Parkinsons disease

All About Parkinson's Disease

Parkinson Diseases Handbook By Lianna Marie

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CLINICAL FEATURES

Initial symptoms are vague, the patient often complains of aches and pains.

1. A coarse TREMOR at a rate of 4 per second usually develops early in the disease. It begins unilaterally in the upper limbs and eventually spreads to all four limbs. The tremor is often 'pill rolling', the thumb moving rhythmically backwards and forwards on the palm of the hand. It occurs at rest, improves with movement and disappears during sleep.

2. RIGIDITY is detected by examination. It predominates in the flexor muscles of the neck, trunk and limbs and results in the typical 'flexed posture'.

3. BRADYKINESIA: This slowness or paucity of movement affects facial muscles of expression (mask-like appearance) as well as muscles of mastication, speech, voluntary swallowing and muscles of the trunk and limbs. Dysarthria, dysphagia and a slow deliberate gait with little associated movement (e.g. arm swinging) result.

Tremor, rigidity and bradykinesia deteriorate simultaneously, affecting every aspect of the patient's life:

Handwriting reduces in size.

The gait becomes shuffling and festinant (small rapid steps to 'keep up with' the centre of gravity) and the posture more flexed.

Rising from a chair becomes laborious with progressive difficulty in initiating lower limb movement from a stationary position.

Eye movements may be affected with loss of ocular convergence and upward gaze. Excessive sweating and greasy skin (seborrhoea) can be troublesome. Depression, drug-induced confusional states and dementia occur in 30% of patients. Occasionally autonomic features occur - postural hypotension.

Postencephalitic Parkinson's disease (encephalitis lethargica), now rarely encountered, is characterised by an earlier age of onset and oculogyric crises (acute ocular deviation).

Mask-like, expressionless face, often with drooling

'Pill rolling' tremor of hands

Stiff, shuffling gait

Mask-like, expressionless face, often with drooling

'Pill rolling' tremor of hands

Stiff, shuffling gait

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