Tremor (pill-rolling): This resting tremor is described in Parkinson’s disease and gets its name because it looks like the person is rolling a pill between the fingers and thumb.
Bradykinesia: Bradykinesia means slow (“brady”) movements (“kinesia”). Many of the symptoms of Parkinson’s disease are associated with overall slowness or decreased movement, like shuffling gait and lack of automatic movements.
Rigidity: This term is used to describe difficulty in actively or passively moving the muscle. This symptom may be described as stiffness and fluctuates from day to day.
Impaired balance and coordination and increased falls: These are hallmarks of Parkinson’s disease. This is due to loss of postural reflexes and contributes greatly to falls.
Loss of automatic movement: Many of the movements that occur automatically are affected. This includes blinking, facial expressions, and loss of arm swing with walking.
Dysphagia: Persons with Parkinson’s disease experience difficulty swallowing and may have increased choking or coughing with eating or drinking. Coordinated, smooth movement of the muscles in the mouth and throat are needed to protect the airway when swallowing. If the airway is not protected and food or liquid goes into the airway, the cough reflex is triggered. Dysphagia can lead to difficulty controlling your own secretions and may lead to drooling. This can contribute to nutritional deficiencies, weight loss, and decreased socialization.
Hypographia: Persons with Parkinson’s disease may experience difficulty with handwriting when using a pen or pencil.
Hypophonia: Persons with Parkinson’s disease may experience decreased ability to speak or project their voices. This is due to involvement of the throat and vocal cords as well as incoordination of the muscles of breathing.
Constipation: Constipation is a problem with regular bowel elimination. The automatic or reflexive nature of normal bowel function is affected. This symptom can be quite severe and can lead to decreased quality-of-life issues. When persons also have swallowing problems or difficulty getting to the bathroom, they may limit fluid intake and worsen problems with constipation.
Bladder problems: Urinary frequency and urgency can occur with Parkinson’s disease. Although most persons are able to maintain continence, in later stages this may become more problematic. Sometimes bladder incontinence is not caused by bladder dysfunction but by urgency combined with decreased mobility.
Depression: Depression is common. The change in neurotransmitter in the brain with loss of dopaminergic input can lead to a chemical imbalance that can cause depression. Depression is treated with many of the commonly available anti-depressants.
Dementia: Dementia is a loss of cognitive functioning. Although dementia usually develops in later stages of Parkinson’s disease, it can occur early in a small percentage of patients. Over time, this symptom leads to loss of independence and need for 24-hour care. This symptom can also be aggravated or worsened by many different medications, including prescription and over-the-counter medications. (You need to review your list of medications with your doctor to check for possible causes.)
Sleep problems: A variety of sleep problems can occur in Parkinson’s disease. You may have insomnia which causes trouble falling asleep and/or staying asleep. Sleep disturbance can contribute to worsening physical and cognitive performance. A regular sleep routine is important.
Sexual dysfunction: Erectile dysfunction can occur and cause problems with both having and maintaining an erection and problems with ejaculation. Women may experience decreased lubrication and difficulty achieving orgasm.
Orthostatic hypotension: Orthostatic hypotension is when decreases in blood pressure are associated with changes in body position, usually when going from sitting to standing, but it can occur with lying down to sitting up. This can contribute to falls and fainting or passing out (syncope).
Loss of smell: The olfactory (smell) nerves can be affected and lead to loss of smell. If present, this may actually be one of the earliest symptoms.
Muscle pain/cramps: Muscle pain and cramps are common. The muscle will spontaneously tighten and there is incoordination between muscle relaxation and contraction (agonist and antagonist muscles).
Lack of facial expression (facial masking): The facial muscles are affected and lead to loss of facial expression. This has been termed “masked fascies” like the person is wearing a mask. This can lead to social problems when it is important to communicate the emotional content of a conversation or can give the impression that the person is not interested.
