backup og meta
Health Screening
Ask Doctor

Four Cardinal Signs of Parkinson's Disease

Medically reviewed by Nicole Aliling, MD · Neurology · Centre Médicale Internationale

Written by Tracey Romero · Updated Dec 11, 2020

Four Cardinal Signs of Parkinson's Disease

As people age, we may develop certain age-related illnesses or diseases. One of these is Parkinson’s Disease, which primarily affects people over 60 years old. To better understand this condition, learn the four cardinal signs of Parkinson’s Disease, its possible causes, risk factors, and its stages.

What is Parkinson’s Disease?

Parkinson’s Disease, sometimes called PD, is a disorder of the nervous system.

The brain has a substance called dopamine produced by the substantia nigra, found in the cells of the midbrain, the upper part of the brainstem. The disease targets and damages the cells of the substantia nigra. When the cells are reduced by 60 to 80 percent, a person starts to show symptoms of PD.

Since dopamine is a chemical that is vital for the smooth coordination of muscles and movement, a person’s inability to properly do common activities like walking and writing are some of the initial symptoms of PD. Moreover, Parkinson’s is a chronic and progressive disease, which means that its symptoms worsen as the illness develops.

Four Cardinal Signs of Parkinson’s Disease

As stated earlier, problems with muscle control and movement are the most common signs of an onset of this disease. Specifically, the four cardinal signs of Parkinson’s Disease are:

  1. Tremors – Characterized by involuntary rhythmic shaking of a body part that is at rest, which usually starts with just one hand or arm.
  2. Rigidity – Stiffness of the muscles especially of the trunk and neck that may lead to a stooped posture and generalized resistance to movement of affected body parts.
  3. Bradykinesia – In clinical terms, this term covers three similar but distinct movement disorders: bradykinesia (slowness of movement), hypokinesia (decrease in spontaneous movement), and akinesia (inability to start any type of movement).
  4. These three may occur at the same time. For example, a person with PD may exhibit the following:

    • Takes a long time to react when called
    • Rises slowly from a sitting position
    • Unable to quickly open and close their hands
      1. Postural instability – Developing a stooped posture. Stooping may also be due to rigidity. Postural instability refers to difficulty maintaining an upright positioning while walking that may lead to falls if the person trips or has a misstep, which other persons without PD should be able to avoid.

      The cardinal symptoms lead to secondary motor symptoms like:

      • Hypomimia – Reduction in facial expressions or showing emotions on the face.
      • Dysarthria – Weakened or difficulty in controlling the muscles used for speech like the tongue, larynx, and vocal cords.
      • Dysphagia – Swallowing difficulties, including coughing or choking when a person eats or drinks.
      • Sialorrhoea – Difficulty in controlling saliva secretion, which leads to excessive drooling.
      • Micrographia – Abnormally small handwriting that results from the rigidity of the fingers or hands.
      • Festination – Short, shuffling steps instead of normal strides that makes a person appear to be hurrying even though forward propulsion is slow.
      • Dystonia – An involuntary or uncontrolled contraction of one muscle, a muscle group, or the whole body.
      • Glabellar reflexes (glabellar tap) – Normally a person blinks when tapped lightly between the eyebrows then stops blinking when the tap is repeated several times, but a person with PD continues to blink so long as the tap is done.

      A person may also exhibit non-motor symptoms like:

      • Anxiety
      • Constipation
      • Dementia
      • Depression
      • Fatigue
      • Hallucinations
      • Memory lapses
      • Sleep problems.
      • Stages of Parkinson’s Disease

        Doctors use different rating scales to assess a patient’s case but the most commonly used is the Hoehn and Yahr scale, which divides the symptoms into five stages.

        Stage 1. Mild symptoms that affect only one side of the body and do not impair the daily life of a person.

        Stage 2. Symptoms develop into secondary motor types and eventually affect both sides of the body. This stage evolves months or years after the first stage starts.

        Stage 3. Symptoms compromise the daily activities of a person although he or she can still function independently when doing basic tasks like eating and bathing. Movement becomes considerably slow and a person’s balance becomes compromised. At this stage, the symptoms are so marked that there is no doubt about the diagnosis of PD.

        Stage 4. The patient may still manage certain activities like walking unassisted or with tools like walkers. However, the symptoms become so debilitating that the patient needs assistance with daily living.

        Stage 5. The disease has become so advanced that the patient is usually confined to a bed or a wheelchair. This stage requires around-the-clock assistance and monitoring since the patient has a high risk of getting into an accident. This is especially needed if the patient develops hallucinations or dementia.

        About 50% to 80% of those with Parkinson’s eventually experience dementia as their disease progresses.

        How to Prevent Parkinson’s Disease

        Key Takeaways

        With its exact cause still a mystery, Parkinson’s Disease remains a complicated matter. If you believe that you are at risk of getting this disease or if you exhibit some of its symptoms then talk to your doctor so you can be tested and start your treatments.

        Learn more about Parkinson’s Disease here. 


        Hello Health Group does not provide medical advice, diagnosis or treatment.

        Medically reviewed by

        Nicole Aliling, MD

        Neurology · Centre Médicale Internationale

        Written by Tracey Romero · Updated Dec 11, 2020

        ad iconadvertisement

        Was this article helpful?

        ad iconadvertisement
        ad iconadvertisement