Signs and symptoms of Parkinson's disease
Encyclopedia
Signs and symptoms of Parkinson's disease are varied. Parkinson's disease
affects movement, producing motor symptoms. Non-motor symptoms, which include autonomic dysfunction, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common.
in PD: tremor, rigidity, slowness of movement, and postural instability. Other motor symptoms include gait and posture disturbances such as decreased arm swing, a forward-flexed posture
and the use of small steps when walking; speech and swallowing disturbances; and other symptoms such as a mask-like face expression
or small handwriting
are examples of the range of common motor problems that can appear.
in PD: tremor, rigidity, bradykinesia and postural instability.
Parkinson's disease causes neuropsychiatric disturbances, which include mainly cognition, mood and behavior problems and can be as disabling as motor symptoms.
Cognitive disturbances occur even in the initial stages of the disease in some cases. A very high proportion of sufferers will have mild cognitive impairment as the disease advances. Most common deficits in non-demented patients are:
Deficits tend to aggravate with time, developing in many cases into dementia
. A person with PD has a sixfold increased risk of suffering it, and the overall rate in people with the disease is around 30%. Moreover, prevalence of dementia increases in relation to disease duration, going up to 80%. Dementia has been associated with a reduced quality of life
in disease sufferers and caregiver
s, increased mortality
and a higher probability of attending a nursing home
.
Cognitive problems and dementia are usually accompanied by behavior and mood alterations, although these kind of changes are also more common in those patients without cognitive impairment than in the general population. Most frequent mood difficulties include:
Obsessive–compulsive behaviors such as craving, binge eating
, hypersexuality
, pathological gambling, or other, can also appear in PD, and have been related to a dopamine dysregulation syndrome
associated with the medications for the disease.
Psychotic
symptoms are common in PD, generally associated with dopamine therapy. Symptoms of psychosis, or impaired reality testing, are either hallucination
s, typically visual, less commonly auditory, and rarely in other domains including tactile, gustatory or olafactory, or delusion
s, that is, irrational beliefs. Hallucinations are generally stereotyped and without emotional content. Initially patients usually have insight so that the hallucinations are benign in terms of their immediate impact but have poor prognostic implications, with increased risk of dementia, worsened psychotic symptoms and mortality. Delusions occur in about 5-10% of treated patients, and are considerably more disruptive, being paranoid in nature, of spousal infidelity or family abandonment. Psychosis is an independent risk factor for nursing home placement.
Hallucinations can occur in Parkinsonian syndromes for a variety of reasons. There is an overlap between Parkinson's disease and Lewy body dementia, so that where Lewy bodies are present in the visual cortex, hallucinations may result. Hallucinations can also be brought about by excessive dopaminergic stimulation. Most hallucinations are visual in nature, often formed as familiar people or animals, and are generally non-threatening in nature. Some patients find them comforting; however their carers often find this part of the disease most disturbing and the occurrence of hallucinations is a major risk factor for hospitalisation. Treatment options consist of modifying the dosage of dopaminergic drugs taken each day, adding an antipsychotic
drug like quetiapine
, or offering carers a psychosocial intervention to help them cope with the hallucinations.
Sleep problems can be worsened by medications for PD, but they are a core feature of the disease. Some common symptoms are:
and gastric dysmotility that is severe enough to endanger comfort and even health. A factor in this is the appearance of Lewy bodies and Lewy neurites even before these affect the functioning of the substantia nigra in the neurons in the enteric nervous system
that control gut functions.
abnormalities produced by the neurological changes. Among them are:
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
affects movement, producing motor symptoms. Non-motor symptoms, which include autonomic dysfunction, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common.
