In the early stages of the disease, signs and symptoms are pretty less evident. However, as the disease progresses to more advance stages the following symptoms are prominent [7]:

• Tremors characterized by shaking hands, fingers and legs.
• Bradykinesia characterized by slowed movement making everyday simple tasks,difficult to achieve.
• Muscle stiffness sets in as the disease advances.
• Posture and balance of the individual get disrupted.
• Individuals may experience difficulty in writing due to loss of motor movements.
• Changes in the speech may occur.
• Automatic movements such as blinking, swinging arms while walking and making gestures while talking are all lost.

• Falling

  However, use of vibrotactile feedback did not significantly alter dynamics of postural control in older adults with high risk of falling or reduce the magnitude of sway. [ncbi.nlm.nih.gov]

  You’re also prone to broken bones and concussions, and severe falls can be dangerous. A serious fall can reduce your life expectancy due to complications from the fall. Age is another factor in the diagnosis and outlook for Parkinson’s disease. [healthline.com]

  Falls are a frequent problem for people with Parkinson’s disease. Tips for preventing falls are listed. Falls are a frequent complication of Parkinson's disease (PD). [my.clevelandclinic.org]

• Fatigue

  […] basis of experienced fatigue. [ncbi.nlm.nih.gov]

  These co-morbidities include constipation, depression, fatigue, and insomnia. [foodforthebrain.org]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

• Difficulty Walking

  Tremors, rigidity, slow movement (bradykinesia), poor balance, and difficulty walking (called parkinsonian gait) are characteristic primary symptoms of Parkinson's disease. [healthcommunities.com]

  As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 60. Early symptoms of PD are subtle and occur gradually. [web.archive.org]

  An “off” episode is a time when a patient’s medications are not working well, causing an increase in Parkinson’s symptoms, such as tremor and difficulty walking. [fda.gov]

• Hypersomnia

  Nadège Limousin, Eric Konofal, Elias Karroum, Ebba Lohmann, Ioannis Theodorou, Alexandra Dürr and Isabelle Arnulf, Restless legs syndrome, rapid eye movement sleep behavior disorder, and hypersomnia in patients with two parkin mutations, Movement Disorders [doi.org]

• Hyperthermia

  Methamphetamine-induced hyperthermia and dopaminergic neurotoxicity in mice: Pharmacological profile of protective and nonprotective agents. [ncbi.nlm.nih.gov]

• Hyposmia

  In our previous studies, we observed that several pre-Parkinson symptoms (eg, constipation, weight loss, and erectile dysfunction) preceded the onset of motor symptoms. 2 - 4 Hyposmia and REM sleep behavior disorder have been also consistently found to [dx.doi.org]

  Hyposmia and visual hallucinations are helpful pointers in distinguishing Parkinson's disease from atypical Parkinsonism and should be specifically enquired about in the history. [ncbi.nlm.nih.gov]

• Hypophonia

  Supporting parkinsonian features include stooped posture, masked facies, micrographia (small handwriting), drooling, speech changes (eg, hypophonia or soft speech, stuttering, slurring, monotonic speech), and a shuffling, festinating gait (quick short [dx.doi.org]

  […] all of them) include: abnormal walking decreased arm swing excessive salivation feelings of depression or anxiety increase in dandruff or oily skin lack of facial expression ( hypomimia ) less frequent blinking and swallowing lowered voice volume ( hypophonia [medbroadcast.com]

  Lack of facial expression Slowed activities of daily living (for example, eating, dressing, and bathing) Difficulty turning in bed Remaining in a certain position for a long period of time Nonmotor symptoms Diminished sense of smell Low voice volume (hypophonia [columbianeurology.org]

  […] micrographia) Lack of facial expression Slowed activities of daily living (for example, eating, dressing, and bathing) Trouble turning in bed Staying in a certain position for a long period of time Non-motor symptoms Diminished sense of smell Low voice volume (hypophonia [cedars-sinai.org]

  Mechanism of action of voice therapy in Parkinson's hypophonia-a PET study. Poster presented at: the 11th Annual Meeting of the Organization for Human Brain Mapping 2005 Toronto, Ontario, Canada; 51 Farley B G, Koshland G F. [doi.org]

• Constipation

  This paper highlights the importance of early recognition and treatment of constipation to prevent volvulus developing and thevarious treatments currently available. [ncbi.nlm.nih.gov]

