Parkinson’s is a condition which produces three major symptoms:
- Rigidity (stiffness of the muscles)
- Akinesia (abnormal movement)
In addition, because of postural instability, poor balance can be a feature. These symptoms are also associated with disturbance of gait (the manner of walking), particularly as Parkinson’s progresses.
The symptoms may occur alone or in combination. They usually start on one side of the body and after a period of several years will then involve the other side of the body.
The tremor that occurs in Parkinson’s characteristically happens when that part of the body is relaxed. It is therefore called a resting tremor. A percentage of people also suffer from an action tremor, that is, the tremor occurs when the person attempts to do something.
The tremor seen in Parkinson’s is usually worse when the patient is at rest. It improves during voluntary movement and disappears during deep sleep. The tremor may be made worse by anxiety or stress, particularly when in a public place.
Where a person diagnosed with Parkinson’s only has tremor, it is very important to ensure the diagnosis is correct. There are other conditions that produce tremor, particularly familial or essential tremor. These can look very similar to Parkinson’s but may require different treatment.
The stiffness or rigidity of the muscles is a less visible symptom than the tremor. However, it is often more bothersome to the patient. The stiffness may also be accompanied in some degree in the limb affected by an aching type of pain, which is not relieved by analgesics such as aspirin, but which improves when the person is placed on medication for their Parkinson’s.
Akinesia (Abnormal movement)
Probably the most disabling symptom of Parkinson’s is a general lack or slowness of voluntary movements. This is called akinesia and is often seen in association with the rigidity or stiffness of the muscles. Akinesia refers specifically to lack of movement, such as loss of arm swing, but is also used to mean slowing (bradykinesia) or reduction (hypokinesia) in the size of movements. Akinesia affects mainly the hands or the trunk and walking.
Gait disturbance usually does not present a major problem in the early stages of Parkinson’s once treated, but as the years go by the person with Parkinson’s, even with treatment, may begin to walk with short shuffling steps, described as a festinating gait. Sometimes people will say that their feet tend to get stuck or frozen to the ground so that they have trouble taking the first step when starting to walk; or when walking, they will suddenly come to an involuntary halt. They have similar problems when trying to turn around.
Another problem related to the slowness of movement is turning over and getting in and out of bed. Balance can become affected and fear of falling may severely restrict activity, but again this is usually after Parkinson’s has been present for many years.
This may be experienced as poor balance or not being steady on standing, particularly when moving from lying to standing or sitting or when moving from sitting to standing. Other difficulties sometimes experienced
Speech changes include a faster or slower rate, a decrease in clarity and articulation of sounds and words or a change to the fluency so that it sounds like a stutter.
Voice changes include a decreased volume, a change to the quality of the voice so that it may sound husky or a change to the pitch of the voice so it sounds monotonous.
Swallowing changes include difficulty in chewing, increased time in mastication, food sticking in the throat, and coughing or choking on foods or fluids. If severe enough, swallowing changes can result in chest infections.
These changes can affect overall communication skills and, consequently, interactions and relationships with other people.
Memory and Concentration
A common question asked by people with Parkinson’s and relatives is that of dementia. Certainly, recent studies have shown that there is some deterioration in intellectual function with Parkinson’s. However, people with Parkinson’s should be reassured that if this develops it is usually a late manifestation of the condition and in some cases can be improved with medication.
If problems do develop with memory, concentration and dementia in the early stages of Parkinson’s, then one has to be suspicious regarding the correct diagnosis. An increasingly recognised condition called Dementia with Lewy bodies is closely related to Parkinson’s , and causes problems with cognitive functions, such as memory and confusion, at the same time as or even preceding the motor (movement) symptoms.
Depression is very common in people with Parkinson’s. It is related to many factors, and not simply to difficulties with movement. It is very important that depression is treated in its own right as it usually does not respond to treatment aimed at reversing the motor problems of Parkinson’s.
About 40% of people living with Parkinson’s experience anxiety with or without panic attacks. If you are living with Parkinson’s you may experience dizziness, shortness of breath and sweating as part of a panic attack. Some medications may assist along with counselling and relaxation techniques.
Poor sleep is commonly associated with Parkinson’s. Medications are available. Please discuss the problems with your doctor.
Bowel and Bladder
Constipation can be a problem particularly in the latter stages of the condition. As well there may be disturbance of bladder function. This is often the case at night. There may be other causes for disturbed bladder function, particularly in elderly men, e.g. prostate problems. This requires investigation and it should not be just attributed to Parkinson’s unless all other causes for bladder instability have been excluded.
People with Parkinson’s can develop restless leg syndrome, in which the legs feel a discomfort that is relieved by moving them, particularly at night. Sitting still for any length of time, particularly in the evening, can be very difficult. A sense of restlessness often makes a person want to get up and walk about to try to relieve the discomfort. This symptom can sometimes be helped by appropriate medication.
Tiredness or lethargy is a common symptom of Parkinson’s. However, it is important to encourage walking or some exercises (see Therapeutic Exercises section).
No two people will experience Parkinson’s in the same way. While we have outlined the main or most common symptoms associated with Parkinson’s, there may be other symptoms that are experienced and there may be medical or other treatment available for these.
Remember that Parkinson’s does NOT result from something you have done (or not done) in the past. It is NOT caused by overwork or over-indulgence, and it is very unusual for Parkinson’s to be related to injury of any sort. Symptoms are NOT imaginary and difficulties can only be overcome by appropriate treatment and perseverance.
Who Is Affected
It is estimated that there are about 100,000 people living with Parkinson’s in Australia . It affects both men and women. Men develop Parkinson’s a little more commonly than women although the reason for this is not yet known.
One in seven people living with Parkinson’s is under the age of 40, but the average age of diagnosis is around 65 years. The prevalence of Parkinson’s worldwide varies from between 1 in 1000 to 2 in 1000 with the figure increasing to 1 in 100 over the age of 60.
There are several neurological conditions which are described as ‘atypical Parkinsonism’ which may be grouped under the term Atypical Parkinsonism.
Learn about Atypical Parkinsonism