Clinical features

There are many manifestations of Parkinson's disease. The classical diagnostic symptoms are (1):

• slowness and poverty of movement
  
• stiffness
  
• shaking

The physical signs of Parkinson's disease include (1):

• slowness of movement (bradykinesia)
  • loss of facial expression and arm swing (1)
  • difficulties with fine movements e.g. - buttoning, use of utensils (2)
    
    
• poverty of movement (hypokinesia)
  
  
• rigidity
  • classic "lead pipe" or "cog wheel" rigidity (3)
  • there may be associated pain e.g. - painful shoulder is one the commonest initial symptom seen in PD (2)
    
    
• rest tremor
  • is the most common and easily identifiable symptom of the disease
  • described as typical "pill-rolling" involving the thumb and the index finger (3)
  • may involve the lips, chin, jaw and legs (2)
  • fatigue or emotional stress may aggravate the tremor (3)

The many manifestations of Parkinson's disease are:

• shuffling gait
• expressionless, unblinking face
• slurred monotonous speech
• small handwriting
• increased salivation and dribbling
• loss of facial expression and arm swing
• difficulty with fine movements

The signs are usually unilateral at diagnosis and may become bilateral as the disease progresses.

Later in the disease additional signs may be present.These include:

• postural instability
  
• cognitive impairment
  • a degree of cognitive impairment is present in up to 70% of patients
  • dementia occurs in 40% of patients with Parkinson's disease
• orthostatic hypotension

Reference:

• (1) Parkinson's Disease.National clinical guideline for diagnosis and management in primary and secondary care. NICE full guideline.2006
• (2) Jankovic J. Parkinsons's disease:clinical features and diagnosis. Journal of Neurology, Neurosurgery and Psychiatry 2008;79:368-376
• (3) Parkinson's disease society. The professional's guide to Parkinson's disease