Parkinson’s disease (PD) even to date essentially remains a clinical diagnosis and there are no definitive laboratory tests or brain scans to confirm the diagnosis. Most of these tests are diagnosed to eliminate other diseases that mimic PD.

Parkinson’s is a progressive disease and below are the cardinal motor symptoms

1. Resting Tremors

Resting tremors are the most common form of tremors associated with Parkinson’s disease. They occur when the muscles are relaxed and still, such as when the patient is lying in a bed or when their hands are resting on their lap. It is one of the noticeable prime symptoms of Parkinson’s disease.

Resting tremors can also be ‘pill-rolling’ tremors, due to the actions of the tremor resembling the motion of rolling a small pill between the thumb and index finger.

2. Postural Instability

A balancing issue is one of the primary motor symptoms of Parkinson’s disease (PD) that usually emerges in the late stages of the disease. Postural instability appears as tendency to be unstable when standing, as PD affects the reflexes that are necessary for maintaining an upright position.

Parkinson’s disease can also cause non-motor symptoms which include

1. Loss of Sense of Smell

Also known as “Hyposmia”, people with PD experience a reduced sense of smell. If you seem to have trouble smelling foods like fruits, pickles, etc., then it’s often an early sign of Parkinson’s.

2. Sleeping Disorder 

The PD patients experience trouble falling asleep and nightmares regularly. They might also face difficulties such as talking or yelling out while asleep, vivid dreaming, leg movements, jerking, cramping, difficulty turning over in bed, waking up to go to the bathroom, and excessive daytime sleepiness.

6. Speech Problems

People with Parkinson’s Disease might slur words, mumble, or trail off at the end of a sentence. Most people talk softly, monotonously, and even stutter or stammer. This condition is also known as Hypophonia.

Different phases of Parkinson’s Disease

1. ON Period:

In an “on” period when the patient takes doses of medicines like levodopa on a regular schedule, he/she may feel energetic and will be able to do regular activities easily. Patients take maximum advantage of the “on” period to complete their activities.

2. OFF Period

“Off” periods are times when Parkinson’s disease (PD) medication, namely levodopa, is not working optimally. As a result, symptoms return. These can include both motor symptoms, such as tremor and rigidity, and non-motor symptoms, such as anxiety.

In Off period the most common complaint severe body pain, painful spasm, neck and shoulders pain due to sever stiffness of the muscles.

3. Dyskinesia

This usually occurs due to the side effect of long-term levodopa treatment. The symptoms vary from person to person.

Dyskinesia is an involuntary movement which can affect an arm or leg, or the entire body. They are often fluid and dance-like, but they may also cause rapid jerking or slow and extended muscle spasms. Dyskinesia can also cause severe weight loss.

4. Motor Fluctuations 

The “on-off” phenomenon in Parkinson’s disease (PD) refers to a switch between mobility and immobility in levodopa-treated patients, which occurs as an end-of-dose or “wearing-off” worsening of motor function or, much less commonly, as sudden and unpredictable motor fluctuations.

Types of motor fluctuations include the following:

1. “Wearing off,” characterized by the re-emergence of parkinsonian symptoms as the effect of levodopa diminishes near the end of the dosing interval, usually three to four hours after a dose. “Wearing off” is often the first and most encountered fluctuation in patients with PD.
2. Unpredictable “off” periods, with no obvious relationship between the time of levodopa administration and the appearance of “off” episodes.
3. Freezing of gait (FOG), in which forward progression halts or is markedly reduced despite the intention to walk. This is one of the most debilitating motor symptoms in patients with PD and can lead to falls and loss of independence.
4. Failure of the “on” response, with lack of an “on” response or no response following a dose of levodopa.

Advanced Parkinson’s disease

The term “Advanced Parkinson’s Disease” refers to when the symptoms are complex and are adversely affecting the day-to-day life of PD patients.

Symptoms of Advanced Parkinson’s include:

Constipation 

In some people with Parkinson’s disease, constipation may occur due to the improper functioning of the autonomic nervous system. The autonomic nervous system is responsible for regulating smooth muscle activity.

If this system is not working properly, the intestinal tract may operate slowly, causing constipation.

Sexual dysfunction 

Erectile dysfunction is a common non-motor disorder in Parkinson’s disease (PD). In contrast to motor disorder, sexual dysfunction is often not responsive to levodopa treatment.

Orthostatic Hypotension 

Orthostatic hypotension is a severe drop in blood pressure that happens when the person stands up from sitting or lying down. Orthostatic hypotension may cause dizziness or a loss of consciousness, causing the person to faint or pass out. It can occur within three minutes of standing up.

Orthostatic hypotension can be dangerous, as it can put the person at serious risk of falls and injury.

Orthostatic hypotension is common in elderly people, and it occurs frequently in people with Parkinson’s disease (PD).