studies regarding [[Parkinson|PD]] [[prognosis]], it was seen that the percent of dead or severely disabled patients is 25 percent within 5 years, 67 percent within 5 to 9 years and 80 percent within 10 to 14 years of disease onset.<ref name="pmid11775596">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression, and mortality. 1967 |journal=Neurology |volume=57 |issue=10 Suppl 3 |pages=S11–26 |date=November 2001 |pmid=11775596 |doi= |url=}}</ref><ref name="pmid23781007">{{cite journal |vauthors=Williams-Gray CH, Mason SL, Evans JR, Foltynie T, Brayne C, Robbins TW, Barker RA |title=The CamPaIGN study of Parkinson's disease: 10-year outlook in an incident population-based cohort |journal=J. Neurol. Neurosurg. Psychiatry |volume=84 |issue=11 |pages=1258–64 |date=November 2013 |pmid=23781007 |doi=10.1136/jnnp-2013-305277 |url=}}</ref> It was also shown that disability will occurs mostly in 3 to 7 years of disease onset.<ref name="pmid18361474">{{cite journal |vauthors=Shulman LM, Gruber-Baldini AL, Anderson KE, Vaughan CG, Reich SG, Fishman PS, Weiner WJ |title=The evolution of disability in Parkinson disease |journal=Mov. Disord. |volume=23 |issue=6 |pages=790–6 |date=April 2008 |pmid=18361474 |doi=10.1002/mds.21879 |url=}}</ref>


==References==
==References==

Latest revision as of 18:31, 8 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

The most common initiating symptoms in PD are slowness of movement (bradykinesia), shaking hands while they are at rest (resting tremor) and muscle stiffness (rigidity). These symptoms usually starts unilaterally and the severity of them remains higher in the side of onset. Complications that can develop as a result of Parkinson disease include tremor, rigidity, bradykinesia, gait problems, cognitive dysfunction and dementia, psychosis and hallucinations, mood disorders including depression, anxiety, and apathy/abulia, sleep disturbances, fatigue, olfactory dysfunction, pain, autonomic dysfunction including orthostatic hypotension, constipation, dysphagia, urinary and sexual problems. In one of the studies regarding PD prognosis, it was seen that the percent of dead or severely disabled patients is 25 percent within 5 years, 67 percent within 5 to 9 years and 80 percent within 10 to 14 years of disease onset. It was also shown that disability will occurs mostly in 3 to 7 years of disease onset.

Natural History, Complications, and Prognosis

Natural History

  • The most common initiating symptoms in PD are slowness of movement (bradykinesia), shaking hands while they are at rest (resting tremor) and muscle stiffness (rigidity).[1]
  • These symptoms usually starts unilaterally and the severity of them remains higher in the side of onset.[2]
  • In the course of the disease patients may experience motor and nonmotor symptoms:
Motor symptoms
  • Tremor: Tremor is the most common symptom in Parkinson disease and can be the presenting sign in 70 to 80 percent of patients.[3][1]
  • This symptom starts unilaterally mostly in hand and then progress to the other side of the body. It can also involve legs, jaw, lips and tongue.[4][5][6]
  • PD tremor frequency is 3 to 7 Hz.[4]
  • There is a symptom called re-emergent tremor in some of the PD patients. It manifests by postural tremor that starts after several seconds and can make it difficult to differentiate PD from essential tremor.[7][8]
  • Rigidity: Rigidity in PD in very common and can be seen in 75 to 90 percent of patients.[3][1][9]
  • It commonly starts in the same side as the tremor. PD patients have increased resistance to passive movement of their joint and sometimes it’s known as cogwheel rigidity because of the ratchety pattern of resistance and relaxation. Some evidences suggest that superimposition of tremor on increased muscle tone creates this kind of rigidity.[10][11]