  Constipation and Digestive Issues As Parkinson’s disease progresses, your digestive tract will slow down and function less efficiently. This lack of movement may lead to increased bowel irritability and constipation. [healthline.com]

  These co-morbidities include constipation, depression, fatigue, and insomnia. [foodforthebrain.org]

• Nausea

  Nausea (adverse effect, post‐intervention) 150 per 1000 21 per 1000 (1 to 390) RR 0.14 (0.01 to 2.60) 40 (1 study) ⊕⊕⊕⊝ moderate a Memantine does not increase risk for nausea. Not statistically significant. [doi.org]

  Side effects may include heartburn, nausea, dry mouth and dizziness. Confusion, nightmares, hallucinations and headache occur less often and should be reported to the doctor. [aans.org]

  If nausea becomes a problem, your GP may prescribe anti-sickness medication. A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep. [nhsinform.scot]

  Nausea can be prevented by starting trimethobenzamide 300 mg orally 3 times a day 3 days before starting apomorphine and continuing trimethobenzamide for the first 2 months of treatment. [merckmanuals.com]

• Muscle Rigidity

  Parkinson’s disease symptoms include muscle rigidity, tremors, and changes in speech and gait. After diagnosis, treatments can help relieve symptoms, but there is no cure. [webmd.com]

  These medications are most useful in the treatment of tremor and muscle rigidity, as well as in reducing medication-induced parkinsonism. [aans.org]

  A progressive disorder of the nervous system marked by muscle tremors, muscle rigidity, decreased mobility, stooped posture, slow voluntary movements, and a mask-like facial expression. [icd9data.com]

  Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed. [ncbi.nlm.nih.gov]

• Sialorrhea

  Since there is insufficient evidence of glycopyrrolate for the treatment of sialorrhea exceeding 1 week, the practice implication is that it is possibly useful. [ncbi.nlm.nih.gov]

  […] and impulse control disorders and related behaviors); and discuss the management of selected nonmotor symptoms of Parkinson disease, including rapid eye movement sleep behavior disorder, cognitive impairment, depression, orthostatic hypotension, and sialorrhea [doi.org]

  Rascol, Oro‐buccal symptoms (dysphagia, dysarthria, and sialorrhea) in patients with Parkinson’s disease: preliminary analysis from the French COPARK cohort, European Journal of Neurology, 19, 1, (28-37), (2011). Nico J. Weerkamp, Sytse U. [dx.doi.org]

• Increased Sweating

  Having one or more close relatives with PD increases one's risk of developing the disease; however, unless there is a known genetic mutation for PD present, the increased risk is only 2 to 5 percent. [columbianeurology.org]

  sweating Urinary frequency or urgency Male erectile dysfunction As the disease gets worse, walking may become affected. [cedars-sinai.org]

  The stage increase in number value for all stage naming systems reflect the increasing severity of the disease. [medicinenet.com]

• Blepharospasm

  Practice Guideline Update Summary: Botulinum Neurotoxin for the Treatment of Blepharospasm, Cervical Dystonia, Adult Spasticity, and Headache April 2016 Current guideline. [aan.com]

  […] control 0000020 Visual hallucinations 0002367 5%-29% of people have these symptoms Abnormality of the foot Abnormal feet morphology Abnormality of the feet Foot deformities Foot deformity [ more ] 0001760 Apathy Lack of feeling, emotion, interest 0000741 Blepharospasm [rarediseases.info.nih.gov]

• Muscle Spasticity

  Secondary effects are likely to impact on assessment of spastic muscles. [en.wikipedia.org]

• Face Rigidity

  Symptoms usually show up in one or more of four ways: tremor, or trembling in hands, arms, legs, jaw, and face rigidity, or stiffness of limbs and trunk bradykinesia, or slowness of movement postural instability or impaired balance and coordination. [parkinsons.org]

  The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. [web.archive.org]

  It causes trembling in the hands, arms, legs, jaw, and face; rigidity or stiffness of the limbs or trunk; slowness of body movements; and unstable posture and difficulty in walking. Early symptoms are subtle and occur gradually. [brainfoundation.org.au]

• Hypomimia

  Other clinical features include secondary motor symptoms (eg, hypomimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing, dystonia, glabellar reflexes), non-motor symptoms (eg, autonomic dysfunction, cognitive/neurobehavioral [ncbi.nlm.nih.gov]

  Other symptoms that are common in Parkinson's (though no one person will have all of them) include: abnormal walking decreased arm swing excessive salivation feelings of depression or anxiety increase in dandruff or oily skin lack of facial expression ( hypomimia [medbroadcast.com]

