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Signs and Symptoms of
Parkinson's Disease
Any person who has the signs and symptoms characteristic of Parkinson's
disease is said to have parkinsonism, but not every person with
parkinsonism has Parkinson's disease, it's only one of the
possibilities.
Patients and their families need to understand parkinsonism, because
some 20 to 25 percent of people diagnosed with Parkinson's disease will
eventually be discovered to have some other form of parkinsonism.
Parkinsonism may look like Parkinson's disease, but over time it does
not act like it. For this reason, if you have been diagnosed with
Parkinson's disease it is important to see a neurologist who has
experience diagnosing and treating this disorder.
In people with Parkinson's disease, specific groups of brain cells
called neurons are slowly and progressively injured, then selectively
degenerate or die.
This process causes the typical symptoms of Parkinson's disease, which
doctors call "characteristic symptoms."
The four primary symptoms or characteristics of Parkinson's disease are:
* Involuntary trembling
* Stiffness of limbs and trunk; muscles become rigid and
stiff
* Slowness of movement with a typical gait in which the
body is bent or flexed
* Impaired balance and coordination |
Clinical diagnosis is generally based
on having 2 out of the first 3 symptoms listed above.
Early Signs and Symptoms of Parkinson's Disease
It is often difficult to pinpoint when a person with Parkinson's first
began showing signs and symptoms of the disease. Many people vividly
recall when they first noticed their tremor, but through close
questioning, the physician often finds that subtle signs of the disease
were present even before the tremor became noticeable.
The following are some of the early signs and symptoms of Parkinson's
disease:
* Change in facial expression
(staring, lack of blinking)
* Failure to swing one arm when walking
* Flexion (stooped) posture
* Frozen, painful shoulder
* Limping or dragging of one leg
* Numbness, tingling, achiness or discomfort of the neck
or limbs
* Softness of the voice
* Subjective sensation of internal trembling
* Resting tremor |
As symptoms become more
pronounced, patients may have difficulty walking, talking, or completing
other simple tasks. Early symptoms are subtle and occur gradually. In
some people the disease progresses more quickly than it does in others.
Other symptoms may include difficulty in swallowing, chewing, and
speaking; sleep disruptions; and/or depression or other emotional
changes.
Causes of the Symptoms
Parkinson's disease, a motor system disorder, is the result of loss of
dopamine-producing brain cells.
The substantia nigra is a very small area located deep within the
brain. The symptoms of Parkinson's disease do not become noticeable
until about 80 percent of the cells of the substantia nigra have
died.
Under the microscope doctors can see substantially fewer cells in this
substantia nigra than in that of healthy brains, and the
remaining cells often show signs of abnormality.
Once a specific neurotransmitter is produced that causes the
substantia nigra to degenerate and die, dopamine is lost and
dopamine-relayed messages to other motor centers cannot go through. This
is the primary cause of the motor symptoms in Parkinson's disease.
Although doctors have some understanding that neurochemical disturbance
causes the symptoms of Parkinson's, they still do not know what causes
the neurodegeneration.
Because Parkinson's disease is a progressive disorder, it can generally
be expected that each year the signs and symptoms of the disease will
become more pronounced. No one can accurately predict how, or how
quickly, the disease will progress in a specific individual. There
simply is no reliable way to evaluate the degree of cell loss in the
substantia nigra, no laboratory test or widely available imaging
procedure that tells how much cell loss has occurred or how fast it is
progressing.
Although doctors do not yet have treatments capable of slowing or
arresting the progression of the illness, current treatments can very
effectively relieve the symptoms, especially in the early years. Many
people who are adequately treated notice very little or no progression
of symptoms over the first few years.
With time, a person's degree of motor disability does tend to increase,
however, and after five to 10 years of illness the symptoms will disrupt
daily life. At this point, medications are needed in higher doses and
must be monitored and adjusted more frequently.
Advanced Parkinson's Disease
As Parkinson's disease becomes more advanced, facial movement, blinking
and spontaneous smiling and expression all become more difficult, and
people have increasing difficulty functioning independently. However,
many people with Parkinson's never reach this stage, because they live a
normal life span and continue to receive significant benefit from their
anti-Parkinson medications.
Problem areas in advanced Parkinson's disease:
* Cognitive decline and behavioral
problems
* Communication
* Difficulty with urination
* Falls
* Impaired performance of activities of daily living
* Sexual dysfunction
* Swallowing
* Walking and balance problems
* Weight loss |
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