  • Bradykinesia: Bradykinesia or slowness of movement, is seen in 80 percent of PD patients.[1]
  • Postural instability: Gait and postural problems can be the main cause of disability in PD patients and commonly doesn’t response well to dopaminergic treatment.[12][13]
Nonmotor symptoms
  • Sleep disturbances: Sleep disorders is seen in 55 to 80 percent of PD patients in early or late stages of the disease.[37][38] approximately 40 percent of PD patients take medicine for sleep cause insomnia is as common as 60 percent in them.[37][38][39]
  • The most common cause of insomnia and frequent awakening during sleep include nocturia, cramp, pain, nightmares and tremor.[39][40][41][42][43]
  • Another sleep disorder which can be seen in these patients is REM sleep behavior disorder (RBD), characterized by vigorous movement because of increased muscle tone.[44][45]
  • Fatigue: The prevalence of fatigue in PD patients is 33 to 58 percent[46][47][48]
  • It’s mostly associated with depression and excessive day time somnolence but can occur as an isolate problem too.[48][47][49]
  • Olfactory dysfunction: Deficits in odor identification and discrimination are common in PD and can happen even before the motor symptoms of the disease.[50][51][52]
  • Pain: 46 percent of PD patients experience pain as a sense of lancinating, burning or tingling. The pain can be generalized or localized and can happen in different body areas like face, joints and genitals.[53][54][55]

Complications

Prognosis

  • In one of the studies regarding PD prognosis, it was seen that the percent of dead or severely disabled patients is 25 percent within 5 years, 67 percent within 5 to 9 years and 80 percent within 10 to 14 years of disease onset.[62][63] It was also shown that disability will occurs mostly in 3 to 7 years of disease onset.[64]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Pagano G, Ferrara N, Brooks DJ, Pavese N (April 2016). "Age at onset and Parkinson disease phenotype". Neurology. 86 (15): 1400–7. doi:10.1212/WNL.0000000000002461. PMC 4831034. PMID 26865518.
  2. ↑ Hughes AJ, Daniel SE, Kilford L, Lees AJ (March 1992). "Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases". J. Neurol. Neurosurg. Psychiatry. 55 (3): 181–4. PMC 1014720. PMID 1564476.
  3. ↑ 3.0 3.1 3.2 3.3 Hoehn MM, Yahr MD (May 1967). "Parkinsonism: onset, progression and mortality". Neurology. 17 (5): 427–42. PMID 6067254.
  4. ↑ 4.0 4.1 Findley LJ, Gresty MA, Halmagyi GM (June 1981). "Tremor, the cogwheel phenomenon and clonus in Parkinson's disease". J. Neurol. Neurosurg. Psychiatry. 44 (6): 534–46. PMC 491035. PMID 7276968.
  5. ↑ Scott RM, Brody JA, Schwab RS, Cooper IS (July 1970). "Progression of unilateral tremor and rigidity in Parkinson's disease". Neurology. 20 (7): 710–4. PMID 5463541.
  6. ↑ Hunker CJ, Abbs JH (1990). "Uniform frequency of parkinsonian resting tremor in the lips, jaw, tongue, and index finger". Mov. Disord. 5 (1): 71–7. doi:10.1002/mds.870050117. PMID 2296262.
  7. ↑ Jankovic J, Schwartz KS, Ondo W (November 1999). "Re-emergent tremor of Parkinson's disease". J. Neurol. Neurosurg. Psychiatry. 67 (5): 646–50. PMC 1736624. PMID 10519872.
  8. ↑ Louis ED, Levy G, Côte LJ, Mejia H, Fahn S, Marder K (October 2001). "Clinical correlates of action tremor in Parkinson disease". Arch. Neurol. 58 (10): 1630–4. PMID 11594921.
  9. ↑ 9.0 9.1 Hughes AJ, Daniel SE, Lees AJ (1993). "The clinical features of Parkinson's disease in 100 histologically proven cases". Adv Neurol. 60: 595–9. PMID 8420197.
  10. ↑ Deuschl G, Bain P, Brin M (1998). "Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee". Mov. Disord. 13 Suppl 3: 2–23. PMID 9827589.