Motor symptoms
Four motor symptoms are considered cardinalCardinal sign (pathology)
In pathology, a cardinal sign or cardinal symptom is the primary or major clinical sign symptom by which a diagnosis is made.Often, there is a cluster of signs or symptoms that, taken together, are pathognomonic for a specific disease or syndrome....
in PD: tremor, rigidity, slowness of movement, and postural instability. Other motor symptoms include gait and posture disturbances such as decreased arm swing, a forward-flexed posture
Camptocormia
Camptocormia is a medical condition that is characterized by forward flexion of the spine, which is noticeable when standing or walking but disappears when lying down...
and the use of small steps when walking; speech and swallowing disturbances; and other symptoms such as a mask-like face expression
Hypomimia
Hypomimia, a medical sign, is a reduced degree of facial expression. It can be caused by motor impairment , as in Parkinson's disease, or by other causes, like psychological or psychiatric factors ....
or small handwriting
Micrographia (handwriting)
Micrographia is a medical term used to describe abnormally small, cramped handwriting and/or the progression to continually smaller handwriting. This is one of the symptoms of Parkinson's disease...
are examples of the range of common motor problems that can appear.
Cardinal symptoms
Four symptoms are considered cardinalCardinal mark
A cardinal mark is a sea mark used in maritime pilotage to indicate the position of a hazard and the direction of safe water....
in PD: tremor, rigidity, bradykinesia and postural instability.
- TremorTremorA tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the...
is the most apparent and well-known symptom. It is also the most common; though around 30% of individuals with PD do not have tremor at disease onset, most develop it as the disease progresses. It is usually a rest tremor: maximal when the limb is at rest and disappearing with voluntary movement and sleep. It affects to a greater extent the most distal part of the limb, and at onset typically appears in only a single arm or leg, becoming bilateral later. Frequency of PD tremor is between 4 and 6 hertzHertzThe hertz is the SI unit of frequency defined as the number of cycles per second of a periodic phenomenon. One of its most common uses is the description of the sine wave, particularly those used in radio and audio applications....
s (cycles per second). It is a pronationPronationIn anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a...
-supinationSupinationSupination is a position of either the forearm or foot; in the forearm when the palm faces anteriorly, or faces up . Supination in the foot occurs when a person appears "bow-legged" with their weight supported primarily on the anterior of their feet.The hand is supine in the anatomical position...
tremor that is described as "pill-rolling"; a term used to describe the tendency of the index finger of the hand to get into contact with the thumb and perform together a circular movement. Such term was given due to the similarity of the movement in PD patients with the former pharmaceutical technique of manually making pills. PD tremor is not improved with alcohol intake, as opposed to essential tremorEssential tremorEssential tremor is a slowly progressive neurological disorder whose most recognizable feature is a tremor of the arms that is apparent during voluntary movements such as eating and writing...
.
- RigiditySpasticitySpasticity is a feature of altered skeletal muscle performance in muscle tone involving hypertonia, which is also referred to as an unusual "tightness" of muscles...
is a characterized by an increased muscle toneMuscle toneIn physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state. It helps maintain posture, and it declines during REM sleep.-Purpose:Unconscious nerve impulses maintain the...
(an excessive and continuous contraction of the muscles) which produces stiffnessJoint stiffnessJoint stiffness may be either the symptom of pain on moving a joint, the symptom of loss of range of motion or the physical sign of reduced range of motion. Doctors prefer the latter two uses but patients often use the first meaning....
and resistance to movement in joints. Rigidity may be associated with joint pain; such pain being a frequent initial manifestation of the disease. When limbs of the person with PD are passively moved by others a "cogwheel rigidity" is commonly seen. Cogwheel-like refers to the ratchetyRatchet (device)A ratchet is a device that allows continuous linear or rotary motion in only one direction while preventing motion in the opposite direction. Because most socket wrenches today use ratcheting handles, the term "ratchet" alone is often used to refer to a ratcheting wrench, and the terms "ratchet"...
jerks by which the articulation is moved as opposed to the normal fluid movement: when a muscle is externally tried to move it resists at first but with enough force it is partially moved until it resists again and only with further force it will be moved. The combination of tremor and increased tone is considered to be at the origin of cogwheel rigidity.
- Bradykinesia and akinesia: the former refers to slowness of movement while the latter to the absence of it. It is the most characteristic clinical feature of PD, and is associated with difficulties along the whole course of the movement process, from planning to initiation and finally execution of a movement. The performance of sequential and simultaneous movements is also hindered. Bradykinesia is the most disabling symptom in the early stages of the disease. Initial manifestations of bradykinesia are problems when performing daily life tasks requiring fine motor control such as writing, sewing or getting dressed. Clinical evaluation is based in similar tasks consisting such as alternating movements between both hands or feet. Bradykinesia is not equal for all movements or times. It is modified by the activity or emotional state of the subject to the point of some patients barely able to walk being capable of riding a bicycle. Generally patients have less difficulties when some short of external cue is provided.
