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The main clinical manifestations of Parkinson disease include [[tremor]], rigidity and [[bradykinesia]]. Later in the course of the disease patient can have [[postural instability]].<ref name="pmid9923759">{{cite journal |vauthors=Gelb DJ, Oliver E, Gilman S |title=Diagnostic criteria for Parkinson disease |journal=Arch. Neurol. |volume=56 |issue=1 |pages=33–9 |date=January 1999 |pmid=9923759 |doi= |url=}}</ref><ref name="pmid1564476">{{cite journal |vauthors=Hughes AJ, Daniel SE, Kilford L, Lees AJ |title=Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases |journal=J. Neurol. Neurosurg. Psychiatry |volume=55 |issue=3 |pages=181–4 |date=March 1992 |pmid=1564476 |pmc=1014720 |doi= |url=}}</ref><ref name="pmid1564476">{{cite journal |vauthors=Hughes AJ, Daniel SE, Kilford L, Lees AJ |title=Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases |journal=J. Neurol. Neurosurg. Psychiatry |volume=55 |issue=3 |pages=181–4 |date=March 1992 |pmid=1564476 |pmc=1014720 |doi= |url=}}</ref> Some studies suggest that there can be three clinical subtypes for Parkinson disease: [[Tremor]] dominant, akinetic-rigid and [[postural instability]] and [[gait]] difficulty<ref name="pmid22952329">{{cite journal |vauthors=Marras C, Lang A |title=Parkinson's disease subtypes: lost in translation? |journal=J. Neurol. Neurosurg. Psychiatry |volume=84 |issue=4 |pages=409–15 |date=April 2013 |pmid=22952329 |doi=10.1136/jnnp-2012-303455 |url=}}</ref><ref name="pmid24514863">{{cite journal |vauthors=Thenganatt MA, Jankovic J |title=Parkinson disease subtypes |journal=JAMA Neurol |volume=71 |issue=4 |pages=499–504 |date=April 2014 |pmid=24514863 |doi=10.1001/jamaneurol.2013.6233 |url=}}</ref> but other studies demonstrate that clinical course of the disease can be variable and this subtypes can switch to each other through time.<ref name="pmid24514863">{{cite journal |vauthors=Thenganatt MA, Jankovic J |title=Parkinson disease subtypes |journal=JAMA Neurol |volume=71 |issue=4 |pages=499–504 |date=April 2014 |pmid=24514863 |doi=10.1001/jamaneurol.2013.6233 |url=}}</ref><ref name="pmid16637023">{{cite journal |vauthors=Alves G, Larsen JP, Emre M, Wentzel-Larsen T, Aarsland D |title=Changes in motor subtype and risk for incident dementia in Parkinson's disease |journal=Mov. Disord. |volume=21 |issue=8 |pages=1123–30 |date=August 2006 |pmid=16637023 |doi=10.1002/mds.20897 |url=}}</ref>
