Parkinson's disease history and symptoms: Difference between revisions

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


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==Overview==
==Overview==
Common symptoms of Parkinson disease includes: Tremor, rigidity, bradykinesia, [[Cognitive]] dysfunction and [[dementia]], psychosis and hallucinations, [[Mood disorder|mood disorders]] including [[depression]], [[anxiety]], and [[apathy]]/[[abulia]], sleep disturbances, fatigue, olfactory dysfunction, pain and autonomic dysfunction.


==History==
==History and Symptoms==
The main clinical manifestations of Parkinson disease include tremor, rigidity and bradykinesia. Later in the course of the disease patient can have postural instability.(6 ta 10)
 
=== history ===
*The most common [[Symptom|symptoms]] that a [[Parkinson's disease|PD]] patient complains in his/her history are slowness of movement ([[bradykinesia]]), shaking hands while they are at rest (resting [[tremor]]) and muscle stiffness (rigidity).<ref name="pmid26865518" />
*It is in the favor of PD diagnosis if the presenting symptoms start 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 their history they may mention some of the risk factors of Parkinson disease such as:
**[[Family history]]<ref name="pmid23071076">{{cite journal |vauthors=Noyce AJ, Bestwick JP, Silveira-Moriyama L, Hawkes CH, Giovannoni G, Lees AJ, Schrag A |title=Meta-analysis of early nonmotor features and risk factors for Parkinson disease |journal=Ann. Neurol. |volume=72 |issue=6 |pages=893–901 |date=December 2012 |pmid=23071076 |pmc=3556649 |doi=10.1002/ana.23687 |url=}}</ref>
**[[Depression]]<ref name="pmid25995056">{{cite journal |vauthors=Gustafsson H, Nordström A, Nordström P |title=Depression and subsequent risk of Parkinson disease: A nationwide cohort study |journal=Neurology |volume=84 |issue=24 |pages=2422–9 |date=June 2015 |pmid=25995056 |pmc=4478031 |doi=10.1212/WNL.0000000000001684 |url=}}</ref>
**Exposure to [[Pesticide|pesticides]]<ref name="pmid23071076">{{cite journal |vauthors=Noyce AJ, Bestwick JP, Silveira-Moriyama L, Hawkes CH, Giovannoni G, Lees AJ, Schrag A |title=Meta-analysis of early nonmotor features and risk factors for Parkinson disease |journal=Ann. Neurol. |volume=72 |issue=6 |pages=893–901 |date=December 2012 |pmid=23071076 |pmc=3556649 |doi=10.1002/ana.23687 |url=}}</ref>
**High consumption of dairy diet<ref name="pmid24894826">{{cite journal |vauthors=Jiang W, Ju C, Jiang H, Zhang D |title=Dairy foods intake and risk of Parkinson's disease: a dose-response meta-analysis of prospective cohort studies |journal=Eur. J. Epidemiol. |volume=29 |issue=9 |pages=613–9 |date=September 2014 |pmid=24894826 |doi=10.1007/s10654-014-9921-4 |url=}}</ref>
**[[Vitamin D deficiency]]<ref name="pmid24847960">{{cite journal |vauthors=Lv Z, Qi H, Wang L, Fan X, Han F, Wang H, Bi S |title=Vitamin D status and Parkinson's disease: a systematic review and meta-analysis |journal=Neurol. Sci. |volume=35 |issue=11 |pages=1723–30 |date=November 2014 |pmid=24847960 |doi=10.1007/s10072-014-1821-6 |url=}}</ref>
**History