A symptom is something the patient feels and describes, while a sign is something other people, such as the physician notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.
Parkinson’s disease causes problems with movement, cognitive problems, neurobehavioral problems, as well as sensory and sleep difficulties. The signs and symptoms usually begin gradually, slowly and often randomly (in no set order).
Each sufferer will be affected differently, with a unique set of symptoms. Patients also tend to respond differently to treatment. Symptom severity also varies enormously. Some patients may experience tremor (shaking) as their primary symptom, while others may not have tremors, but have balance problems. While the disease may develop slowly for some individuals, for others it progresses rapidly.
The four main signs and symptoms include slow physical movements (bradykinesia), shaking (tremor), muscle stiffness (rigidity) and postural instability (impaired balance and coordination). They are called the primary motor symptoms:Primary motor symptoms:
Bradykinesia (slowness of movement, slowed motion) - initiating movement, such as beginning to get up from a chair can become more difficult. The patient typically takes longer to carry out tasks. There is also a lack of coordination. The difficulty is not only with the execution of movement, but also with its planning and initiation.
Bradykinesia is often tolerated by elderly patients, who think they are entering normal milestones of aging - such patients may eventually be diagnosed with PD later on, when other signs and symptoms develop.
Resting tremor (shaking) - the characteristic shaking frequently starts in one hand, such as a back-and-forth rubbing of the thumb or forefinger (pill-rolling). Tremor may start in a foot or one side of the body, and less commonly in the jaw or face. Tremor is usually more likely to occur when that part of the body is resting - stress and/or anxiety may make the tremor more noticeable. However, substantial tremor is not always present in many patients.
Other conditions may include tremor as one of their symptoms, such as multiple sclerosis, encephalitis (inflammation of the brain), or alcoholism. The presence of tremor does not necessarily mean the individual has Parkinson’s disease.
According to the Parkinson’s Disease Foundation, USA, approximately 70% of people with Parkinson’s experience a slight tremor in the early stages.
Rigidity (muscle stiffness) - the muscles feel stiff. Doing some everyday tasks may be troublesome, such as getting out of a chair, rolling over in bed, using body language appropriately, or making fine finger movements.
Most commonly, stiffness occurs in the limbs and neck. It can be so severe that the range of movements is severely undermined. Sometimes there is pain.
- Posture and balance - there may be instability when standing, or impaired balance and coordination. These symptoms, combined with bradykinesia significantly increase the risk of falling.
- A tendency to stoop, to lean forward
- Handwriting may be very small and cramped (micrographia)
- Impaired fine motor dexterity (fine finger movements)
- Impaired motor coordination
- Involuntary movements and prolonged muscle contractions (dystonia)
- Loss of facial expression - some individuals may appear uninterested (not animated) when speaking, while others stare fixedly with unblinking eyes.
- Sexual dysfunction
- Speech problems - the sufferer may have a softer voice, utterances may come out more rapidly or slowly, or in a monotone. There may be repeated words or slurring.
- Swallowing difficulties (dysphagia)
- The arms may not swing when walking
- Dementia - this may develop in the later stages of the disease. The patient may have memory and mental clarity problems. A person with Parkinson’s is six times more likely to develop dementia, compared to other people.
- Sleep problems - which may be worsened by medications for Parkinson’s disease. However, sleep problems are a core feature of the disease. The patient may be excessively sleepy during the day; there may be disturbances in REM (rapid eye movement) sleep, as well as insomnia.
- Dysphagia (difficulty swallowing)
- Fatigue, tiredness, loss of energy
- Paresthesia - a sensation of tingling, pricking, or numbness of a person's skin (pins and needles)
- Reduced sensation of pain
- Reduced sense of smell
- Urinary incontinence (bladder weakness)
- Urinary retention (difficulty getting rid of urine)