The main clinical manifestations of Parkinson disease include [[tremor]], rigidity and [[bradykinesia]]. Later in the course of the disease patient can have [[postural instability]].<ref name="pmid9923759">{{cite journal |vauthors=Gelb DJ, Oliver E, Gilman S |title=Diagnostic criteria for Parkinson disease |journal=Arch. Neurol. |volume=56 |issue=1 |pages=33–9 |date=January 1999 |pmid=9923759 |doi= |url=}}</ref><ref name="pmid1564476">{{cite journal |vauthors=Hughes AJ, Daniel SE, Kilford L, Lees AJ |title=Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases |journal=J. Neurol. Neurosurg. Psychiatry |volume=55 |issue=3 |pages=181–4 |date=March 1992 |pmid=1564476 |pmc=1014720 |doi= |url=}}</ref><ref name="pmid1564476">{{cite journal |vauthors=Hughes AJ, Daniel SE, Kilford L, Lees AJ |title=Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases |journal=J. Neurol. Neurosurg. Psychiatry |volume=55 |issue=3 |pages=181–4 |date=March 1992 |pmid=1564476 |pmc=1014720 |doi= |url=}}</ref> Some studies suggest that there can be three clinical subtypes for Parkinson disease: [[Tremor]] dominant, akinetic-rigid and [[postural instability]] and [[gait]] difficulty<ref name="pmid22952329">{{cite journal |vauthors=Marras C, Lang A |title=Parkinson's disease subtypes: lost in translation? |journal=J. Neurol. Neurosurg. Psychiatry |volume=84 |issue=4 |pages=409–15 |date=April 2013 |pmid=22952329 |doi=10.1136/jnnp-2012-303455 |url=}}</ref><ref name="pmid24514863">{{cite journal |vauthors=Thenganatt MA, Jankovic J |title=Parkinson disease subtypes |journal=JAMA Neurol |volume=71 |issue=4 |pages=499–504 |date=April 2014 |pmid=24514863 |doi=10.1001/jamaneurol.2013.6233 |url=}}</ref> but other studies demonstrate that clinical course of the disease can be variable and this subtypes can switch to each other through time.<ref name="pmid24514863">{{cite journal |vauthors=Thenganatt MA, Jankovic J |title=Parkinson disease subtypes |journal=JAMA Neurol |volume=71 |issue=4 |pages=499–504 |date=April 2014 |pmid=24514863 |doi=10.1001/jamaneurol.2013.6233 |url=}}</ref><ref name="pmid16637023">{{cite journal |vauthors=Alves G, Larsen JP, Emre M, Wentzel-Larsen T, Aarsland D |title=Changes in motor subtype and risk for incident dementia in Parkinson's disease |journal=Mov. Disord. |volume=21 |issue=8 |pages=1123–30 |date=August 2006 |pmid=16637023 |doi=10.1002/mds.20897 |url=}}</ref>