  11. ↑ LANCE JW, SCHWAB RS, PETERSON EA (March 1963). "Action tremor and the cogwheel phenomenon in Parkinson's disease". Brain. 86: 95–110. PMID 13928399.
  12. ↑ 12.0 12.1 Koller WC, Glatt S, Vetere-Overfield B, Hassanein R (April 1989). "Falls and Parkinson's disease". Clin Neuropharmacol. 12 (2): 98–105. PMID 2720700.
  13. ↑ 13.0 13.1 Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ (June 2008). "Determinants of disability and quality of life in mild to moderate Parkinson disease". Neurology. 70 (23): 2241–7. doi:10.1212/01.wnl.0000313835.33830.80. PMID 18519873.
  14. ↑ 14.0 14.1 Svenningsson P, Westman E, Ballard C, Aarsland D (August 2012). "Cognitive impairment in patients with Parkinson's disease: diagnosis, biomarkers, and treatment". Lancet Neurol. 11 (8): 697–707. doi:10.1016/S1474-4422(12)70152-7. PMID 22814541.
  15. ↑ 15.0 15.1 Muslimovic D, Post B, Speelman JD, Schmand B (October 2005). "Cognitive profile of patients with newly diagnosed Parkinson disease". Neurology. 65 (8): 1239–45. doi:10.1212/01.wnl.0000180516.69442.95. PMID 16247051.
  16. ↑ 16.0 16.1 Levin BE, Llabre MM, Reisman S, Weiner WJ, Sanchez-Ramos J, Singer C, Brown MC (March 1991). "Visuospatial impairment in Parkinson's disease". Neurology. 41 (3): 365–9. PMID 2006002.
  17. ↑ 17.0 17.1 Stern Y, Richards M, Sano M, Mayeux R (October 1993). "Comparison of cognitive changes in patients with Alzheimer's and Parkinson's disease". Arch. Neurol. 50 (10): 1040–5. PMID 8215961.
  18. ↑ 18.0 18.1 Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, Broe GA, Cummings J, Dickson DW, Gauthier S, Goldman J, Goetz C, Korczyn A, Lees A, Levy R, Litvan I, McKeith I, Olanow W, Poewe W, Quinn N, Sampaio C, Tolosa E, Dubois B (September 2007). "Clinical diagnostic criteria for dementia associated with Parkinson's disease". Mov. Disord. 22 (12): 1689–707, quiz 1837. doi:10.1002/mds.21507. PMID 17542011.
  19. ↑ Hobson P, Meara J (September 2004). "Risk and incidence of dementia in a cohort of older subjects with Parkinson's disease in the United Kingdom". Mov. Disord. 19 (9): 1043–9. doi:10.1002/mds.20216. PMID 15372593.
  20. ↑ Aarsland D, Andersen K, Larsen JP, Lolk A, Nielsen H, Kragh-Sørensen P (March 2001). "Risk of dementia in Parkinson's disease: a community-based, prospective study". Neurology. 56 (6): 730–6. PMID 11274306.
  21. ↑ Aarsland D, Bronnick K, Williams-Gray C, Weintraub D, Marder K, Kulisevsky J, Burn D, Barone P, Pagonabarraga J, Allcock L, Santangelo G, Foltynie T, Janvin C, Larsen JP, Barker RA, Emre M (September 2010). "Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis". Neurology. 75 (12): 1062–9. doi:10.1212/WNL.0b013e3181f39d0e. PMC 2942065. PMID 20855849.
  22. ↑ Emre M (August 2004). "Dementia in Parkinson's disease: cause and treatment". Curr. Opin. Neurol. 17 (4): 399–404. PMID 15247534.
  23. ↑ 23.0 23.1 "Hallucinations in Parkinson's disease. prevalence, phenomenology and risk factors. Fenelon G* mahieux F, huon R, Ziegler M. Brain 2000;123:733-745". Am. J. Ophthalmol. 130 (2): 261–2. August 2000. PMID 11004314.
