Parkinson’s disease – symptoms
Parkinson’s disease is a chronic and progressive disease. Idiopathic Parkinsonism appears without evidence of widening the brain damage. Parkinsonism is a syndrome that consists of a variable combination of tremor, rigidity, bradykinesia, and disturbance in gait and postural characteristics.
In general, Parkinson’s disease occurs in middle age or later, causing over time progressive disability. The disease occurs in all ethnic groups and has equal distribution in both sexes. It is common, with prevalence in the general population of 1.2 per 1000 and reported in people over 65 years, with a prevalence of 1%.
Signs of Parkinsonism are extremely common in the elderly. A recent surveillance indicated that 15% of individuals that are 65-74 years old and more than half of those over 85 years old, at the examination show the anomalies consisting of the present extrapyramidal signs.
Tremor with a frequency of 4-6 Hz is typically at rest and worsens in emotional stress. Often begins with a rhythmic flexion-extension of the fingers, hand or foot or a rhythmic movement of the forearm pronation-supination. Initially, it may be limited to one member or two members on the same side, before becoming generalized. It can involve the mouth and chin. In 10-15% of patients, tremor is still faster (7-8 Hz) and postural tremor similar to essential from both clinically and in terms of response to pharmacotherapy.
Stiffness, defined as an increased resistance to passive movement is a common clinical feature that contributes to flexion the posture of many patients. A disabling feature is bradykinesia (or, in the most severe form, akinesis), slowing down the voluntary movements and associates reduction in automatic movements such as rocking arms while walking.
There is immobility of facial expression with increased palpebral fissure and blinking slowly. May be present blefaroclonus (the vibration of the closed eyelids), blepharospasm (closing involuntary of the eyelids) and leakage of saliva from the mouth.
The voice is weak and modulated. Strength is preserved, but fine movements are affected, rapidly alternating. The combination of tremor, rigidity and bradykinesia result in small print, trembling and often unintelligible. Patients have difficulty getting up from a bed and from a chair and tend to keep a flexed posture when lifting. Often it is difficult to start walking, and patients can lean increasingly longer to be able to advance.
They are taking small steps. No rocking arms. Are uncertain (especially when changing direction) and may have difficulty stopping. Some patients go with a rushed step, for example, increasing speed to prevent the fall, however, because of the center of gravity being abnormal.
Tendon reflexes are normal, and the response is plantar flexion. Repetitive percussion (about 2 Hz) of glabella produces a response of repetitive blinking (Myerson sign), in contrast to normal answer of the subjects. Depression is a common state and the impaired cognitive function – sometimes reaching dementia – is often evident in advanced cases.