==== Motor symptoms ====
=== Motor symptoms ===
* Neuromuscular  
Neuromuscular
Tremor: [[Tremor]] is the most common [[symptom]] in Parkinson disease and can be the presenting sign in 70 to 80 percent of patients.<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref> This [[symptom]] starts unilaterally mostly in [[hand]] and then progress to the other side of the body. It can also involve [[Leg|legs]], [[jaw]], [[lips]] and [[tongue]].<ref name="pmid7276968">{{cite journal |vauthors=Findley LJ, Gresty MA, Halmagyi GM |title=Tremor, the cogwheel phenomenon and clonus in Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=44 |issue=6 |pages=534–46 |date=June 1981 |pmid=7276968 |pmc=491035 |doi= |url=}}</ref><ref name="pmid5463541">{{cite journal |vauthors=Scott RM, Brody JA, Schwab RS, Cooper IS |title=Progression of unilateral tremor and rigidity in Parkinson's disease |journal=Neurology |volume=20 |issue=7 |pages=710–4 |date=July 1970 |pmid=5463541 |doi= |url=}}</ref><ref name="pmid2296262">{{cite journal |vauthors=Hunker CJ, Abbs JH |title=Uniform frequency of parkinsonian resting tremor in the lips, jaw, tongue, and index finger |journal=Mov. Disord. |volume=5 |issue=1 |pages=71–7 |date=1990 |pmid=2296262 |doi=10.1002/mds.870050117 |url=}}</ref> [[Parkinson's disease|PD]] [[tremor]] frequency is 3 to 7 Hz.<ref name="pmid7276968">{{cite journal |vauthors=Findley LJ, Gresty MA, Halmagyi GM |title=Tremor, the cogwheel phenomenon and clonus in Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=44 |issue=6 |pages=534–46 |date=June 1981 |pmid=7276968 |pmc=491035 |doi= |url=}}</ref> There is a [[symptom]] called re-emergent tremor in some of the [[Parkinson's disease|PD]] patients. It manifests by postural tremor that starts after several seconds and can make it difficult to differentiate [[Parkinson's disease|PD]] from [[essential tremor]].<ref name="pmid10519872">{{cite journal |vauthors=Jankovic J, Schwartz KS, Ondo W |title=Re-emergent tremor of Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=5 |pages=646–50 |date=November 1999 |pmid=10519872 |pmc=1736624 |doi= |url=}}</ref><ref name="pmid11594921">{{cite journal |vauthors=Louis ED, Levy G, Côte LJ, Mejia H, Fahn S, Marder K |title=Clinical correlates of action tremor in Parkinson disease |journal=Arch. Neurol. |volume=58 |issue=10 |pages=1630–4 |date=October 2001 |pmid=11594921 |doi= |url=}}</ref>
* Tremor: [[Tremor]] is the most common [[symptom]] in Parkinson disease and can be the presenting sign in 70 to 80 percent of patients.<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref> This [[symptom]] starts unilaterally mostly in [[hand]] and then progress to the other side of the body. It can also involve [[Leg|legs]], [[jaw]], [[lips]] and [[tongue]].<ref name="pmid7276968">{{cite journal |vauthors=Findley LJ, Gresty MA, Halmagyi GM |title=Tremor, the cogwheel phenomenon and clonus in Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=44 |issue=6 |pages=534–46 |date=June 1981 |pmid=7276968 |pmc=491035 |doi= |url=}}</ref><ref name="pmid5463541">{{cite journal |vauthors=Scott RM, Brody JA, Schwab RS, Cooper IS |title=Progression of unilateral tremor and rigidity in Parkinson's disease |journal=Neurology |volume=20 |issue=7 |pages=710–4 |date=July 1970 |pmid=5463541 |doi= |url=}}</ref><ref name="pmid2296262">{{cite journal |vauthors=Hunker CJ, Abbs JH |title=Uniform frequency of parkinsonian resting tremor in the lips, jaw, tongue, and index finger |journal=Mov. Disord. |volume=5 |issue=1 |pages=71–7 |date=1990 |pmid=2296262 |doi=10.1002/mds.870050117 |url=}}</ref> [[Parkinson's disease|PD]] [[tremor]] frequency is 3 to 7 Hz.<ref name="pmid7276968">{{cite journal |vauthors=Findley LJ, Gresty MA, Halmagyi GM |title=Tremor, the cogwheel phenomenon and clonus in Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=44 |issue=6 |pages=534–46 |date=June 1981 |pmid=7276968 |pmc=491035 |doi= |url=}}</ref> There is a [[symptom]] called re-emergent tremor in some of the [[Parkinson's disease|PD]] patients. It manifests by postural tremor that starts after several seconds and can make it difficult to differentiate [[Parkinson's disease|PD]] from [[essential tremor]].<ref name="pmid10519872">{{cite journal |vauthors=Jankovic J, Schwartz KS, Ondo W |title=Re-emergent tremor of Parkinson's disease |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=5 |pages=646–50 |date=November 1999 |pmid=10519872 |pmc=1736624 |doi= |url=}}</ref><ref name="pmid11594921">{{cite journal |vauthors=Louis ED, Levy G, Côte LJ, Mejia H, Fahn S, Marder K |title=Clinical correlates of action tremor in Parkinson disease |journal=Arch. Neurol. |volume=58 |issue=10 |pages=1630–4 |date=October 2001 |pmid=11594921 |doi= |url=}}</ref>


