Parkinson's Disease

Parkinson’s Disease

This most common form of movement disorder affects 1 in 100 people. Medical science will ensure that you are not handicapped or disabled by it, read more…..

Symptoms of Parkinson's Disease

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-symptoms of Parkinson's disease

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

Postural Instability -symptoms-of-parkinson-disease

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.

3. Micrographia or Small Hand Writing

Parkinson’s patients often experience a sudden change in their handwriting and the medical term is known as “Micrographia”. A person with PD may begin with regular handwriting but, gradually they end up writing in smaller font, and letters may look cramped. Note how the handwriting becomes progressively smaller even in signing. The first letter ‘R’ is big and the last letter ‘A’ is barely legible. Also the same becomes normal in ON phase of medication


4. Rigidity

Rigidity-symtoms of parkinson's disease

Rigidity or stiffness is one of the primary motor symptoms of Parkinson’s disease. The Parkinson’s patients usually experience uncomfortable or painful motions while performing their day to day activities like they may feel their feet seem to be stuck on the floor, difficulty in moving from their bed, or arising from the chair which can result in painful muscle cramps.

5. Bradykinesia

bradykinesia-symptom-of-parkinson's disease

The slowness of movement is one of the main symptoms of Parkinson’s.  The general effect of bradykinesia is that it takes more time and effort to complete daily tasks, which can result in fatigue.

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.

3. Gait disturbances- Non-motor Symptoms of Parkinson’s Disease

Shuffling Gait

Shuffling gait appears as if the person is dragging their feet as they walk. Steps may also be shorter in stride (length of the step) in a shuffling gait.

Freezing of Gait

Freezing of gait is characterized by a hesitation before stepping forward, or difficulties when initiating walking. Some people with PD report it feels like their feet are glued to the floor.

Festination Gait

A quickening and shortening of normal strides characterize festinating gait. While the steps are quicker, the stride is shorter, causing this to be a very inefficient gait, which can be frustrating and tiring for the person experiencing it

4. Masked Face

Parkinson’s often affects the natural facial expressions of the PD patients, such as a serious look or depressed facial look even though the discussion is normal. Their face seems expressionless and they blink less often.

5. Stooping or Hunching Over

Stooping or Hunching over, not standing up as straight. The patient seems to be stooping, leaning, or slouching when standing.

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:


Difficulty swallowing, called dysphagia, can happen at any stage of Parkinson’s disease. Signs and symptoms can range from mild to severe and may include, difficulty swallowing certain foods or liquids, coughing or throat clearing during or after eating/drinking, and feeling as if food is getting stuck.

As the disease progresses, swallowing can become severely compromised and food/liquid can get into the lungs, causing aspiration pneumonia.

Cognitive impairment 

The term “Cognitive impairment” is characterized by predominant executive function deficits, difficulty in finding words and learning, recalling information, and slow thinking. Many people with PD face difficulty in focusing on a task or managing household chores.

Mood Disorder

Parkinson’s patient often develops the non-motor symptoms, including depression, anxiety, anger, and the apathy which impacts on their quality of life. Depression is one of the most common symptoms which can be effectively controlled by medication and hallucination occurs due to side effect of long-term dopamine treatment.

Urinary problems 

Urinary symptoms are frequently present in patients affected by Parkinson’s disease (PD). Symptoms such as urgency, frequency, nocturia, and urge incontinence significantly impact the patient’s quality of life.


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).