Parkinson’s Disease (Pd)

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Parkinson’s Disease (PD)

Parkinson’s disease may have a long premotor phase. Mid-life risk factors for the later development of Parkinson’s disease include constipation and daytime sleepiness. These may well be the first clinical manifestations of the disease but are nonspecific. Additional features that commonly precede onset of motor signs include decreased sense of smell and REM behavior disorder (RBD).

REM behavior disorder is a sleep disorder in which there is a loss of normal atonia during REM sleep. Patients are observed by their bed partners to “act out their dreams” and the partners may not kicking, hitting, talking or crying out. In one study, 38% of 50 year old men with REM behavior disorder and no neurologic signs went on to develop Parkinsonism. REM behavior disorder is common throughout the course Parkinson’s disease.

Onset of motor signs in Parkinson’s disease is typically asymmetric, with the most common initial finding being an asymmetric resting tremor in an upper extremity. About 20% of patients first experience clumsiness in one hand. Over time, patients notice symptoms related to progressive bradykinesia, rigidity, and gait difficulty.

There are three signs of Parkinson’s disease. These are the resting tremor, rigidity, and bradykinesia. Of these cardinal features, 2 of 3 are required to make the clinical diagnosis. Postural instability (balance dysfunction) is the fourth cardinal sign, but it merges late in the disease, usually after 8 more years or more. The initial symptoms of Parkinson’s disease may be nonspecific and include fatigue, depression, constipation, and sleep problems.

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