Rigidity: Rigidity in [[Parkinson's disease|PD]] in very common and can be seen in 75 to 90 percent of patients.<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |doi=10.1212/WNL.0000000000002461 |url=}}</ref><ref name="pmid8420197">{{cite journal |vauthors=Hughes AJ, Daniel SE, Lees AJ |title=The clinical features of Parkinson's disease in 100 histologically proven cases |journal=Adv Neurol |volume=60 |issue= |pages=595–9 |date=1993 |pmid=8420197 |doi= |url=}}</ref> It commonly starts in the same side as the [[tremor]]. [[Parkinson's disease|PD]] patients have increased resistance to passive movement of their [[joint]] and sometimes it’s known as cogwheel rigidity because of the ratchety pattern of resistance and relaxation. Some evidences suggest that superimposition of [[tremor]] on increased [[muscle tone]] creates this kind of rigidity.<ref name="pmid9827589">{{cite journal |vauthors=Deuschl G, Bain P, Brin M |title=Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee |journal=Mov. Disord. |volume=13 Suppl 3 |issue= |pages=2–23 |date=1998 |pmid=9827589 |doi= |url=}}</ref><ref name="pmid13928399">{{cite journal |vauthors=LANCE JW, SCHWAB RS, PETERSON EA |title=Action tremor and the cogwheel phenomenon in Parkinson's disease |journal=Brain |volume=86 |issue= |pages=95–110 |date=March 1963 |pmid=13928399 |doi= |url=}}</ref>
* Rigidity: Rigidity in [[Parkinson's disease|PD]] in very common and can be seen in 75 to 90 percent of patients.<ref name="pmid6067254">{{cite journal |vauthors=Hoehn MM, Yahr MD |title=Parkinsonism: onset, progression and mortality |journal=Neurology |volume=17 |issue=5 |pages=427–42 |date=May 1967 |pmid=6067254 |doi= |url=}}</ref><ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |doi=10.1212/WNL.0000000000002461 |url=}}</ref><ref name="pmid8420197">{{cite journal |vauthors=Hughes AJ, Daniel SE, Lees AJ |title=The clinical features of Parkinson's disease in 100 histologically proven cases |journal=Adv Neurol |volume=60 |issue= |pages=595–9 |date=1993 |pmid=8420197 |doi= |url=}}</ref> It commonly starts in the same side as the [[tremor]]. [[Parkinson's disease|PD]] patients have increased resistance to passive movement of their [[joint]] and sometimes it’s known as cogwheel rigidity because of the ratchety pattern of resistance and relaxation. Some evidences suggest that superimposition of [[tremor]] on increased [[muscle tone]] creates this kind of rigidity.<ref name="pmid9827589">{{cite journal |vauthors=Deuschl G, Bain P, Brin M |title=Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee |journal=Mov. Disord. |volume=13 Suppl 3 |issue= |pages=2–23 |date=1998 |pmid=9827589 |doi= |url=}}</ref><ref name="pmid13928399">{{cite journal |vauthors=LANCE JW, SCHWAB RS, PETERSON EA |title=Action tremor and the cogwheel phenomenon in Parkinson's disease |journal=Brain |volume=86 |issue= |pages=95–110 |date=March 1963 |pmid=13928399 |doi= |url=}}</ref>


