Four Cardinal Signs of Parkinson’s Disease

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Published on 11/12/2020 . 4 mins read
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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.

6 Parkinson’s Disease Late-Stage Complications

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).

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.

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Parkinson Disease is a certain type of movement disorder that leads to shaking, stiffness, difficulty maintaining balance, hand-eye coordination, or any form of coordination relating to the patient’s body. Parkinson's Disease occurs when the brain’s nerve cells don’t produce enough dopamine, a neurotransmitter and hormone that plays several roles in the brain and body, including sending messages between nerve cells. Let's learn more about Parkinson's Disease cure research here.  Symptoms of Parkinson’s Disease In general, symptoms develop gradually, often concentrating on one side of the body, eventually progressing to a point where both sides of the body are affected. Symptoms include: Trembling of body parts, notably the jaw, face, hands, arms, and legs Slowness and clumsiness of movement Severely debilitated balance and coordination Stiffness of certain body parts, such as the trunk, arms, and legs In later stages, and as symptoms worsen, people with the disease begin to struggle with talking, walking, and fulfilling simple tasks. Symptoms also include but are not limited to Trouble with sleeping Depression Difficulty controlling the mouth with regards to chewing, swallowing, or speaking Parkinson's Disease Cure Research In recent years, there has been no specific test developed for Parkinson’s Disease, thus creating difficulty in diagnosing patients. Medical practitioners relied on neurological examinations and medical history to determine if a patient is afflicted with the disorder.  Although there is no cure for Parkinson’s disease at this time, medicines, surgical treatment, and different forms of therapy have been developed to help patients in alleviating the symptoms they experience. Medication for Parkinson Medications designed for Parkinson’s Disease generally comprise 3 categories: 1. Medicines that aim to increase the brain’s dopamine levels The most prevalent drugs for Parkinson’s Disease are dopamine precursors. This includes substances including levodopa, which cross the barrier between the blood and the brain, which in turn are transformed into the much needed dopamine for the patient. Several other drugs aim to copy the effects of dopamine to purposely act as its replacement. 2. Drugs affecting neurotransmitters in the patient’s body for the purpose of mitigating the effects of Parkinson’s Disease Prime examples of such are anticholinergic drugs that stagnate the generation of acetylcholine, a type of neurotransmitter. Drugs of this category can significantly help in reducing the occurrence of tremors for patients. 3. Drugs that aim to affect the non-motor symptoms of Parkinson’s disease This refers to patients who express symptoms of depression, for example, and require medicines that classify as antidepressants. Symptoms may drastically ameliorate within the first assessment after administering medication. But effects and symptoms may resurface over time, as the development of Parkinson escalates, with symptoms worsening and medicines possessing less effects as resistance develops. This puts pressure on Parkinson’s Disease cure research to find a permanent solution to this disease. At any rate, medications designed to stem the effects and symptoms of Parkinson’s disease consist of: Levodopa/Carbidopa Regarded as the most prevalent and successful medication for Parkinson Disease, which is sometimes referred to as L-Dopa. The drug works in such a way that the body’s cells use the drug to generate dopamine and replenish the brain’s lacking supply of cells. It is worth noting that patients are not able to utilize dopamine medications due to the fact that dopamine does not readily move through the barrier between the patient’s blood and brain. In most cases, patients are prescribed levodopa in combination with another medication known as carbidopa. Levodopa and/or carbidopa are known to have a high success rate at reducing or eliminating the symptoms associated with motor symptoms of Parkinson Disease during its early stages. Levodopa usually assists patients by mitigating the effects of Parkinson pertaining to movement.  Dopamine agonists These drugs aim to replace or mimic the role of  the substance dopamine in the patient’s  brain and can be given alone or in combination with levodopa. They are regarded as a lackluster treatment in comparison to levodopa  in terms of treating Parkinson symptoms, but are also known to work on patients for a longer duration. Most of the potential side effects of dopamine agonists are similar to what is experienced by patients who use levodopa. Such symptoms include: Onset of sleep that is sudden or spontaneous in nature Symptoms relating to drowsiness Occurrence of hallucination, and confusion, vomiting Onset of nightmares In rare cases, said agents may create an uncontrollable desire for patients to do specific actions.  The same are also responsible for creating tense feelings in patients that may relate  to hypersexuality, gambling, or compulsive shopping. 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Amantadine’s side effects mainly consist of edema, mottled skin, insomnia, the occurrence of hallucinations, and patient’s agitation. Surgery Surgical treatment is reserved for patients who do not respond well to medications, and is identified as DBS, or Deep Brain Stimulation. It is a surgical procedure that implants electrodes into the patient’s brain, that is then connected to a device attached to the patient’s chest, creating a stimulation in the brain that is painless for the patient and which rebukes many of the problems Parkinson brings in relation to the movement of the patient. Therapy Therapy includes but is not limited to occupational, physical and speech therapy. These are known to assist patients with tremors, rigidity, gait disorders, voice disorders. These also give other benefits to patients depending on their current situation. Therapy is a viable option as it may be customized and designed to suit the patient’s needs. Interestingly enough, research on Parkinson Disease has gained traction and recent advances have helped in improving symptomatic therapy for motor and non-motor symptoms of patients, though research on a definitive cure is still ongoing and some efforts are being turned into collectives. For example, The National Institute of Neurological Disorders and Stroke, otherwise known as NINDS, has formed collectives to seek fundamental knowledge of the brain and use available information to conduct research on ideas that may direct them towards a cure, or at least to create an effort to help reduce the severity of symptoms on patients. In 2014, the same institution organized the Parkinson’s Disease 2014: Advancing Research, Improving Lives Conference, which gave birth to a collaboration of researchers, clinicians, patients and benefactors to create a total of 31 recommendations for Parkinson Disease research. Another example of a research breakthrough is the discovery of a Genetic “switch,” and the possibility of it preventing the symptoms of Parkinson Disease altogether. The research was conducted by the Medical Research Council at the University of Leicester in 2017. The study focused on the gene ATF4 and its key role in Parkinson Disease.  Key Takeaways What steps have been made in Parkinson's Disease cure research? Researchers all over the world are still working on developing a cure. However, a multitude of breakthroughs has been developed. These mitigate and, in some cases, prevent the progression of Parkinson Disease symptoms altogether. And that is no small feat. While a number of Old Adults are at risk, any of the aforementioned treatment methods may prove effective in mitigating the development of their symptoms. Learn more about Parkinson's Disease here. 

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