... immobile patients who become excited may be able to make quick movements such as catching a ball (or may be able to suddenly run if someone screams "fire"). This phenomenon (kinesia paradoxica) suggests that patients with PD have intact motor programmes but have difficulties accessing them without an external trigger, such as a loud noise, marching music or a visual cue requiring them to step over an obstacle.
- Postural instability: In the late stages postural instability is typical, which leads to impaired balanceBalance disorderA balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness or wooziness, or having a sensation of movement, spinning, or floating...
and frequent falls, and secondarily to bone fractures. Instability is often absent in the initial stages, especially in younger people. Up to 40% of the patients may experience falls and around 10% may have falls weekly, with number of falls being related to the severity of PD. It is produced by a failure of postural reflexes, along other disease related factors such as orthostatic hypotensionOrthostatic hypotensionOrthostatic hypotension, also known as postural hypotension, orthostasis, and colloquially as head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when the person stands up or stretches. The decrease is typically greater than 20/10 mm Hg, and may be...
or cognitiveCognitionIn science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...
and sensoryPerceptionPerception is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information. All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs...
changes
Other motor symptoms
Other motor symptoms include:- GaitGaitGait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency...
and posture disturbances:- Shuffling gait: gait is characterized by short steps, with feet barely leaving the ground. Small obstacles tend to cause the patient to trip.
- Decreased arm-swing.
- 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.
- CamptocormiaCamptocormiaCamptocormia is a medical condition that is characterized by forward flexion of the spine, which is noticeable when standing or walking but disappears when lying down...
: stooped, forward-flexed posture. In severe forms, the head and upper shoulders may be bent at a right angleRight angleIn geometry and trigonometry, a right angle is an angle that bisects the angle formed by two halves of a straight line. More precisely, if a ray is placed so that its endpoint is on a line and the adjacent angles are equal, then they are right angles...
relative to the trunk. - 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: also called motor blocks, is a manifestation of akinesia. Gait freezing is characterized by a sudden inability to move the lower extremities which usually lasts less than 10 seconds. It may worsen in tight, cluttered spaces, when attempting to initiate gait or turning around, or when approaching a destination. Freezing improves with treatment and also with behavioral techniques such as marching to command or following a given rhythm.
- DystoniaDystoniaDystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning or reaction to...
: abnormal, sustained, painful twisting muscle contractions, often affecting the foot and ankle (mainly toe flexion and foot inversion) which often interferes with gait. - ScoliosisScoliosisScoliosis is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line...
- Speech and swallowing disturbances.
- HypophoniaHypophoniaHypophonia is soft speech, especially resulting from a lack of coordination in the vocal musculature. This condition is a common presentation in Parkinson's Disease....
: soft speech. - Monotonic speech: Speech quality tends to be soft, hoarse, and monotonous.
- Festinating speech: excessively rapid, soft, poorly-intelligible speech.
- DroolingDroolingDrooling is when saliva flows outside the mouth...
: most likely caused by a weak, infrequent swallow. - DysphagiaDysphagiaDysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia....
: impaired ability to swallow; which in the case of PD is probably related to an inability to initiate the swallowing reflex or by a too long laryngeal or oesophageal movement. Can lead to aspiration pneumoniaAspiration pneumoniaAspiration pneumonia is bronchopneumonia that develops due to the entrance of foreign materials into the bronchial tree, usually oral or gastric contents...
. - DysarthriaDysarthriaDysarthria is a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system and is characterized by poor articulation of phonemes...
- Hypophonia
- Other motor symptoms and signs:
- FatigueFatigue (physical)Fatigue is a state of awareness describing a range of afflictions, usually associated with physical and/or mental weakness, though varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles...
- HypomimiaHypomimiaHypomimia, a medical sign, is a reduced degree of facial expression. It can be caused by motor impairment , as in Parkinson's disease, or by other causes, like psychological or psychiatric factors ....
: a mask-like face - Difficulty rolling in bed or rising from a seated position.