of [[brain trauma]]<ref name="pmid23609436">{{cite journal |vauthors=Jafari S, Etminan M, Aminzadeh F, Samii A |title=Head injury and risk of Parkinson disease: a systematic review and meta-analysis |journal=Mov. Disord. |volume=28 |issue=9 |pages=1222–9 |date=August 2013 |pmid=23609436 |doi=10.1002/mds.25458 |url=}}</ref>
**History of [[migraine]] with [[aura]]<ref name="pmid25230997">{{cite journal |vauthors=Scher AI, Ross GW, Sigurdsson S, Garcia M, Gudmundsson LS, Sveinbjörnsdóttir S, Wagner AK, Gudnason V, Launer LJ |title=Midlife migraine and late-life parkinsonism: AGES-Reykjavik study |journal=Neurology |volume=83 |issue=14 |pages=1246–52 |date=September 2014 |pmid=25230997 |pmc=4180488 |doi=10.1212/WNL.0000000000000840 |url=}}</ref>
**History of [[anemia]]<ref name="pmid19858460">{{cite journal |vauthors=Savica R, Grossardt BR, Carlin JM, Icen M, Bower JH, Ahlskog JE, Maraganore DM, Steensma DP, Rocca WA |title=Anemia or low hemoglobin levels preceding Parkinson disease: a case-control study |journal=Neurology |volume=73 |issue=17 |pages=1381–7 |date=October 2009 |pmid=19858460 |pmc=2769554 |doi=10.1212/WNL.0b013e3181bd80c1 |url=}}</ref>
**Using of well water<ref name="pmid12433267">{{cite journal |vauthors=Petrovitch H, Ross GW, Abbott RD, Sanderson WT, Sharp DS, Tanner CM, Masaki KH, Blanchette PL, Popper JS, Foley D, Launer L, White LR |title=Plantation work and risk of Parkinson disease in a population-based longitudinal study |journal=Arch. Neurol. |volume=59 |issue=11 |pages=1787–92 |date=November 2002 |pmid=12433267 |doi= |url=}}</ref>
**Excess intake of [[iron]] and [[manganese]]<ref name="pmid12796527">{{cite journal |vauthors=Powers KM, Smith-Weller T, Franklin GM, Longstreth WT, Swanson PD, Checkoway H |title=Parkinson's disease risks associated with dietary iron, manganese, and other nutrient intakes |journal=Neurology |volume=60 |issue=11 |pages=1761–6 |date=June 2003 |pmid=12796527 |doi= |url=}}</ref>
**[[Obesity]]<ref name="pmid17159100">{{cite journal |vauthors=Hu G, Jousilahti P, Nissinen A, Antikainen R, Kivipelto M, Tuomilehto J |title=Body mass index and the risk of Parkinson disease |journal=Neurology |volume=67 |issue=11 |pages=1955–9 |date=December 2006 |pmid=17159100 |doi=10.1212/01.wnl.0000247052.18422.e5 |url=}}</ref>
**Exposure to hydrocarbons solvents<ref name="pmid22083847">{{cite journal |vauthors=Goldman SM, Quinlan PJ, Ross GW, Marras C, Meng C, Bhudhikanok GS, Comyns K, Korell M, Chade AR, Kasten M, Priestley B, Chou KL, Fernandez HH, Cambi F, Langston JW, Tanner CM |title=Solvent exposures and Parkinson disease risk in twins |journal=Ann. Neurol. |volume=71 |issue=6 |pages=776–84 |date=June 2012 |pmid=22083847 |pmc=3366287 |doi=10.1002/ana.22629 |url=}}</ref>
**Low [[muscle]] strength<ref name="pmid25841033">{{cite journal |vauthors=Gustafsson H, Aasly J, Stråhle S, Nordström A, Nordström P |title=Low muscle strength in late adolescence and Parkinson disease later in life |journal=Neurology |volume=84 |issue=18 |pages=1862–9 |date=May 2015 |pmid=25841033 |pmc=4433465 |doi=10.1212/WNL.0000000000001534 |url=}}</ref>