  24. ↑ 24.0 24.1 Sanchez-Ramos JR, Ortoll R, Paulson GW (December 1996). "Visual hallucinations associated with Parkinson disease". Arch. Neurol. 53 (12): 1265–8. PMID 8970453.
  25. ↑ 25.0 25.1 Lee AH, Weintraub D (June 2012). "Psychosis in Parkinson's disease without dementia: common and comorbid with other non-motor symptoms". Mov. Disord. 27 (7): 858–63. doi:10.1002/mds.25003. PMC 3511789. PMID 22674352.
  26. ↑ Cummings JL (July 1991). "Behavioral complications of drug treatment of Parkinson's disease". J Am Geriatr Soc. 39 (7): 708–16. PMID 2061539.
  27. ↑ Goetz CG, Wuu J, Curgian LM, Leurgans S (January 2005). "Hallucinations and sleep disorders in PD: six-year prospective longitudinal study". Neurology. 64 (1): 81–6. doi:10.1212/01.WNL.0000148479.10865.FE. PMID 15642908.
  28. ↑ Friedman JH (May 1985). "'Drug holidays' in the treatment of Parkinson's disease. A brief review". Arch. Intern. Med. 145 (5): 913–5. PMID 3888135.
  29. ↑ 29.0 29.1 29.2 Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, Cummings JL (October 1999). "Range of neuropsychiatric disturbances in patients with Parkinson's disease". J. Neurol. Neurosurg. Psychiatry. 67 (4): 492–6. PMC 1736593. PMID 10486397.
  30. ↑ 30.0 30.1 Ravina B, Camicioli R, Como PG, Marsh L, Jankovic J, Weintraub D, Elm J (July 2007). "The impact of depressive symptoms in early Parkinson disease". Neurology. 69 (4): 342–7. doi:10.1212/01.wnl.0000268695.63392.10. PMC 2031220. PMID 17581943.
  31. ↑ 31.0 31.1 Tandberg E, Larsen JP, Aarsland D, Cummings JL (February 1996). "The occurrence of depression in Parkinson's disease. A community-based study". Arch. Neurol. 53 (2): 175–9. PMID 8639068.
  32. ↑ Gotham AM, Brown RG, Marsden CD (April 1986). "Depression in Parkinson's disease: a quantitative and qualitative analysis". J. Neurol. Neurosurg. Psychiatry. 49 (4): 381–9. PMC 1028762. PMID 3701347.
  33. ↑ 33.0 33.1 Broen MP, Narayen NE, Kuijf ML, Dissanayaka NN, Leentjens AF (August 2016). "Prevalence of anxiety in Parkinson's disease: A systematic review and meta-analysis". Mov. Disord. 31 (8): 1125–33. doi:10.1002/mds.26643. PMID 27125963.
  34. ↑ Wee N, Kandiah N, Acharyya S, Chander RJ, Ng A, Au WL, Tan LC (February 2016). "Depression and anxiety are co-morbid but dissociable in mild Parkinson's disease: A prospective longitudinal study of patterns and predictors". Parkinsonism Relat. Disord. 23: 50–6. doi:10.1016/j.parkreldis.2015.12.001. PMID 26711668.
  35. ↑ 35.0 35.1 Reijnders JS, Scholtissen B, Weber WE, Aalten P, Verhey FR, Leentjens AF (October 2010). "Neuroanatomical correlates of apathy in Parkinson's disease: A magnetic resonance imaging study using voxel-based morphometry". Mov. Disord. 25 (14): 2318–25. doi:10.1002/mds.23268. PMID 20669264.
  36. ↑ 36.0 36.1 Robert G, Le Jeune F, Lozachmeur C, Drapier S, Dondaine T, Péron J, Travers D, Sauleau P, Millet B, Vérin M, Drapier D (September 2012). "Apathy in patients with Parkinson disease without dementia or depression: a PET study". Neurology. 79 (11): 1155–60. doi:10.1212/WNL.0b013e3182698c75. PMID 22895582.