- MicrographiaMicrographia (handwriting)Micrographia is a medical term used to describe abnormally small, cramped handwriting and/or the progression to continually smaller handwriting. This is one of the symptoms of Parkinson's disease...
: small, cramped handwriting. - Impaired fine motor dexterity and motor coordinationMotor coordinationthumb|right|Motor coordination is shown in this animated sequence by [[Eadweard Muybridge]] of himself throwing a diskMotor coordination is the combination of body movements created with the kinematic and kinetic parameters that result in intended actions. Such movements usually smoothly and...
. - Impaired gross motor coordination.
- AkathisiaAkathisiaAkathisia, or acathisia, is a syndrome characterized by unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless...
: an unpleasant desire to move. - Reemergence of primitive reflexesPrimitive reflexesPrimitive reflexes are reflex actions originating in the central nervous system that are exhibited by normal infants but not neurologically intact adults, in response to particular stimuli. These reflexes disappear or are inhibited by the frontal lobes as a child moves through normal child...
. - Glabellar reflexGlabellar reflexGlabellar reflex is a primitive reflex. It is elicited by repetitive tapping on the forehead. Subjects blink in response to the first several taps...
- Fatigue
Neuropsychiatric
| Mood problem | Prevalence |
|---|---|
| Depression | 58% |
| Apathy | 54% |
| Anxiety | 49% |
Cognitive disturbances occur even in the initial stages of the disease in some cases. A very high proportion of sufferers will have mild cognitive impairment as the disease advances. Most common deficits in non-demented patients are:
- Executive dysfunctionExecutive dysfunctionExecutive dysfunction , in psychology , is a disruption to the efficacy of the executive system. It can refer to both neurocognitive deficits and behavioural symptoms...
, which translates into impaired set shifting, poor problem solving, and fluctuations in attention among other difficulties. - Slowed cognitive speedBradyphreniaBradyphrenia is a neurological term referring to the slowness of thought common to many disorders of the brain.-Diseases:Disorders characterized by bradyphrenia include Parkinson's disease and forms of schizophrenia...
(Bradyphrenia). - Memory problems; specifically in recalling learned information, with an important improvement with cues. Recognition is less impaired than free recall pointing towards a retrieving more than to an encoding problem.
- Regarding language, patients are found to have problems in verbal fluency testVerbal fluency testVerbal fluency tests are a kind of psychological test in which participants have to say as many words as possible from a category in a given time . This category can be semantic, such as animals or fruits, or phonemic, such as words that begin with letter p.The semantic fluency test is sometimes...
s. - Visuospatial skills difficulties, which are seen when the person with PD is for example asked to perform tests of facial recognition and perception of line orientation.
Deficits tend to aggravate with time, developing in many cases into dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
. A person with PD has a sixfold increased risk of suffering it, and the overall rate in people with the disease is around 30%. Moreover, prevalence of dementia increases in relation to disease duration, going up to 80%. Dementia has been associated with a reduced quality of life
Quality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
in disease sufferers and caregiver
Caregiver
Caregiver may refer to:* Caregiver or carer - an unpaid person who cares for someone requiring support due to a disability, frailty, mental health problem, learning disability or old age...
s, increased mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
and a higher probability of attending a nursing home
Nursing home
A nursing home, convalescent home, skilled nursing unit , care home, rest home, or old people's home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living...
.
Cognitive problems and dementia are usually accompanied by behavior and mood alterations, although these kind of changes are also more common in those patients without cognitive impairment than in the general population. Most frequent mood difficulties include:
- DepressionDepression (mood)Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
: DepressionClinical depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
is well recognized in PD, having been identified as "melancholia" by James ParkinsonJames ParkinsonJames Parkinson was an English apothecary surgeon, geologist, paleontologist, and political activist. He is most famous for his 1817 work, An Essay on the Shaking Palsy in which he was the first to describe "paralysis agitans", a condition that would later be renamed Parkinson's disease by...