==Common symptoms==
==Common symptoms==
Parkinson disease affects movement (motor symptoms). Typical other symptoms include disorders of mood, behavior, thinking, and sensation (non-motor symptoms). Individual patients' symptoms may be quite dissimilar and progression of the disease is also distinctly individual.
The main clinical manifestations of Parkinson disease include [[tremor]], rigidity and [[bradykinesia]]. Later in the course of the disease patient can have [[postural instability]].<ref name="pmid9923759">{{cite journal |vauthors=Gelb DJ, Oliver E, Gilman S |title=Diagnostic criteria for Parkinson disease |journal=Arch. Neurol. |volume=56 |issue=1 |pages=33–9 |date=January 1999 |pmid=9923759 |doi= |url=}}</ref><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><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> Some studies suggest that there can be three clinical subtypes for Parkinson disease: [[Tremor]] dominant, akinetic-rigid and [[postural instability]] and [[gait]] difficulty<ref name="pmid22952329">{{cite journal |vauthors=Marras C, Lang A |title=Parkinson's disease subtypes: lost in translation? |journal=J. Neurol. Neurosurg. Psychiatry |volume=84 |issue=4 |pages=409–15 |date=April 2013 |pmid=22952329 |doi=10.1136/jnnp-2012-303455 |url=}}</ref><ref name="pmid24514863">{{cite journal |vauthors=Thenganatt MA, Jankovic J |title=Parkinson disease subtypes |journal=JAMA Neurol |volume=71 |issue=4 |pages=499–504 |date=April 2014 |pmid=24514863 |doi=10.1001/jamaneurol.2013.6233 |url=}}</ref> but other studies demonstrate that clinical course of the disease can be variable and this subtypes can switch to each other through time.<ref name="pmid24514863">{{cite journal |vauthors=Thenganatt MA, Jankovic J |title=Parkinson disease subtypes |journal=JAMA Neurol |volume=71 |issue=4 |pages=499–504 |date=April 2014 |pmid=24514863 |doi=10.1001/jamaneurol.2013.6233 |url=}}</ref><ref name="pmid16637023">{{cite journal |vauthors=Alves G, Larsen JP, Emre M, Wentzel-Larsen T, Aarsland D |title=Changes in motor subtype and risk for incident dementia in Parkinson's disease |journal=Mov. Disord. |volume=21 |issue=8 |pages=1123–30 |date=August 2006 |pmid=16637023 |doi=10.1002/mds.20897 |url=}}</ref>
 