  37. ↑ 37.0 37.1 37.2 Tandberg E, Larsen JP, Karlsen K (November 1998). "A community-based study of sleep disorders in patients with Parkinson's disease". Mov. Disord. 13 (6): 895–9. doi:10.1002/mds.870130606. PMID 9827612.
  38. ↑ 38.0 38.1 38.2 Oerlemans WG, de Weerd AW (March 2002). "The prevalence of sleep disorders in patients with Parkinson's disease. A self-reported, community-based survey". Sleep Med. 3 (2): 147–9. PMID 14592234.
  39. ↑ 39.0 39.1 Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP (May 2007). "Insomnia in Parkinson's disease: frequency and progression over time". J. Neurol. Neurosurg. Psychiatry. 78 (5): 476–9. doi:10.1136/jnnp.2006.100370. PMC 2117851. PMID 17098844.
  40. ↑ Kumar S, Bhatia M, Behari M (July 2002). "Sleep disorders in Parkinson's disease". Mov. Disord. 17 (4): 775–81. doi:10.1002/mds.10167. PMID 12210875.
  41. ↑ Lees AJ, Blackburn NA, Campbell VL (December 1988). "The nighttime problems of Parkinson's disease". Clin Neuropharmacol. 11 (6): 512–9. PMID 3233589.
  42. ↑ Schrempf W, Brandt MD, Storch A, Reichmann H (2014). "Sleep disorders in Parkinson's disease". J Parkinsons Dis. 4 (2): 211–21. doi:10.3233/JPD-130301. PMID 24796235.
  43. ↑ Askenasy JJ, Yahr MD (September 1990). "Parkinsonian tremor loses its alternating aspect during non-REM sleep and is inhibited by REM sleep". J. Neurol. Neurosurg. Psychiatry. 53 (9): 749–53. PMC 1014251. PMID 2246656.
  44. ↑ Sixel-Döring F, Trautmann E, Mollenhauer B, Trenkwalder C (September 2011). "Associated factors for REM sleep behavior disorder in Parkinson disease". Neurology. 77 (11): 1048–54. doi:10.1212/WNL.0b013e31822e560e. PMID 21832215.
  45. ↑ Schenck CH, Mahowald MW (March 2002). "REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP". Sleep. 25 (2): 120–38. PMID 11902423.
  46. ↑ 46.0 46.1 van Hilten JJ, Weggeman M, van der Velde EA, Kerkhof GA, van Dijk JG, Roos RA (1993). "Sleep, excessive daytime sleepiness and fatigue in Parkinson's disease". J Neural Transm Park Dis Dement Sect. 5 (3): 235–44. PMID 8369103.
  47. ↑ 47.0 47.1 47.2 Friedman J, Friedman H (October 1993). "Fatigue in Parkinson's disease". Neurology. 43 (10): 2016–8. PMID 8413960.
  48. ↑ 48.0 48.1 48.2 Karlsen K, Larsen JP, Tandberg E, Jørgensen K (March 1999). "Fatigue in patients with Parkinson's disease". Mov. Disord. 14 (2): 237–41. PMID 10091615.
  49. ↑ Alves G, Wentzel-Larsen T, Larsen JP (November 2004). "Is fatigue an independent and persistent symptom in patients with Parkinson disease?". Neurology. 63 (10): 1908–11. PMID 15557510.
  50. ↑ 50.0 50.1 Tissingh G, Berendse HW, Bergmans P, DeWaard R, Drukarch B, Stoof JC, Wolters EC (January 2001). "Loss of olfaction in de novo and treated Parkinson's disease: possible implications for early diagnosis". Mov. Disord. 16 (1): 41–6. PMID 11215591.
