Parkinson's Disease: Comprehensive Symptom Overview

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by loss of dopaminergic neurons in the substantia nigra pars compacta, leading to motor and non-motor manifestations.

Cardinal Motor Symptoms (TRAP)

Other Motor Features

• Freezing of gait (FOG): "Feet glued to floor" — narrow spaces, turns, dual-tasking.
• Dystonia: Sustained muscle contractions (e.g., foot inversion, toe curling), often off-period or drug-induced.
• Speech changes: Hypophonia, monotone, festinating (accelerating), dysarthria.
• Dysphagia: Silent aspiration risk; weight loss, pneumonia.
• Seborrheic dermatitis: Oily, flaky skin (face/scalp).

Non-Motor Symptoms (Often Precede Motor by Years)

• Autonomic: Constipation, orthostatic hypotension, urinary urgency/frequency, sexual dysfunction, hyperhidrosis.
• Neuropsychiatric: Depression (40–50%), anxiety, apathy, psychosis (hallucinations — often drug-related), impulse control disorders (dopamine agonists).
• Cognitive: Executive dysfunction → dementia (PDD) in ~80% at 20 years.
• Sleep: REM sleep behavior disorder (RBD — prodromal), insomnia, excessive daytime sleepiness, restless legs.
• Sensory: Hyposmia (early), pain (musculoskeletal, neuropathic, central).

Progression and Heterogeneity

• Hoehn & Yahr stages 1–5 (unilateral → wheelchair/bedbound).
• MDS-UPDRS: Comprehensive rating scale (Parts I–IV).
• Subtypes: Tremor-dominant (slower progression), PIGD (postural instability/gait difficulty — faster decline, more cognitive impairment).

Management

• Levodopa (gold standard), dopamine agonists, MAO-B/COMT inhibitors, amantadine.
• DBS (subthalamic nucleus or GPi) for motor fluctuations/dyskinesias refractory to meds.
• Exercise (aerobic, resistance, balance), PT/OT/SLT, multidisciplinary care.

Early diagnosis and holistic management optimize quality of life.

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Symptom	Description
Tremor at rest	4–6 Hz "pill-rolling" tremor; starts asymmetrically (hand/jaw/foot); decreases with action, disappears in sleep.
Rigidity	Lead-pipe (uniform) or cogwheel (tremor-superimposed) resistance to passive movement; causes pain, reduced range.
Akinesia/Bradykinesia	Slowness, reduced amplitude, difficulty initiating movement; micrographia, hypomimia, shuffling gait.
Postural instability	Impaired righting reflexes; retropulsion; falls (late feature; early falls suggest atypical parkinsonism).