in his original report of the disease in 1817. Estimated prevalence rates of depression vary widely according to the population sampled and methodology used although prevalence at a given time is most probably around 31%; which doubles the numbers in the general population. There is an increased risk for any individual with depression to go on to develop Parkinson's disease at a later date. It is increasingly thought to be a consequence of the disease rather than an emotional reaction to disability. Since Parkinson's affects many areas of the brain that control mood (specifically the frontal lobeFrontal lobeThe frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
as well as those areas that produce serotoninSerotoninSerotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
, norepinephrineNorepinephrineNorepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...
and dopamineDopamineDopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
), depression may result. Depression is one of the most common neuropsychiatric conditions found in patients who have Parkinson's disease, and it is associated with more rapid progression of physical symptoms and a greater decline in cognitive skills. Depression in patients with PD was found to be more predictive of overall disability than was the motor disability from the PD. An interesting finding is that although there is a high rate of depression in patients with PD, the incidence of suicide is lower in this group of patients. Many of the symptoms of PD may overlap with those of depression, making diagnosis a difficult issue.
- ApathyApathyApathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.They may lack a sense of purpose or meaning in...
- AnxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
: Seventy percent of individuals with Parkinson's disease diagnosed with pre-existing depression go on to develop anxiety. Ninety percent of Parkinson's disease patients with pre-existing anxiety subsequently develop depression; apathyApathyApathy is a state of indifference, or the suppression of emotions such as concern, excitement, motivation and passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.They may lack a sense of purpose or meaning in...
or abulia.
Obsessive–compulsive behaviors such as craving, binge eating
Binge eating
Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is sometimes as a symptom of binge eating disorder. During such binges, a person rapidly consumes an excessive amount of food...
, hypersexuality
Hypersexuality
Hypersexuality is extremely frequent or suddenly increased sexual urges or sexual activity. Hypersexuality is typically associated with lowered sexual inhibitions. Although hypersexuality can be caused by some medical conditions or medications, in most cases the cause is unknown...
, pathological gambling, or other, can also appear in PD, and have been related to a dopamine dysregulation syndrome
Dopamine dysregulation syndrome
Dopamine dysregulation syndrome , sometimes known as hedonistic homeostatic dysregulation in Parkinson's disease, is a dysfunction of the reward system in subjects with Parkinson's disease due to a long exposure to dopamine replacement therapy...
associated with the medications for the disease.
Psychotic
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
symptoms are common in PD, generally associated with dopamine therapy. Symptoms of psychosis, or impaired reality testing, are either hallucination
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s, typically visual, less commonly auditory, and rarely in other domains including tactile, gustatory or olafactory, or delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s, that is, irrational beliefs. Hallucinations are generally stereotyped and without emotional content. Initially patients usually have insight so that the hallucinations are benign in terms of their immediate impact but have poor prognostic implications, with increased risk of dementia, worsened psychotic symptoms and mortality. Delusions occur in about 5-10% of treated patients, and are considerably more disruptive, being paranoid in nature, of spousal infidelity or family abandonment. Psychosis is an independent risk factor for nursing home placement.
Hallucinations can occur in Parkinsonian syndromes for a variety of reasons. There is an overlap between Parkinson's disease and Lewy body dementia, so that where Lewy bodies are present in the visual cortex, hallucinations may result. Hallucinations can also be brought about by excessive dopaminergic stimulation. Most hallucinations are visual in nature, often formed as familiar people or animals, and are generally non-threatening in nature. Some patients find them comforting; however their carers often find this part of the disease most disturbing and the occurrence of hallucinations is a major risk factor for hospitalisation. Treatment options consist of modifying the dosage of dopaminergic drugs taken each day, adding an antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
drug like quetiapine
Quetiapine
Quetiapine , is an atypical antipsychotic approved for the treatment of schizophrenia, and bipolar disorder....
, or offering carers a psychosocial intervention to help them cope with the hallucinations.
Sleep
- Excessive daytime somnolenceSomnolenceSomnolence is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods . It has two distinct meanings, referring both to the usual state preceding falling asleep, and the chronic condition referring to being in that state independent of a circadian rhythm...
. - InsomniaInsomniaInsomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
, characterized mostly by sleep fragmentation. - Disturbances in REM sleep: disturbingly vivid dreams, and rapid eye movement behavior disorderRapid eye movement behavior disorderRapid eye movement sleep behaviour disorder is a sleep disorder that involves abnormal behaviour during the sleep phase with rapid eye movement . It was first described in 1986....
