Tremors

Symptoms often start with an occasional tremor in one finger that spreads over time to involve the whole arm. The tremor is often rhythmic -- 4 to 5 cycles per second -- and frequently causes an action of the thumb and fingers known as the pill-rolling tremor. Tremor is present when the limb is at rest or held up in a stiff unsupported position and usually disappears briefly during movement. Tremors can also occur in the head, lips, tongue, and feet, although they do not occur during sleep. In one study, 44% of patients reported experiencing internal tremors lasting less than half an hour, but occurring several times a week. Symptoms can occur on one or both sides of the body.

Motion and Motor Impairment

Slowness of motion (bradykinesia) is one of the classic symptoms of Parkinson's disease. Patients may eventually develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady and cause a person to fall. After a number of years, muscles may freeze up or stall, usually when a patient is making a turn or passing through narrow spaces, such as a doorway. Intestinal motility -- e.g., swallowing, digestion, and elimination -- may also slow down, causing eating problems and constipation. The muscle rigidity (akinesia) experienced in Parkinson's disease often begins in the legs and neck. Muscle rigidity in the face can produce a mask-like, staring appearance. Hand deformities may develop in late stages, causing severe discomfort and limitation. Handwriting, for instance, often becomes diminutive. Normally spontaneous muscle movements, such as blinking, may need to be done consciously.

Speech Impairment

About half of Parkinson's patients develop some speech difficulty caused by rigidity of the facial muscles, loss of motor control, and impaired breath control. Tone can become monotonous, words may be repeated over and over, or the rate of speech may even be very fast. Swallowing may be difficult.

Depression and Mental Problems

Depression is often present as one of the first symptoms and is probably partially caused by a chemical imbalance in the brain. Because depression is common in old age or can be caused by other factors, the patient often does not connect it with other early symptoms of Parkinson's. Defects in thinking, memory, language, and problem solving skills often occur later on. Dementia occurs in almost 30% of Parkinson's patients, who are usually older individuals who have had major depression.

Other Symptoms of Parkinson's Disease

The sense of smell is impaired in about 70% of patients. Vision is also effected, including color perception. The patient may experience changes in sensations of temperature, hot flashes, excessive sweating, and cramps and burning in the legs. Parkinson symptoms that may occur after encephalitis include greasy skin and hair, tics, spasms, rapid and repetitive speech, and oculogyric crises -- disturbances in which the eyes become fixed in one direction for minutes or even hours. In people with a history of migraine, the onset of Parkinson's is associated with change in migraine symptoms (most often improvement). Constipation is a major problem for Parkinson patients and occurs both as a result of the disease and a side effect of its treatment. Laxatives, stool softeners, and other medications may be prescribed. The drug cisapride (Propulsid) appears to help some people with constipation and a poor response to levodopa (see Diet, in this report). Bladder control and urinary incontinence are also problems, which can be helped by taking Sudafed.

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