  Other manifestations of bradykinesia include loss of spontaneous movements and gesturing, drooling because of impaired swallowing, 25 monotonic and hypophonic dysarthria, loss of facial expression (hypomimia) and decreased blinking, and reduced arm swing [doi.org]

• Mask-like Facies

  facies Expressionless face Lack of facial expression Mask-like facial appearance [ more ] 0000298 Paraparesis Partial paralysis of legs 0002385 Parkinsonism with favorable response to dopaminergic medication 0002548 Postural instability Balance impairment [rarediseases.info.nih.gov]

• Dull Facial Expression

  facial expression 0000338 Leg muscle stiffness 0008969 Lethargy 0001254 Myoclonus 0001336 Oculogyric crisis 0010553 Short attention span Poor attention span Problem paying attention [ more ] 0000736 Urinary incontinence Loss of bladder control 0000020 [rarediseases.info.nih.gov]

• Sexual Dysfunction

  in men difficulty becoming sexually aroused and achieving an orgasm (sexual dysfunction) in women dizziness, blurred vision or fainting when moving from a sitting or lying position to a standing one – caused by a sudden drop in blood pressure excessive [nhs.uk]

  dysfunction, decreased ability to smell, restless legs and muscle cramps. [health.harvard.edu]

  dysfunction – Cramping – micrographia (abnormally small or cramped handwriting) – a mask-like expression Refer: https://parkinsonsnewstoday.com/parkinsons-disease-symptoms/motor/ [Last accessed on 29/11/2017] 9. [slideshare.net]

  Parkinson’s patients also suffer incontinence, constipation, and sexual dysfunction and are at higher risk for developing depression, anxiety, memory, and emotional problems. [sleepfoundation.org]

• Tremor

  Treating the patients with hand tremors is clinically difficult, because a wide range of disorders can result in hand tremors. Therefore, when treatment for hand tremors begins, various pharmacological options have to be considered. [ncbi.nlm.nih.gov]

  This form of stimulation helps rebalance the control messages in the brain, thereby suppressing tremor. [aans.org]

  Tremor is the major symptom for some individuals, while for others tremor is only a minor complaint and other symptoms are more troublesome. [web.archive.org]

• Bradykinesia

  Table 1 Parkinson’s disease symptoms Bradykinesia Bradykinesia refers to slowness of movement and is the most characteristic clinical feature of PD, although it may also be seen in other disorders, including depression. [web.archive.org]

  Subtle “bradykinesia” has been reported to occur in the “normal elderly” population, but this may reflect a non-specific slowness rather than bradykinesia as defined above. [movementdisorders.org]

• Postural Instability

  Management of postural instability is challenging as it is often resistant to dopaminergic therapy. Greater knowledge of postural control is essential to understand postural instability in PD. [ncbi.nlm.nih.gov]

  […] tool=bestpractice.com The cardinal features include resting tremor, rigidity, bradykinesia, and postural instability. Patients may demonstrate a combination of these motor symptoms, as well as other non-motor symptoms. [bestpractice.bmj.com]

  Postural instability usually develops later rather than sooner in the disease progression. The patient may need to hold onto someone to maintain balance when getting up or walking. [dx.doi.org]

• Resting Tremor

  Right-side resting tremor and rigidity were abolished immediately following the ultrasound energy delivery. In addition, left-side resting tremor and rigidity also improved. No adverse events occurred during the procedure. [ncbi.nlm.nih.gov]

  […] tool=bestpractice.com The cardinal features include resting tremor, rigidity, bradykinesia, and postural instability. Patients may demonstrate a combination of these motor symptoms, as well as other non-motor symptoms. [bestpractice.bmj.com]

• Dystonia

  SUBJECTS/PATIENTS: Six patients with Parkinson's disease with deep brain stimulation experiencing disabling foot dystonia. [ncbi.nlm.nih.gov]

So far no laboratory tests exist for diagnosing Parkinson's disease. A neurologist will diagnose the disease based on the past medial history of the affected individual followed by thorough analysis of the signs and symptoms. In addition, certain tests may also be required to rule out the possibility of any underlying disease condition. In order to arrive at an appropriate diagnosis, the neurologist will give medications meant for Parkinson's disease to the individual. If the individual benefits from the drug then the diagnosis is confirmed [8].