===Motor symptoms===
 
The [[cardinal symptom]]s are:
* ''[[Tremor]]'': normally 4-7 Hz tremor, maximal when the limb is at rest, and decreased with voluntary movement. It is typically unilateral at onset.  This is the most apparent and well-known symptom, though an estimated 30% of patients have little perceptible tremor; these are classified as akinetic-rigid.
* ''[[Spasticity|Rigidity]]'': stiffness; increased muscle tone. In combination with a resting tremor, this produces a ratchety, "cogwheel" rigidity when the limb is passively moved.
* ''[[Bradykinesia]]/[[Akinesia]]'':  respectively, slowness or absence of movement. Rapid, repetitive movements produce a dysrhythmic and decremental loss of amplitude. Also "dysdiadokinesia", which is the loss of ability to perform rapid ''alternating'' movements
* ''[[Postural instability]]'': failure of postural [[reflexes]], which leads to impaired balance and falls.
 
Other motor symptoms include:
* [[Gait]] and posture disturbances:
** Shuffling: gait is characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to trip the patient
** Decreased arm swing: a form of bradykinesia
** Turning "en bloc": rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
** Stooped, forward-flexed posture.  In severe forms, the head and upper shoulders may be bent at a right angle relative to the trunk (camptocormia) <ref>{{cite journal |author=Lepoutre A, Devos D, Blanchard-Dauphin A, ''et al'' |title=A specific clinical pattern of camptocormia in Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatr. |volume=77 |issue=11 |pages=1229-34 |year=2006 |pmid=16735399}}</ref>.
** Festination: a combination of stooped posture, imbalance, and short steps.  It leads to a gait that gets progressively faster and faster, often ending in a fall.
** Gait freezing: "freezing" is another word for akinesia, the inability to move.  Gait freezing is characterized by inability to move the feet, especially in tight, cluttered spaces or when initiating gait. 
** [[Dystonia]] (in about 20% of cases): abnormal, sustained, painful twisting muscle contractions, usually affecting the foot and ankle, characterized by toe flexion and foot inversion, interfering with gait. However, dystonia can be quite generalized, involving a majority of skeletal muscles; such episodes are acutely painful and completely disabling.
* Speech and swallowing disturbances
** Hypophonia: soft speech. Speech quality tends to be soft, hoarse, and monotonous. Some people with Parkinson's disease claim that their tongue is "heavy" or have [[cluttered speech]].<ref>{{cite book
| first=Michael
| middle=J
| last=Fox
| title= Lucky Man: A Memoir
| location =  
| publisher= Hyperion
| isbn=0786888741
| pages=214
| year = 2003
}}</ref>.
** Festinating speech: excessively rapid, soft, poorly-intelligible speech.
** [[Drooling]]: most likely caused by a weak, infrequent swallow and stooped posture.
** Non-motor causes of speech/language disturbance in both expressive and receptive language: these include decreased verbal fluency and cognitive disturbance especially related to comprehension of emotional content of speech and of facial expression<ref>{{cite journal | author = Pell M | title = On the receptive prosodic loss in Parkinson's disease. | journal = Cortex | volume = 32 | issue = 4 | pages = 693-704 | year = 1996 | pmid = 8954247}}</ref>
** [[Dysphagia]]: impaired ability to swallow.  Can lead to [[Pulmonary aspiration|aspiration]], [[pneumonia]].
* Other motor symptoms:
** [[Fatigue (physical)|Fatigue]] (up to 50% of cases);
** Masked faces (a mask-like face also known as [[hypomimia]]), with infrequent [[blinking]];<ref>{{cite journal |author=Deuschl G, Goddemeier C |title=Spontaneous and reflex activity of facial muscles in dystonia, Parkinson's disease, and in normal subjects |journal=J. Neurol. Neurosurg. Psychiatr. |volume=64 |issue=3 |pages=320-4 |year=1998 |pmid=9527141 |url=http://jnnp.bmjjournals.com/cgi/content/full/64/3/320}}</ref>
** Difficulty rolling in bed or rising from a seated position;
** [[Micrographia (handwriting)|Micrographia]] (small, cramped handwriting);
** Impaired fine motor dexterity and [[motor coordination]];
** Impaired gross motor coordination;
** Poverty of movement: overall loss of accessory movements, such as decreased arm swing when walking, as well as spontaneous movement.


===Non-motor symptoms===
=== Motor symptoms ===
====Mood disturbances====
* 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>
*Estimated prevalence rates of depression vary widely according to the population sampled and methodology used. Reviews of [[clinical depression|depression]] estimate its occurrence in anywhere from 20-80% of cases.<ref>{{cite journal | author = Lieberman A | title = Depression in Parkinson's disease -- a review. | journal = Acta Neurol Scand | volume = 113 | issue = 1 | pages = 1-8 | year = 2006|pmid = 16367891}}</ref> Estimates from community samples tend to find lower rates than from specialist centres. Most studies use self-report questionnaires such as the [[Beck Depression Inventory]], which may overinflate scores due to physical symptoms. Studies using diagnostic interviews by trained psychiatrists also report lower rates of depression.  


*More generally, there is an increased risk for any individual with depression to go on to develop Parkinson's disease at a later date.<ref>{{cite journal | author = Ishihara L, Brayne C | title = A systematic review of depression and mental illness preceding Parkinson's disease. | journal = Acta Neurol Scand | volume = 113 | issue = 4 | pages = 211-20 | year = 2006 | pmid = 16542159}}</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>
 
*70% of individuals with Parkinson's disease diagnosed with pre-existing depression go on to develop anxiety. 90%  of Parkinson's disease patients with pre-existing anxiety subsequently develop depression; [[apathy]] or [[abulia]].
<!--VERY STRONG evidence of pre-emergence of either depression (up to ten years prior) or (anxiety) up to 20 years prior; essentially a prodome? CAN DOCUMENT-->


====Cognitive disturbances====
* 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>
*slowed reaction time; both voluntary and involuntary motor responses are significantly slowed.
* 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>
*[[executive dysfunction]], characterized by difficulties in: differential allocation of attention, impulse control, set shifting, prioritizing, evaluating the salience of ambient data, interpreting social cues, and subjective time awareness. This complex is present to some degree in most Parkinson's patients; it may progress to:
*[[dementia]]: a later development in approximately 20-40% of all patients, typically starting with slowing of thought and progressing to difficulties with abstract thought, memory, and behavioral regulation. [[Hallucinations]], [[delusions]] and [[paranoia]] may develop.
*short term [[memory loss]]; [[procedural memory]] is more impaired than [[declarative memory]]. Prompting elicits improved recall.
*medication effects: some of the above cognitive disturbances are improved by dopaminergic medications, while others are actually worsened.<ref>{{cite journal |author=Frank MJ |title=Dynamic dopamine modulation in the basal ganglia: a neurocomputational account of cognitive deficits in medicated and nonmedicated Parkinsonism |journal=Journal of cognitive neuroscience |volume=17 |issue=1 |pages=51-72 |year=2005 |pmid=15701239 |doi=10.1162/0898929052880093}}</ref>


