Disease Symptoms

Parkinson's disease is a motor system disorder, which is the result of the destruction of dopamine-producing neurons. The four major symptoms of Parkinson disease consist in tremor, ( trembling in arms, hands, legs, jaw) stiffness of the arms, legs and trunk (rigidity); bradykinesia, (the slowness of movement); and postural instability (impaired balance and lack of coordination). As the disease progresses and the symptoms become more obvious, patients will have trouble walking, talking, or completing simple tasks. Parkinson disease usually occurs people over 50 but there have been reported cases of early onset Parkinson disease.
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Early symptoms of Parkinson disease are subtle and develop gradually, going unnoticed even for years and the speed with whic the disease progresses varies from one patient to another.  As the disease progresses, the tremor, which affects Most of the Parkinson Disease patients,  may begin to interfere with their daily routine.  The tremor is characteristic: a rest tremor ( with a maximal intensity when the limb is resting and it disappears with voluntary movement and sleep); which it consists in a pronation - supination movement that is described as "pill-rolling" or "coin counting". Tremor affects in a greater extent the distal part of the limb and at the onset of the disease is usually unilateral.

Rigidity, determined by the muscular hypertonia (increased muscle tone) and articular stiffness, combined with the tremos produces a the typycal "cogwheel rigidity" a ratchety type of rigidity which occurs when the limb is passively moved. Joint pain may occur, frequently representing the first sign of the disease.

Bradykinesia (the slowness of movement) and akinesia (the absence of movement) will also occur as the disease aggravates. Bradykinesia is the most specific clinical aspect of Parkinson disease and it impairs not only the execution of a voluntary movement but also it affects the planning and the initiation of movement The performance simultaneous or sequential movements is also affected.The amplitude of the movements decreases too. Motor blocks, or gait freezing are a specific manifestation of akinesia . It represents a sudden episode of inability to move the feet and legs lasting  less than 10 seconds. Its intensity and duration may increase cluttered spaces usually when the patient approaches a destination.

The speech and the swallowing are also impaired, Parkinson Disease leading to : soft speech (hypophonia), monotonic speech (hoarse, soft speech), Drooling (determined by a weak swallow)most likely caused by a weak, infrequent swallow. The difficulties to swallow (dysphagia); which occurs in Parkinson Disease is probably determined either by an inability in initiating the swallowing reflex or by an impaired laryngeal or oesophageal movement (prolonged swallowing movements).

The neuropsychiatric features are either determined by the disease (dementia, loss of short term memory, difficulties in: differential allocation of attention,  set shifting, prioritizing and impulse control) or are a consequence of the impact hat the disease has on the patient's life and the life of his/her family (depression).