There are many manifestations of Parkinson's disease. The classical diagnostic symptoms are (1):
- slowness and poverty of movement
- stiffness
- shaking
The physical signs of Parkinson's disease include (1):
- slowness of movement (bradykinesia)
- loss of facial expression and arm swing (1)
- difficulties with fine movements e.g. - buttoning, use of utensils (2)
- poverty of movement (hypokinesia)
- rigidity
- classic "lead pipe" or "cog wheel" rigidity (3)
- there may be associated pain e.g. - painful shoulder is one the commonest initial symptom seen in PD (2)
- rest tremor
- is the most common and easily identifiable symptom of the disease
- described as typical "pill-rolling" involving the thumb and the index finger (3)
- may involve the lips, chin, jaw and legs (2)
- fatigue or emotional stress may aggravate the tremor (3)
The many manifestations of Parkinson's disease are:
- shuffling gait
- expressionless, unblinking face
- slurred monotonous speech
- small handwriting
- increased salivation and dribbling
- loss of facial expression and arm swing
- difficulty with fine movements
The signs are usually unilateral at diagnosis and may become bilateral as the disease progresses.
Later in the disease additional signs may be present.These include:
- postural instability
- cognitive impairment
- a degree of cognitive impairment is present in up to 70% of patients
- dementia occurs in 40% of patients with Parkinson's disease
- orthostatic hypotension
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