====Sleep disturbances====
=== Nonmotor symptoms ===
*Excessive daytime [[somnolence]]
* [[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>
*Initial, intermediate, and terminal [[insomnia]]
*Disturbances in [[Rapid eye movement sleep|REM]] sleep: disturbingly vivid dreams, and [[Rapid eye movement sleep|REM]] Sleep Disorder, characterized by acting out of dream content - can occur years prior to diagnosis


====Sensation disturbances====
* 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<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> but can resolve when [[Parkinson's disease|PD]] medications are discontinued.<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>
*impaired visual [[contrast sensitivity]], spatial reasoning, [[color|colour]] discrimination, convergence insufficiency (characterized by [[double vision]]) and [[oculomotor control]]
*[[dizziness]] and fainting; usually attributable orthostatic hypotension, a failure of the autonomous nervous system to adjust blood pressure in response to changes in body position
*impaired [[proprioception]] (the awareness of bodily position in three-dimensional space)
*reduction or loss of sense of [[olfaction|smell]] (microsmia or [[anosmia]]) - can occur years prior to diagnosis,
*[[Pain and nociception|pain]]: neuropathic, muscle, joints, and tendons, attributable to tension, dystonia, rigidity, joint stiffness, and injuries associated with attempts at accommodation


====Autonomic disturbances====
* [[Mood disorder|Mood disorders]] including [[depression]], [[anxiety]], and [[apathy]]/[[abulia]]:
*oily skin and [[seborrheic dermatitis]]<ref>{{cite journal |author=Gupta A, Bluhm R |title=Seborrheic dermatitis |journal=Journal of the European Academy of Dermatology and Venereology : JEADV |volume=18 |issue=1 |pages=13-26; quiz 19-20 |year=2004 |pmid=14678527}}</ref>
# 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>
*[[urinary incontinence]], typically in later disease progression
# 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>
*[[nocturia]] (getting up in the night to pass urine) - up to 60% of cases
# 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>
*[[constipation]] and [[gastric]] dysmotility that is severe enough to endanger comfort and even health
* 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>
*altered sexual function: characterized by profound impairment of sexual arousal, behavior, orgasm, and drive is found in mid and late Parkinson disease. Current data addresses male sexual function almost exclusively
* 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>
*[[weight loss]], which is significant over a period of ten years - 8% of body [[weight loss|weight lost]] compared with 1% in a control group.
* Olfactory dysfunction: Deficits in [[odor]] identification and discrimination are common in [[Parkinson's disease|PD]]<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> and can happen even before the motor symptoms of the disease.<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>


== Less common symptoms ==
* 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 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>


==References==
==References==

Latest revision as of 13:32, 12 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

Common symptoms of Parkinson disease includes: Tremor, rigidity, bradykinesia, Cognitive dysfunction and dementia, psychosis and hallucinations, mood disorders including depression, anxiety, and apathy/abulia, sleep disturbances, fatigue, olfactory dysfunction, pain and autonomic dysfunction.

History and Symptoms

history

Common symptoms

The main clinical manifestations of Parkinson disease include tremor, rigidity and bradykinesia. Later in the course of the disease patient can have postural instability.[15][2][2] Some studies suggest that there can be three clinical subtypes for Parkinson disease: Tremor dominant, akinetic-rigid and postural instability and gait difficulty[16][17] but other studies demonstrate that clinical course of the disease can be variable and this subtypes can switch to each other through time.[17][18]

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.[19][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.[20][21][22] PD tremor frequency is 3 to 7 Hz.[20] 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.[23][24]
  • Rigidity: Rigidity in PD in very common and can be seen in 75 to 90 percent of patients.[19][1][25] 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.[26][27]
  • 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.[28][29]

