The four major symptoms of Parkinson's disease are:
- Rigidity - stiffness when the arm, leg, or neck are moved
- Resting tremor - tremor most prominent at rest, when sitting quietly
- Bradykinesia - slowness in initiating movement which may contribute to decreased facial expression, change in speech pattern, shuffling gait, smaller-lettered handwriting, trouble with fine finger movements.
- Loss of postural reflexes - poor balance and coordination
In addition, a number of other findings that are associated with Parkinson's disease include mask like face, micrographia, emotional lability, depression, sleep problems and change in speech pattern.
Not every one with Parkinson's disease experiences the same symptoms. The speed at which symptoms appear in each individual also differs. Hence few people have an accelerated progress of the disease where as some people remains static and slowly progressive in their disease. The disease is never symmetrical on both the sides. It usually affects one side of the body first followed by the involvement of the other side of the body at the later stage.
About 60% of the people with Parkinson's disease experience resting tremor. Symptoms often begin with occasional trembling of one hand that gradually becomes constant. The tremor can progress to the other hand, to the legs and occasionally to the face. However in some patients first manifestation of the disease is bradykinesia i.e. slowness of body activities.
There are many other diseases that can present with parkinsonian symptoms. However they are different in their progress, response to treatment and outcome, than Parkinson's disease. This includes diseases like multi-system atrophy, progressive supranuclear palsy (PSP), cortico-basal ganglionic degeneration (CBGD), etc.
Although tremors would seem to be the biggest problem with the people suffering from Parkinson's disease, the most frustrating symptoms are the symptoms associated with slow movements and gait disturbances. As a result, people with this disease often have trouble dressing, handling utensils, eating, and with personal hygiene. They may also experience difficulty in rising from chair, turning in bed, or getting in and out of car. Without treatment, pronounced disability occurs in about 9 years. However current symptomatic medication may control progression and patients continue to do well longer.
There are no laboratory tests or radiological investigations to diagnose Parkinson's disease. The diagnosis of the disease still remains a clinical judgment. The Parkinson's disease disabilities can be assessed by Unified Parkinson's disease rating score (UPDRS), Schwab and England activities of daily living score and Hoehn and Yahr scoring.