The three cardinal signs of Parkinson disease are resting tremor, rigidity and bradykinesia. Of these, two are essential for diagnosis.Postural instability is the fourth cardinal sign, but occurs late, usually after 8 years of disease evolution.- In 70% of cases, uncontrollable rhythmic gestures of the hands, head or leg is the first symptom and mainly occurs at rest and during periods of stress. The tremor is reduced during movement, and disappears in sleep, is exacerbated by stress and fatigue. The tremor becomes less obvious as the disease.- Stiffness refers to increased resistance to passive mobilization of the muscles and is more evident in voluntary movement of contralateral limb.- Bradykinesia refers to slowness of movement, but also includes decreased spontaneous movements and decreased range of motion. Bradykinesia is visible through micrographic (small handwriting, illegible), hipomimie (decrease mimic movements), blinking slowly and hipofonie (voice diminished).- Postural instability refers to disorders of balance and coordination. Its appearance is an important stage in the disease, postural instability is difficult because it is treatable and a common source of disability in later stages of the disease.- Dementia occurs late in the evolution of Parkinson's disease and affects 15% - 30% of patients. Recent memory is affected.
Other signs are:
- Sleep disorders- Difficulty swallowing- Sialoree (abundant salivation)- Micrographic (small print, illegible)- Hipofonie (voice diminished, monotone) and difficulty in articulating words- Urinary incontinence and constipation, bowel and bladder function due to alteration- Confusion, memory loss- Gait disorders, in small steps, shuffling, strong tendency to fall through the loss of postural reflexes- Loss of balance while walking arm- Orthostatic hypotension- Seborrheic dermatitis- Personality changes
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