Nonmotor symptoms

  1. Depression: Mild to moderate depression is very common in PD and can be seen in 50 percent of PD patients.[45][46][47] these patients can present with anhedonia, sadness, guilt and feeling of worthlessness.[48]
  2. Anxiety: Anxiety, especially generalized anxiety disorder and social phobia is common in PD and can be seen in more than 30 percent of patients.[45][49] Anxiety is usually combined by depression.[50]
  3. 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 PD patients.[51][52]
  • Sleep disturbances: Sleep disorders is seen in 55 to 80 percent of PD patients in early or late stages of the disease.[53][54] approximately 40 percent of PD patients take medicine for sleep cause insomnia is as common as 60 percent in them.[53][54][55] the most common cause of insomnia and frequent awakening during sleep include nocturia, cramp, pain, nightmares and tremor.[55][56][57][58][59] 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[60][61]
  • Fatigue: The prevalence of fatigue in PD patients is 33 to 58 percent[62][63][64] it’s mostly associated with depression and excessive day time somnolence but can occur as an isolate problem too.[64][63][65]
  • Olfactory dysfunction: Deficits in odor identification and discrimination are common in PD[66] and can happen even before the motor symptoms of the disease.[67][68]
  • 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.[69][70][71]

References

  1. ↑ 1.0 1.1 1.2 1.3 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. ↑ 2.0 2.1 2.2 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 Noyce AJ, Bestwick JP, Silveira-Moriyama L, Hawkes CH, Giovannoni G, Lees AJ, Schrag A (December 2012). "Meta-analysis of early nonmotor features and risk factors for Parkinson disease". Ann. Neurol. 72 (6): 893–901. doi:10.1002/ana.23687. PMC 3556649. PMID 23071076.
  4. ↑ Gustafsson H, Nordström A, Nordström P (June 2015). "Depression and subsequent risk of Parkinson disease: A nationwide cohort study". Neurology. 84 (24): 2422–9. doi:10.1212/WNL.0000000000001684. PMC 4478031. PMID 25995056.
  5. ↑ Jiang W, Ju C, Jiang H, Zhang D (September 2014). "Dairy foods intake and risk of Parkinson's disease: a dose-response meta-analysis of prospective cohort studies". Eur. J. Epidemiol. 29 (9): 613–9. doi:10.1007/s10654-014-9921-4. PMID 24894826.
  6. ↑ Lv Z, Qi H, Wang L, Fan X, Han F, Wang H, Bi S (November 2014). "Vitamin D status and Parkinson's disease: a systematic review and meta-analysis". Neurol. Sci. 35 (11): 1723–30. doi:10.1007/s10072-014-1821-6. PMID 24847960.
  7. ↑ Jafari S, Etminan M, Aminzadeh F, Samii A (August 2013). "Head injury and risk of Parkinson disease: a systematic review and meta-analysis". Mov. Disord. 28 (9): 1222–9. doi:10.1002/mds.25458. PMID 23609436.
  8. ↑ Scher AI, Ross GW, Sigurdsson S, Garcia M, Gudmundsson LS, Sveinbjörnsdóttir S, Wagner AK, Gudnason V, Launer LJ (September 2014). "Midlife migraine and late-life parkinsonism: AGES-Reykjavik study". Neurology. 83 (14): 1246–52. doi:10.1212/WNL.0000000000000840. PMC 4180488. PMID 25230997.
  9. ↑ Savica R, Grossardt BR, Carlin JM, Icen M, Bower JH, Ahlskog JE, Maraganore DM, Steensma DP, Rocca WA (October 2009). "Anemia or low hemoglobin levels preceding Parkinson disease: a case-control study". Neurology. 73 (17): 1381–7. doi:10.1212/WNL.0b013e3181bd80c1. PMC 2769554. PMID 19858460.
  10. ↑ Petrovitch H, Ross GW, Abbott RD, Sanderson WT, Sharp DS, Tanner CM, Masaki KH, Blanchette PL, Popper JS, Foley D, Launer L, White LR (November 2002). "Plantation work and risk of Parkinson disease in a population-based longitudinal study". Arch. Neurol. 59 (11): 1787–92. PMID 12433267.
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