, characterized by acting out of dream content. It appears in a third of the patients and it is a risk factor for Parkinson's disease in the overall population.
Perception
- Impaired proprioceptionProprioceptionProprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
(the awareness of bodily position in three-dimensional space). - Reduction or loss of sense of smellOlfactionOlfaction is the sense of smell. This sense is mediated by specialized sensory cells of the nasal cavity of vertebrates, and, by analogy, sensory cells of the antennae of invertebrates...
(hyposmiaHyposmiaHyposmia is a reduced ability to smell and to detect odours. A related condition is anosmia, in which no odours can be detected. Some of the causes of olfaction problems are allergies, nasal polyps, viral infections and head trauma...
or anosmiaAnosmiaAnosmia is a lack of functioning olfaction, or in other words, an inability to perceive odors. Anosmia may be either temporary or permanent. A related term, hyposmia, refers to a decreased ability to smell, while hyperosmia refers to an increased ability to smell. Some people may be anosmic for one...
). It may be an early marker of the disease. - PainPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
: neuropathic, muscle, joints, and tendons, attributable to tension, dystonia, rigidity, joint stiffness, and injuries associated with attempts at accommodation. - Paresthesias.
Autonomic
- Orthostatic hypotensionOrthostatic hypotensionOrthostatic hypotension, also known as postural hypotension, orthostasis, and colloquially as head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when the person stands up or stretches. The decrease is typically greater than 20/10 mm Hg, and may be...
, leading to dizzinessDizzinessDizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....
and fainting - Oily skin
- Urinary incontinenceUrinary incontinenceUrinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
(typically in later disease progression) and nocturiaNocturiaNocturia , also called nycturia , is the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly...
(getting up in the night to pass urine) - Altered sexual function: characterized by profound impairment of sexual arousal, behavior, orgasm, and drive is found in mid and late Parkinson disease.
- Excessive sweating
Gastrointestinal
Parkinson' disease causes constipationConstipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
and gastric dysmotility that is severe enough to endanger comfort and even health. A factor in this is the appearance of Lewy bodies and Lewy neurites even before these affect the functioning of the substantia nigra in the neurons in the enteric nervous system
Enteric nervous system
The enteric nervous system is a subdivision of the autonomic nervous system that directly controls the gastrointestinal system in vertebrates.It is derived from neural crest.-Function:...
that control gut functions.
Neuro-ophthalmological
PD is related to different ophthalmologicalOphthalmology
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...
abnormalities produced by the neurological changes. Among them are:
- Decreased blinkBlinkBlinking is the rapid closing and opening of the eyelid. It is an essential function of the eye that helps spread tears across and remove irritants from the surface of the cornea and conjunctiva. Blink speed can be affected by elements such as fatigue, eye injury, medication, and disease...
rate - Irritation of the eye surface
- Alteration in the tear film
- Visual hallucinationHallucinationA hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s - Decreased eye convergenceConvergence insufficiencyConvergence insufficiency or Convergence Disorder is a sensory and neuromuscular anomaly of the binocular vision system, characterized by an inability of the eyes to turn towards each other, or sustain convergence.-Symptoms:...
- BlepharospasmBlepharospasmA blepharospasm , is any abnormal contraction or twitch of the eyelid....
- Abnormalities in ocular pursuit and saccadic movementsSaccadeA saccade is a fast movement of an eye, head or other part of an animal's body or device. It can also be a fast shift in frequency of an emitted signal or other quick change. Saccades are quick, simultaneous movements of both eyes in the same direction...
- Difficulties to open the eye-lids This can have particular relevance when driving. People with Parkinson's have been shown to be less accurate in spotting landmarks and roadsigns whilst driving.
- Limitations in the upward gaze
- Blurred visionBlurred vision-Causes:There are many causes of blurred vision:* Use of atropine or other anticholinergics* Presbyopia -- Difficulty focusing on objects that are close. The elderly are common victims....
- DiplopiaDiplopiaDiplopia, commonly known as double vision, is the simultaneous perception of two images of a single object that may be displaced horizontally, vertically, or diagonally in relation to each other...
(double vision), produced by a reduced eye convergence.