The three main motor symptoms of Parkinson’s are: Bradykinesia A slowing of movement that affects everyone with Parkinson’s. It can make coordinated movement of your arms and hands difficult and lead to trouble with walking and standing. Rigidity Many people with Parkinson’s experience stiffness in the arms, legs, or torso. Other Parkinson’s motor symptoms include: Postural instability Loss of balance is often a problem in the later stages of Parkinson’s. Loss of automatic movements Actions that may no longer happen include spontaneous smiling and swinging your arms when you walk. A decreased rate of blinking the eyes can also occur, sometimes leading to dry eyes. Freezing This describes difficulty taking a step, usually the first step. You may feel like your feet are glued to the floor. Micrographia Some people with Parkinson’s find that the size of their handwriting gets smaller over time. Mask-like expression (hypomimia) A decrease in the range of facial expressions is common in people with Parkinson’s. Unwanted accelerations You may experience suddenly rapid speech, or an uncontrolled acceleration in your walking, known as festination. Parkinsonian gait This is a common way of walking stooped over, with a combination of freezing and festination. Difficulty speaking These problems may include an unusually soft voice or slurring of your words. Difficulty swallowing This can lead to drooling and an increased risk of choking. Drooling may also result from a reduction in automatic movements, including swallowing of saliva. Common nonmotor symptoms include: Cognitive problems and dementia Problems with thinking, memory, multitasking, and judging distances are estimated to occur in 40 percent or more of people with Parkinson’s. Hallucinations often become more frequent and severe as the disease progresses. Some people with Parkinson’s also have delusions, including false beliefs that they’re in danger, being stolen from, or being cheated on by a spouse. Mood disorders Some people with Parkinson’s become depressed, anxious, or apathetic — lacking the motivation to walk, talk, or express emotion. These problems may be caused or worsened by difficulty turning over in bed, muscle cramps or pain, a frequent need to urinate, or vivid dreams and nightmares. Up to half of people with Parkinson’s disease may have REM sleep behavior disorder (RBD), in which a person physically acts out their dreams in their sleep. Dreams associated with RBD are often frightening, and the person may react by kicking, punching, or shouting. This can be dangerous for both the person experiencing the dream and their bed partner. Daytime sleepiness Excessive daytime sleepiness affects up to 75 percent of people with Parkinson’s. It may be worsened by medication for the disease. Some people with Parkinson’s may fall asleep suddenly, which can be very dangerous if they drive a car. Talk to your doctor about adjusting your medication if you experience this symptom. Autonomic dysfunction The autonomic nervous system controls automatic functions of the body, including heart rate, blood pressure, breathing, digestion, sweating, urination, and sexual arousal. Any of these body functions can become abnormal in Parkinson’s disease, leading to issues like low blood pressure upon standing up (causing dizziness), constipation, urinary difficulties, abnormal sweating, and a decreased interest in sex. If any of these symptoms began on one side of your body, or if you experience a tremor when your arm is at rest, Parkinson’s may be strongly suspected. Most likely, your doctor will also ask you about any other symptoms you may have, even if they seem unrelated.
Elimination of Other Conditions
Although no test can diagnose Parkinson’s disease itself, your doctor may order blood tests or imaging studies to rule out other possible causes of your symptoms. Your doctor will want to know about any medications or recreational drugs you take, since some drugs can cause symptoms similar to those of Parkinson’s. Parkinson’s disease doesn’t show up on radiological studies like X-ray, MRI (magnetic resonance imaging), or CT (computed tomography) scans.
Levodopa Challenge
A combination of the drugs levodopa and carbidopa — often referred to just as levodopa — is the most common and effective treatment of motor symptoms related to Parkinson’s disease. It works by increasing the amount of dopamine in the brain. Sometimes doctors will administer a levodopa challenge, in which the drug is administered for a trial period, to assist in the diagnosis of Parkinson’s disease. If your symptoms improve when you take levodopa, a diagnosis of Parkinson’s is likely. This technique is usually not useful for people with mild symptoms that don’t interfere with daily activities. People who respond less well to drug treatment also tend to develop additional Parkinson’s symptoms, often including various nonmotor symptoms. As symptoms advance, people with Parkinson’s increasingly need assistance carrying out activities of daily living.