Bradykinesia: [[Bradykinesia]] or slowness of movement, is seen in 80 percent of [[Parkinson's disease|PD]] patients.<ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref>  
* Bradykinesia: [[Bradykinesia]] or slowness of movement, is seen in 80 percent of [[Parkinson's disease|PD]] patients.<ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref>
* Postural instability: [[Gait]] and postural problems can be the main cause of disability in [[Parkinson's disease|PD]] patients and commonly doesn’t response well to [[Dopamine|dopaminergic]] treatment.<ref name="pmid2720700">{{cite journal |vauthors=Koller WC, Glatt S, Vetere-Overfield B, Hassanein R |title=Falls and Parkinson's disease |journal=Clin Neuropharmacol |volume=12 |issue=2 |pages=98–105 |date=April 1989 |pmid=2720700 |doi= |url=}}</ref><ref name="pmid18519873">{{cite journal |vauthors=Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ |title=Determinants of disability and quality of life in mild to moderate Parkinson disease |journal=Neurology |volume=70 |issue=23 |pages=2241–7 |date=June 2008 |pmid=18519873 |doi=10.1212/01.wnl.0000313835.33830.80 |url=}}</ref>


Postural instability: [[Gait]] and postural problems can be the main cause of disability in [[Parkinson's disease|PD]] patients and commonly doesn’t response well to [[Dopamine|dopaminergic]] treatment.<ref name="pmid2720700">{{cite journal |vauthors=Koller WC, Glatt S, Vetere-Overfield B, Hassanein R |title=Falls and Parkinson's disease |journal=Clin Neuropharmacol |volume=12 |issue=2 |pages=98–105 |date=April 1989 |pmid=2720700 |doi= |url=}}</ref><ref name="pmid18519873">{{cite journal |vauthors=Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ |title=Determinants of disability and quality of life in mild to moderate Parkinson disease |journal=Neurology |volume=70 |issue=23 |pages=2241–7 |date=June 2008 |pmid=18519873 |doi=10.1212/01.wnl.0000313835.33830.80 |url=}}</ref>
=== Nonmotor symptoms ===
* Cognitive dysfunction and dementia: Cognitive impairment can occur in the PD but in some ways it’s different from Alzheimer disease. Language dysfunction and memory deficit is less prominent while executive and visuospatial dysfunction is more prominent in PD.(2_10_76_77_78_79) Parkinson’s diseases memory deficits are in the area of retrieval of learned information. Aphasia, apraxia and sever memory loss are uncommon in PD.(5_6_83 ta 87)


==== Nonmotor symptoms ====
* Psychosis and hallucinations: Psychosis, especially visual hallucination occurs in PD patients who are under treatment.(50 ta 52) All of the antiparkinsonism drugs can cause this but dopamine agonists are the most common cause.(56_57_58) Severity and prevalence of these hallucinations increase over time(54) but can resolve when PD medications are discontinued.(59)
Cognitive dysfunction and dementia


Psychosis and hallucinations
* Mood disorders including depression, anxiety, and apathy/abulia:
 
# Depression: Mild to moderate depression is very common in PD and can be seen in 50 percent of PD patients. (67_70 ta 72) these patients can present with anhedonia, sadness, guilt and feeling of worthlessness.(77)
Mood disorders including depression, anxiety, and apathy/abulia
# Anxiety: Anxiety, especially generalized anxiety disorder and social phobia is common in PD and can be seen in more than 30 percent of patients.(67_79_81) Anxiety is usually combined by depression.(82)
 
# Apathy and abulia: Apathy and abulia are characterized by lack of motivation, speech, emotional and motor function. The pathophysiology behind this symptom is involvement of frontal lobe in PD patients.(86_87_89)
Sleep disturbances
* Sleep disturbances: Sleep disorders is seen in 55 to 80 percent of PD patients in early or late stages of the disease.(93_94_49) approximately 40 percent of PD patients take medicine for sleep cause insomnia is as common as 60 percent in them.(93_95) the most common cause of insomnia and frequent awakening during sleep include nocturia, cramp, pain, nightmares and tremor.(95 ta 99 va 100) another sleep disorder which can be seen in these patients is REM sleep behavior disorder (RBD), characterized by vigorous movement because of increased muscle tone(104_105)
 
* Fatigue: The prevalence of fatigue in PD patients is 33 to 58 percent (109_121 ta 127)  it’s mostly associated with depression and excessive day time somnolence but can occur as an isolate problem too.(122_123_126)
Fatigue
* Autonomic dysfunction:
 
* Olfactory dysfunction
Autonomic dysfunction
* Gastrointestinal dysfunction
 
* Pain and sensory disturbances
Olfactory dysfunction
* Dermatologic findings (seborrhea)
 
* Rhinorrhea
Gastrointestinal dysfunction
 
Pain and sensory disturbances
 
Dermatologic findings (seborrhea)
 
Rhinorrhea


== Less common symptoms ==
== Less common symptoms ==

Revision as of 15:14, 15 April 2018

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Overview

History

Common symptoms

The main clinical manifestations of Parkinson disease include tremor, rigidity and bradykinesia. Later in the course of the disease patient can have postural instability.[1][2][2] Some studies suggest that there can be three clinical subtypes for Parkinson disease: Tremor dominant, akinetic-rigid and postural instability and gait difficulty[3][4] but other studies demonstrate that clinical course of the disease can be variable and this subtypes can switch to each other through time.[4][5]

