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What Are The Cardinal Signs Of Parkinson’s Disease

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Is Early Diagnosis Possible

Introduction to Parkinson’s Disease: The Cardinal Symptoms

Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.

Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.

For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.

Parkinson’s Disease and Movement Disorders Center

Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.

What Is Parkinsons Disease

Parkinsons 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 persons inability to properly do common activities like walking and writing are some of the initial symptoms of PD. Moreover, Parkinsons is a chronic and progressive disease, which means that its symptoms worsen as the illness develops.

Signs And Symptoms Of Parkinson’s Disease

Signs and symptoms of Parkinson’s disease are varied. Parkinson’s disease affects movement, producing motor symptoms. Non-motor symptoms, which include dysautonomia, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common. When other diseases mimic Parkinson’s disease, they are categorized as parkinsonism.

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The Cardinal Signs Of Parkinson’s Disease

By | Submitted On October 13, 2011

Let’s begin with a caveat. No two cases of Parkinson’s disease will follow the exact same course. We are like snowflakes… similar to each other in so many areas, but ever-so-slightly different with the details.

That being said, there are four so-called ” Cardinal Signs” of PD. They are…

1. Resting Tremor

3. Bradykinesia

4. Postural Instability

Think of it as a great Big Brain Buffet, where you can help yourself to a little of some, a lot of the other, very little of one and none of the fourth one. I’m not going to spend a great deal of time on the signs I don’t have. Why not? Because I don’t have them. I’ll tell you what they are, what you should watch out for, but I will not be able to offer any real practical advice on things I don’t experience on a daily basis.

Let me put it this way. When I went to the Big Brain Buffet in late 1999, I decided I’d help myself to several serving spoons full of Rigidity and Bradykinesia, just a little bit of Resting Tremor, and I decided to pass on the Postural Instability.

Now that I approach the 12th anniversary of my first visit to the Buffet, I’ve found that I heap my plate FULL of the Postural Instability and Bradykinesia. The Deep Brain Stimulation I had in 2007 keeps my appetite for the Rigidity to a minimum and I’ve never really had all that much of a taste for the Tremor in the first place, so I leave that alone.

So, let’s get started with…

A. Resting Tremor

So… moving on.

B. Rigdity.

What Are The Surgical Treatments For Parkinsons Disease

Pin by Sung Song on Parkinson

Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.

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Testing For Parkinsons Disease

There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.

A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.

The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.

The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.

What Doctors Look For When Diagnosing Parkinsons

Certain physical signs and symptoms noticed by the patient or his or her loved ones are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:

  • Shaking or tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving

  • Bradykinesia: Slowness of movement in the limbs, face, walking or overall body

  • Rigidity: Stiffness in the arms, legs or trunk

  • Posture instability: Trouble with balance and possible falls

Once the patient is at the doctors office, the physician:

  • Takes a medical history and does a physical examination.

  • Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.

  • Performs a neurological examination, testing agility, muscle tone, gait and balance.

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What Can You Do If You Have Pd

  • Work with your doctor to create a plan to stay healthy. This might include the following:
  • A referral to a neurologist, a doctor who specializes in the brain
  • Care from an occupational therapist, physical therapist or speech therapist
  • Meeting with a medical social worker to talk about how Parkinson’s will affect your life
  • Start a regular exercise program to delay further symptoms.
  • Talk with family and friends who can provide you with the support you need.
  • For more information, visit our Treatment page.

    Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

    What Are The Cardinal Signs Of Parkinsons Disease

    Parkinson’s Disease [Part 1] | The 4 Cardinal Signs

    Parkinsons disease is a neurodegenerative disease affecting the motor abilities of a patient. The cardinal signs of Parkinsons disease are normally related to the motor functions which may be voluntary or involuntary in nature. Such symptoms usually start on the one side of the body which are initially mild, and progresses over the period of time. The cardinal signs include-

    Tremors: Tremors originating in fingers, hands, feet, arms, jaw, legs or head. Such tremors are seen to occur most often while the patient is resting. These tremors may worsen when the patient gets excited, stressed, or tired.

    Rigidity in Limbs: A pattern of stiffness or rigidity is seen in the limbs and trunk, which may increase in case of movement. Such rigidity may produce muscle aches and pain.

    Loss of Fine Motor Skills: Loss of fine motor skills may lead to cramped handwriting which may be difficult to read. Such condition is called micrographia. Patient may also find it difficult to eat.

    Loss of Movement: Progressive slowness of voluntary movement which may result in difficulty to initiate movement and to even complete a movement gradually.

    Loss of Reflexes: Impairment or loss of reflexes to adjust the posture and maintain balance is also cardinal signs of Parkinsons disease.

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    Stooping Or Hunched Posture

    People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.

    People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.