  51. ↑ Ponsen MM, Stoffers D, Booij J, van Eck-Smit BL, Wolters E, Berendse HW (August 2004). "Idiopathic hyposmia as a preclinical sign of Parkinson's disease". Ann. Neurol. 56 (2): 173–81. doi:10.1002/ana.20160. PMID 15293269. Vancouver style error: initials (help)
  52. ↑ Ross GW, Petrovitch H, Abbott RD, Tanner CM, Popper J, Masaki K, Launer L, White LR (February 2008). "Association of olfactory dysfunction with risk for future Parkinson's disease". Ann. Neurol. 63 (2): 167–73. doi:10.1002/ana.21291. PMID 18067173.
  53. ↑ 53.0 53.1 Goetz CG, Tanner CM, Levy M, Wilson RS, Garron DC (1986). "Pain in Parkinson's disease". Mov. Disord. 1 (1): 45–9. doi:10.1002/mds.870010106. PMID 3504231.
  54. ↑ 54.0 54.1 Hillen ME, Sage JI (November 1996). "Nonmotor fluctuations in patients with Parkinson's disease". Neurology. 47 (5): 1180–3. PMID 8909426.
  55. ↑ 55.0 55.1 Ford B, Louis ED, Greene P, Fahn S (July 1996). "Oral and genital pain syndromes in Parkinson's disease". Mov. Disord. 11 (4): 421–6. doi:10.1002/mds.870110411. PMID 8813222.
  56. ↑ 56.0 56.1 Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ (July 2007). "Patient-reported autonomic symptoms in Parkinson disease". Neurology. 69 (4): 333–41. doi:10.1212/01.wnl.0000266593.50534.e8. PMID 17646625.
  57. ↑ 57.0 57.1 Asahina M, Vichayanrat E, Low DA, Iodice V, Mathias CJ (June 2013). "Autonomic dysfunction in parkinsonian disorders: assessment and pathophysiology". J. Neurol. Neurosurg. Psychiatry. 84 (6): 674–80. doi:10.1136/jnnp-2012-303135. PMID 22942216.
  58. ↑ Lemack GE, Dewey RB, Roehrborn CG, O'Suilleabhain PE, Zimmern PE (August 2000). "Questionnaire-based assessment of bladder dysfunction in patients with mild to moderate Parkinson's disease". Urology. 56 (2): 250–4. PMID 10925088.
  59. ↑ Araki I, Kitahara M, Oida T, Kuno S (November 2000). "Voiding dysfunction and Parkinson's disease: urodynamic abnormalities and urinary symptoms". J. Urol. 164 (5): 1640–3. PMID 11025724.
  60. ↑ Koller WC, Vetere-Overfield B, Williamson A, Busenbark K, Nash J, Parrish D (October 1990). "Sexual dysfunction in Parkinson's disease". Clin Neuropharmacol. 13 (5): 461–3. PMID 2272026.
  61. ↑ Singer C, Weiner WJ, Sanchez-Ramos JR (1992). "Autonomic dysfunction in men with Parkinson's disease". Eur. Neurol. 32 (3): 134–40. doi:10.1159/000116810. PMID 1592069.
  62. ↑ Hoehn MM, Yahr MD (November 2001). "Parkinsonism: onset, progression, and mortality. 1967". Neurology. 57 (10 Suppl 3): S11–26. PMID 11775596.
  63. ↑ Williams-Gray CH, Mason SL, Evans JR, Foltynie T, Brayne C, Robbins TW, Barker RA (November 2013). "The CamPaIGN study of Parkinson's disease: 10-year outlook in an incident population-based cohort". J. Neurol. Neurosurg. Psychiatry. 84 (11): 1258–64. doi:10.1136/jnnp-2013-305277. PMID 23781007.
  64. ↑ Shulman LM, Gruber-Baldini AL, Anderson KE, Vaughan CG, Reich SG, Fishman PS, Weiner WJ (April 2008). "The evolution of disability in Parkinson disease". Mov. Disord. 23 (6): 790–6. doi:10.1002/mds.21879. PMID 18361474.

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