Motor symptoms

Neuromuscular

  • Tremor: Tremor is the most common symptom in Parkinson disease and can be the presenting sign in 70 to 80 percent of patients.[6][7] This symptom starts unilaterally mostly in hand and then progress to the other side of the body. It can also involve legs, jaw, lips and tongue.[8][9][10] PD tremor frequency is 3 to 7 Hz.[8] There is a symptom called re-emergent tremor in some of the PD patients. It manifests by postural tremor that starts after several seconds and can make it difficult to differentiate PD from essential tremor.[11][12]
  • Rigidity: Rigidity in PD in very common and can be seen in 75 to 90 percent of patients.[6][7][13] It commonly starts in the same side as the tremor. PD patients have increased resistance to passive movement of their joint and sometimes it’s known as cogwheel rigidity because of the ratchety pattern of resistance and relaxation. Some evidences suggest that superimposition of tremor on increased muscle tone creates this kind of rigidity.[14][15]
  • Bradykinesia: Bradykinesia or slowness of movement, is seen in 80 percent of PD patients.[7]
  • Postural instability: Gait and postural problems can be the main cause of disability in PD patients and commonly doesn’t response well to dopaminergic treatment.[16][17]

Nonmotor symptoms

  • Cognitive dysfunction and dementia: Cognitive impairment can occur in the PD but in some ways it’s different from Alzheimer disease. Language dysfunction and memory deficit is less prominent while executive and visuospatial dysfunction is more prominent in PD.(2_10_76_77_78_79) Parkinson’s diseases memory deficits are in the area of retrieval of learned information. Aphasia, apraxia and sever memory loss are uncommon in PD.(5_6_83 ta 87)
  • Psychosis and hallucinations: Psychosis, especially visual hallucination occurs in PD patients who are under treatment.(50 ta 52) All of the antiparkinsonism drugs can cause this but dopamine agonists are the most common cause.(56_57_58) Severity and prevalence of these hallucinations increase over time(54) but can resolve when PD medications are discontinued.(59)
  • Mood disorders including depression, anxiety, and apathy/abulia:
  1. Depression: Mild to moderate depression is very common in PD and can be seen in 50 percent of PD patients. (67_70 ta 72) these patients can present with anhedonia, sadness, guilt and feeling of worthlessness.(77)
  2. Anxiety: Anxiety, especially generalized anxiety disorder and social phobia is common in PD and can be seen in more than 30 percent of patients.(67_79_81) Anxiety is usually combined by depression.(82)
  3. Apathy and abulia: Apathy and abulia are characterized by lack of motivation, speech, emotional and motor function. The pathophysiology behind this symptom is involvement of frontal lobe in PD patients.(86_87_89)
  • Sleep disturbances: Sleep disorders is seen in 55 to 80 percent of PD patients in early or late stages of the disease.(93_94_49) approximately 40 percent of PD patients take medicine for sleep cause insomnia is as common as 60 percent in them.(93_95) the most common cause of insomnia and frequent awakening during sleep include nocturia, cramp, pain, nightmares and tremor.(95 ta 99 va 100) another sleep disorder which can be seen in these patients is REM sleep behavior disorder (RBD), characterized by vigorous movement because of increased muscle tone(104_105)
  • Fatigue: The prevalence of fatigue in PD patients is 33 to 58 percent (109_121 ta 127)  it’s mostly associated with depression and excessive day time somnolence but can occur as an isolate problem too.(122_123_126)
  • Autonomic dysfunction:
  • Olfactory dysfunction
  • Gastrointestinal dysfunction
  • Pain and sensory disturbances
  • Dermatologic findings (seborrhea)
  • Rhinorrhea