Parkinson's disease cannot be cured; the symptoms can be effectively managed and progression of the condition slowed down with appropriate treatment methods. Medications form an important part of treatment regime. In more advanced stages, however surgery may be advised. The following are the various medications prescribed for treating Parkinson's disease.

• Carbidopa-levodopa is one of the most effective medications for Parkinson disease. This is a natural chemical that gets converted to dopamine when it reaches the brain [9].
• Medications containing dopamine antagonists are prescribed which unlike levodopa do not get converted to dopamine but mimic the effects of the brain chemical.
• Monoamine oxidase B (MAO-B) inhibitors do not allow the breakdown of dopamine. However, this class of medication has various side effects when taken with other drugs.
• Anticholinergics help in controlling the tremors; however are seldom prescribed due to associated side effects.
• Amantadine is prescribed for short term relief from the symptoms. It is also given in association with levodopa to reduce dyskinesias that may accompany as a side effect of carbidopa-levodopa drug [10].

As the disease progresses, there is gradual loss of neurological functions in the affected individuals. Individuals who do not receive proper treatment often suffer from other secondary debilitating conditions. There is absolute loss of movement making the individual completely bed ridden for rest of the life. However, with introduction of newer generation medications, it has now been possible to effectively manage the symptoms and improve the quality of life [6].

Parkinson disease occurs due to necrosis of certain nerve cells in the brain which are responsible for producing dopamine. The exact cause that triggers the development of such a type of movement disorder is yet to be known. However, interplay of several factors such as environment and genetic are known to play a role. Genetic factors attribute to 10% cases of Parkinson disease.

Genetic factors

Certain genes have been identified to play a major role in causation of Parkinson's disease. Individuals with family history of this disease are at an increased risk of contracting it as they age.

Environmental factors

Exposure to certain toxins can predispose an individual to develop Parkinson's disease [2].

Parkinson disease is the second most common neurological disorder affecting about 7 million individuals across the globe. An estimated 1 million individuals of United States suffer from this neurodegenerative disorder [3]. Individuals aged 60 years and above fall easy prey to this disease. Men are 1.5 times more likely to contract Parkinson's disease, compared to women. Statistics have revealed that a small percentage of individuals (5 – 10%) between the age group of 20 – 50 years have been known to develop this kind of movement disorder [4].

Parkinson's disease is a result of death of neurons in the brain. These are responsible for producing dopamine. Dopamine is a chemical messenger of the brain that transmits information to control the movements in various parts of the body [5]. The inability of the neurons to produce dopamine causes motor impairment which is the major cause of disability amongst the affected individuals. It has also been found that about 60 – 80% of necrosis of the nerve cells occurs even before the preliminary signs and symptoms of Parkinson's disease occur.

Till date, no methods have been developed to prevent Parkinson's disease. Since the cause is unknown, ways to prevent the onset of the disease also remains a mystery. However, there have been some pieces of evidence suggesting the use of caffeine to help prevent Parkinson's disease.

Individuals over the age of 60 years are the most affected.The disease steadily causes disability greatly interfering with the individual’s ability to carry out daily functions. The preliminary stage of the disease may showcase little or no symptoms. Parkinson's disease cannot be cured. The symptoms can be effectively managed with appropriate medications. In some cases, surgical procedures may be required to improve the symptoms [1].

Definition

Parkinson's disease is a neurodegenerative disorder characterized by loss of neurological functions due to necrosis of the nerve cells in the brain. It is known to be the second most common neurological disorder after Alzheimer disease. Individuals above the age of 60 years are more prone to develop this condition. Parkinson's disease greatly affects the movement ability of the individuals and therefore the disease is also commonly referred to as movement disorder.

Cause

The exact factor that leads to development of Parkinson's disease is not clear. However certain genetic factors and exposure to environmental toxins is known to cause this type of neurological disorder.

Symptoms

In the initial stages, Parkinson's disease may show little or no signs at all. As the disease progresses to more advance stages, individuals experience tremors of the hands, fingers and legs. They also have difficulty in walking and their movements slow down to a great extent. Difficulty in talking is evident with slurred speech.

Diagnosis

No laboratory tests help in diagnosing the condition. A thorough examination of the signs and symptoms help in confirming Parkinson's disease.

Treatment

Medications form the basis of the treatment regime. Various classes of drugs are prescribed to keep the symptoms under control. Carbidopa-levodopa is the most effective drug for treating Parkinson's disease. It works by getting converted into dopamine once it reaches the brain.

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