Parkinson's disease history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.[1][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[3][4] but other studies demonstrate that clinical course of the disease can be variable and this subtypes can switch to each other through time.[4][5]
Motor symptoms
Neuromuscular
- Tremor: Tremor is the most common symptom in Parkinson disease and can be the presenting sign in 70 to 80 percent of patients.[6][7] 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.[8][9][10] PD tremor frequency is 3 to 7 Hz.[8] 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.[11][12]
- Rigidity: Rigidity in PD in very common and can be seen in 75 to 90 percent of patients.[6][7][13] 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.[14][15]
- Bradykinesia: Bradykinesia or slowness of movement, is seen in 80 percent of PD patients.[7]
- 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.[16][17]
Nonmotor symptoms
- Cognitive dysfunction and dementia: Cognitive impairment can occur in the PD but in some ways it’s different from Alzheimer disease. Language dysfunction and memory deficit is less prominent while executive and visuospatial dysfunction is more prominent in PD.(2_10_76_77_78_79) Parkinson’s diseases memory deficits are in the area of retrieval of learned information. Aphasia, apraxia and sever memory loss are uncommon in PD.(5_6_83 ta 87)
- Psychosis and hallucinations: Psychosis, especially visual hallucination occurs in PD patients who are under treatment.(50 ta 52) All of the antiparkinsonism drugs can cause this but dopamine agonists are the most common cause.(56_57_58) Severity and prevalence of these hallucinations increase over time(54) but can resolve when PD medications are discontinued.(59)
- Mood disorders including depression, anxiety, and apathy/abulia:
- Depression: Mild to moderate depression is very common in PD and can be seen in 50 percent of PD patients. (67_70 ta 72) these patients can present with anhedonia, sadness, guilt and feeling of worthlessness.(77)
- Anxiety: Anxiety, especially generalized anxiety disorder and social phobia is common in PD and can be seen in more than 30 percent of patients.(67_79_81) Anxiety is usually combined by depression.(82)
- 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.(86_87_89)
- Sleep disturbances: Sleep disorders is seen in 55 to 80 percent of PD patients in early or late stages of the disease.(93_94_49) approximately 40 percent of PD patients take medicine for sleep cause insomnia is as common as 60 percent in them.(93_95) the most common cause of insomnia and frequent awakening during sleep include nocturia, cramp, pain, nightmares and tremor.(95 ta 99 va 100) 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(104_105)
- Fatigue: The prevalence of fatigue in PD patients is 33 to 58 percent (109_121 ta 127) it’s mostly associated with depression and excessive day time somnolence but can occur as an isolate problem too.(122_123_126)
- Autonomic dysfunction: Autonomic dysfunction includes orthostatic hypotension, constipation, dysphagia, urinary and sexual problems.(128_129) urinary symptoms is mostly cause by reduced bladder capacity due to detresor muscle contraction and manifest as frequency, urgency and urge incontinence.(131_132) sexual dysfunction in men manifest with erection dysfunction and in women with vaginal tightness and lack of orgasm(135_138_139)
- Olfactory dysfunction: Deficits in odor identification and discrimination are common in PD(140) and can happen even before the motor symptoms of the disease.(141_142)
- 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.(146ta 148)
Less common symptoms
References
- ↑ Gelb DJ, Oliver E, Gilman S (January 1999). "Diagnostic criteria for Parkinson disease". Arch. Neurol. 56 (1): 33–9. PMID 9923759.
- ↑ 2.0 2.1 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.
- ↑ Marras C, Lang A (April 2013). "Parkinson's disease subtypes: lost in translation?". J. Neurol. Neurosurg. Psychiatry. 84 (4): 409–15. doi:10.1136/jnnp-2012-303455. PMID 22952329.
- ↑ 4.0 4.1 Thenganatt MA, Jankovic J (April 2014). "Parkinson disease subtypes". JAMA Neurol. 71 (4): 499–504. doi:10.1001/jamaneurol.2013.6233. PMID 24514863.
- ↑ Alves G, Larsen JP, Emre M, Wentzel-Larsen T, Aarsland D (August 2006). "Changes in motor subtype and risk for incident dementia in Parkinson's disease". Mov. Disord. 21 (8): 1123–30. doi:10.1002/mds.20897. PMID 16637023.
- ↑ 6.0 6.1 Hoehn MM, Yahr MD (May 1967). "Parkinsonism: onset, progression and mortality". Neurology. 17 (5): 427–42. PMID 6067254.
- ↑ 7.0 7.1 7.2 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.
- ↑ 8.0 8.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ LANCE JW, SCHWAB RS, PETERSON EA (March 1963). "Action tremor and the cogwheel phenomenon in Parkinson's disease". Brain. 86: 95–110. PMID 13928399.
- ↑ Koller WC, Glatt S, Vetere-Overfield B, Hassanein R (April 1989). "Falls and Parkinson's disease". Clin Neuropharmacol. 12 (2): 98–105. PMID 2720700.
- ↑ 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.