Less common symptoms

References

  1. ↑ Gelb DJ, Oliver E, Gilman S (January 1999). "Diagnostic criteria for Parkinson disease". Arch. Neurol. 56 (1): 33–9. PMID 9923759.
  2. ↑ 2.0 2.1 Hughes AJ, Daniel SE, Kilford L, Lees AJ (March 1992). "Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases". J. Neurol. Neurosurg. Psychiatry. 55 (3): 181–4. PMC 1014720. PMID 1564476.
  3. ↑ Marras C, Lang A (April 2013). "Parkinson's disease subtypes: lost in translation?". J. Neurol. Neurosurg. Psychiatry. 84 (4): 409–15. doi:10.1136/jnnp-2012-303455. PMID 22952329.
  4. ↑ 4.0 4.1 Thenganatt MA, Jankovic J (April 2014). "Parkinson disease subtypes". JAMA Neurol. 71 (4): 499–504. doi:10.1001/jamaneurol.2013.6233. PMID 24514863.
  5. ↑ Alves G, Larsen JP, Emre M, Wentzel-Larsen T, Aarsland D (August 2006). "Changes in motor subtype and risk for incident dementia in Parkinson's disease". Mov. Disord. 21 (8): 1123–30. doi:10.1002/mds.20897. PMID 16637023.
  6. ↑ 6.0 6.1 Hoehn MM, Yahr MD (May 1967). "Parkinsonism: onset, progression and mortality". Neurology. 17 (5): 427–42. PMID 6067254.
  7. ↑ 7.0 7.1 7.2 Pagano G, Ferrara N, Brooks DJ, Pavese N (April 2016). "Age at onset and Parkinson disease phenotype". Neurology. 86 (15): 1400–7. doi:10.1212/WNL.0000000000002461. PMC 4831034. PMID 26865518.
  8. ↑ 8.0 8.1 Findley LJ, Gresty MA, Halmagyi GM (June 1981). "Tremor, the cogwheel phenomenon and clonus in Parkinson's disease". J. Neurol. Neurosurg. Psychiatry. 44 (6): 534–46. PMC 491035. PMID 7276968.
  9. ↑ Scott RM, Brody JA, Schwab RS, Cooper IS (July 1970). "Progression of unilateral tremor and rigidity in Parkinson's disease". Neurology. 20 (7): 710–4. PMID 5463541.
  10. ↑ Hunker CJ, Abbs JH (1990). "Uniform frequency of parkinsonian resting tremor in the lips, jaw, tongue, and index finger". Mov. Disord. 5 (1): 71–7. doi:10.1002/mds.870050117. PMID 2296262.
  11. ↑ Jankovic J, Schwartz KS, Ondo W (November 1999). "Re-emergent tremor of Parkinson's disease". J. Neurol. Neurosurg. Psychiatry. 67 (5): 646–50. PMC 1736624. PMID 10519872.
  12. ↑ Louis ED, Levy G, Côte LJ, Mejia H, Fahn S, Marder K (October 2001). "Clinical correlates of action tremor in Parkinson disease". Arch. Neurol. 58 (10): 1630–4. PMID 11594921.
  13. ↑ Hughes AJ, Daniel SE, Lees AJ (1993). "The clinical features of Parkinson's disease in 100 histologically proven cases". Adv Neurol. 60: 595–9. PMID 8420197.
  14. ↑ Deuschl G, Bain P, Brin M (1998). "Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee". Mov. Disord. 13 Suppl 3: 2–23. PMID 9827589.
  15. ↑ LANCE JW, SCHWAB RS, PETERSON EA (March 1963). "Action tremor and the cogwheel phenomenon in Parkinson's disease". Brain. 86: 95–110. PMID 13928399.
  16. ↑ Koller WC, Glatt S, Vetere-Overfield B, Hassanein R (April 1989). "Falls and Parkinson's disease". Clin Neuropharmacol. 12 (2): 98–105. PMID 2720700.
  17. ↑ Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ (June 2008). "Determinants of disability and quality of life in mild to moderate Parkinson disease". Neurology. 70 (23): 2241–7. doi:10.1212/01.wnl.0000313835.33830.80. PMID 18519873.

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