What are the main symptoms?
Symptoms tend to appear gradually, normally in just one side of the body at first, although both sides will be affected as Parkinson's progresses. Each person will encounter different symptoms, in terms of severity and rate of progression, and there may be fluctuations from day-to-day, with 'good' and 'bad' days being experienced.
Loss of smell is now recognised as being one of the earliest symptoms. A reduced ability to smell will probably have been present for a considerable time before more obvious symptoms (listed below) are noticed, but often goes undetected for some time. Researchers are now beginning to realise that early symptoms such as this may be useful in aiding diagnosis and highlighting those at risk of developing Parkinson’s. Neuroprotective strategies are continually evolving and it is hoped that development of a reliable smell test could be an invaluable tool for early diagnosis and prompt neuroprotective treatment, which could in turn slow or prevent the progression of the disease.
The three main physical, motor-symptoms are:
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tremor: this can affect the hands and feet. The tremor is most marked at rest, and actually improves when performing a task. Another condition known as Essential Tremor (ET) is often misdiagnosed as Parkinson's as it too causes a tremor, but one which is absent at rest and most marked when performing a task
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muscular rigidity: this causes stiffness during movement
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bradykinesia: causing slowness, this symptom makes initiating movements very difficult.
Balance and posture can deteriorate as Parkinson’s progresses, resulting in problems with walking, turning around, rolling over in bed, and transfers, such as getting in and out of a chair or bed. Postural imbalance is therefore sometimes quoted as the fourth main symptom.
Communication difficulties are also common. Speech, facial expressions, body language and handwriting are affected in many people. Facial expression and body language are very important as they reveal emotions; people with Parkinson’s can be misunderstood because changes in facial expression are slow and limited, and body language is considerably diminished. Some people with Parkinson's say they can’t show on the outside how they feel on the inside.
Other symptoms include sleep disturbances, depression and anxiety, pain and fatigue. Swallowing and memory problems may also occur in the later stages of the condition.
As Parkinson's progresses
Progression is usually very gradual. Many people believe they had Parkinson's for some time - often two to three years - before seeking a formal diagnosis. Often it is only when the symptoms become noticeable or begin interfering with daily activities that a visit to the doctor is prompted.
Symptoms and responses to treatment are different for each individual, so it is not possible to accurately predict progression. For some it may take many years for the condition to develop, for others it may take less time.
How is Parkinson's diagnosed?
Because Parkinson's has symptoms similar to a number of
other neurological disorders and because every case is unique, diagnosis
of the disease can be difficult. There are similar conditions, often
referred to as Parkinson’s Plus syndromes or atypical-Parkinson
syndromes, which make diagnosis and treatment problematic. As such, a
thorough examination is required by a specialist doctor or neurologist.
Sometimes it may take several examinations over a period of time
(perhaps several years) before the diagnosis can be made confidently.
The doctor will discuss your general medical history
looking for the main Parkinson’s symptoms. Certainly he or she will be
looking for slowness of movement (bradykinesia) accompanied by at least
one of the following: tremor, rigidity and/or difficulty with balance.
Diagnosis may be further confirmed if there is a
positive response to medication used to treat Parkinson’s, whereas other
similar conditions may not respond well to such treatments.
Blood tests may be carried out to eliminate other causes
of symptoms. ‘Neuro-imaging’ may also be performed which shows and
assesses the anatomy and functioning of the brain and other parts of the
nervous system, and can effectively rule out conditions that have
similar symptoms.