    Abnormalities Of Physical Function

    • Walking with a shuffling gait while slouching
    • Inability to take a step when attempting to initiate gait
    • Speed gradually increases while walking etc.
  • Abnormal posture
  • Facial expressions disappear etc.
  • Impaired swallowing
  • Handwriting becomes smaller and shaky
  • Handwriting gradually becomes smaller while writing
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    What Medications Are Used To Treat Parkinsons Disease

    Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.

    Medications combat Parkinsons disease by:

    • Helping nerve cells in the brain make dopamine.
    • Mimicking the effects of dopamine in the brain.
    • Blocking an enzyme that breaks down dopamine in the brain.
    • Reducing some specific symptoms of Parkinsons disease.

    Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .

    How Do I Prevent Falls From Common Hazards

    Ideal Cure...: Parkinson
    • Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
    • Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
    • Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
    • Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
    • Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
    • Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

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    What Causes Parkinsons Disease

    Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

    People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

    Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

    New Diagnostic Standards For Parkinsons

    Until recently, the gold-standard checklist for diagnosis came from the U.K.s Parkinsons Disease Society Brain Bank. It was a checklist that doctors followed to determine if the symptoms they saw fit the disease. But thats now considered outdated. Recently, new criteria from the International Parkinson and Movement Disorder Society have come into use. This list reflects the most current understanding of the condition. It allows doctors to reach a more accurate diagnosis so patients can begin treatment at earlier stages.

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    Stooping Or Hunching Over

    Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .

    What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.

    Environmental Factors And Exposures

    Parkinson’s Disease [Parts 1 & 2] | 4 Cardinal Signs & Detailed Mechanism with Basal Nuclei

    Exposure to pesticides and a history of head injury have each been linked with PD, but the risks are modest. Never drinking caffeinated beverages, are also associated with small increases in risk of developing PD. Although smokers are at a reduced risk of developing PD, tobacco smoking has overwhelmingly negative effects on health and as many as half of people who use tobacco die from complications of tobacco use.

    Low concentrations of urate in the blood is associated with an increased risk of PD.

    Drug-induced parkinsonism

    Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:

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    Conflict Of Interest Statement

    EB has equity stake in Motac holding Ltd. and receives consultancy payments from Motac Neuroscience Ltd., companies which pre-clinical activity has no relationship with the present study.

    The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Cognitive And Psychiatric Symptoms

    • depression and anxiety
    • mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
    • dementia a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there and believing things that are not true

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    What Are The Risk Factors Of Developing Dementia After Parkinsons Disease

    Certain patients with Parkinsons disease are at higher risk of developing dementia than others. Some of the vital risk factors for developing dementia after Parkinsons disease may include older age, severity of symptoms and presence of mild cognitive impairment. Other additional symptoms which act as risk factor for developing into full fledged dementia include-

    • Excessive sleepiness in the daytime.
    • Presence of hallucination in the absence of other dementia related symptoms.
    • Presence of postural instability and gait which include freezing that occurs suddenly, difficulty in initiating movement and problems with balancing and frequent falling.

    Stiffness And Slow Movement


    Parkinsons disease mainly affects adults older than 60. You may feel stiff and a little slow to get going in the morning at this stage of your life. This is a completely normal development in many healthy people. The difference with PD is that the stiffness and slowness it causes dont go away as you get up and start your day.

    Stiffness of the limbs and slow movement appear early on with PD. These symptoms are caused by the impairment of the neurons that control movement. A person with PD will notice jerkier motions and move in a more uncoordinated pattern than before. Eventually, a person may develop the characteristic shuffling gait.

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    What Are The Symptoms Of Parkinsons Disease

    Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:

    Other symptoms include:

    • Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
    • Handwriting changes: You handwriting may become smaller and more difficult to read.
    • Depression and anxiety.
    • Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
    • Pain, lack of interest , fatigue, change in weight, vision changes.
    • Low blood pressure.

    Cardinal Motor Features Of Early Parkinsons Disease


    Tremor is the most common presenting sign of early PD . Approximately 70% of patients notice tremor as the first symptom . Onset of tremor is usually in one hand it may later involve the contralateral upper limb or ipsilateral lower limb. Typically, the tremor is a 3- to 5-Hz rhythmic pill-rolling movement of the thumb and index finger while the hand is at rest. There may be abduction and adduction of the thumb or flexion and extension of the wrist or of the metacarpophalangeal joints. The tremor may also extend to the forearm with pronation/ supination or even to the elbow and upper arm.

    During early disease, tremor is often intermittent and is evident only under stress. Tremor is worsened by anxiety, fatigue, and sleep deprivation. It diminishes with voluntary activity but may reappear with static posture and is absent during sleep. Resting tremor is enhanced by mental task performance, such as serial 7 subtractions, and by motor task performance in a different body part. The hand tremor may also be enhanced during ambulation. Compared with essential tremor, the resting tremor of PD is generally less likely to be exacerbated by caffeine or improved with alcohol.



    Generalized bradykinesia is rated by the overall slowing of all body parts, including an evaluation of how easily the patient stands from a seated position with or without pushing off the arm rests and of the patients speed of ambulation.

    Postural Instability and Gait Disturbance

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