The symptoms of Parkinson's disease
The onset is most often insidious and is usually around fifty-five years. In fact, it can occur at any age but rarely before age 40 or after 75, year was found in about 5% of cases the onset of the disease between 20 and 40 similar to Parkinson's disease described in the older people.
Often without apparent reason, sometimes due to stress (emotional, trauma, surgery)
Loss or reduction of automatic movements, such as the lack of arm swing when walking, is sometimes an early sign of onset of Parkinson's disease. This is the classical description. In fact, generally, it is only after years of evolution or another symptom that appears when there are already several years. It can be among other difficulties for a person to use his hands to make gestures purposes; it was usually easy. This may be the case of an athlete or a handyman accustomed to using small tools; it can be less.
Sometimes it's the voice that gradually decreases.
It is sometimes possible to observe a change in the near attitude of gestures, the bending of an arm, hand positioning, the stiffness of one leg behind, etc. ... but these are not typical symptoms that can readily establish the diagnosis of Parkinson's disease.
For some patients, the onset of this disease simply results in a feeling of fatigue, a general loss of energy, physical fatigue that is sometimes confused with fibromyalgia among others because these symptoms are accompanied by sleep disturbances and memory, for example.
Weight loss has also been reported as an early symptom of Parkinson's disease, associated or not with depression, loss of orbital, etc. ... Depression, not to be taken as a symptom of Parkinson's disease, must be analyzed in the following sense. It usually occurs in a person 50 to 60 years previously showed no such trouble.
Again, these symptoms are not sufficient to pose with certainty the diagnosis of Parkinson's disease.
Some symptoms may in turn geared more towards a certain Parkinson's disease. It can be, for example, a member numb, pain in joints while additional tests such as X-ray and blood tests show no inflammation, for example.
There are usually repetitive movements like rubbing a table, grooming, wiping, and become more difficult, leading to more fatigue, are in favor of early Parkinson's disease. More specifically, it is the effort that is required for a person to perform a movement, which can put a flea in the ear of a practitioner. If we consider that for movement, it is usually unnecessary to focus before and ask her body an extra effort, it is in this case possible to diagnose Parkinson's disease.
Then the earthquake. Often, at the beginning, it is not noticed by the entourage. Indeed, it is usually just a small tremor that is not very visible. And if we observe carefully certain movements, especially those of large amplitude, it is possible to highlight a loss of fluidity of movement that appeared as irregular and chopped. Tremors, to guide the diagnosis to Parkinson's disease should occur at rest, ie when the patient does not use the member who is being considered.
Another way to guide the diagnosis is the occurrence of the first symptoms that sometimes the patient can precise date. Take, for example, this 55-year-old man who, on the date of 16 February 1999, when he had to make a speech at a union meeting, was suddenly taken tremor. If you ask the patient why these quakes occurred, he says he felt rising in him anguish and his right hand began to tremble. Until now, this has never stopped trembling. This phenomenon may be explained as follows. It is difficult to believe that this type injury is probable to cause the onset of Parkinson's disease. It seems likely that the disease was already latently present and the stress has only increased, worsening evolution, leading to the disease itself.
The characteristic symptoms of this disease, apart from tremor, rigidity is and what neurologists call the akinesia. It is the parkinsonian triad in which akinesia takes the first place, contrary to what we have thought long about the earthquake was considered emblematic of this disease.
It must stop for a moment on akinesia. This term means depriving the movement. Some neurologists prefer that bradykinesia, which means slowness of movement, and in fact, refers to the lengthening of the time between when the patient wishes to make his move and run it.
Physiologically, that is to say, normally, a movement, as everyone knows, or could know it, is fluid. This is the result of the action of muscle's agonists / antagonists. These two muscles must work together. Indeed, while the agonist muscle performs the movement, the antagonist muscle at the same time, must be able to relax. On the other hand, for movement, always in a normal person, it is not necessary to consider. Several movements are possible conversely and coordination of these is perfectly undisturbed, especially in case of impossibility of concentration or stress occurs when, for example.
In individuals with Parkinson, he is nothing. First, gestures are rarer; the automatism of movements does not properly spontaneous gestures either. To realize this, just look at the face of a patient with Parkinson's disease. It is impassive, expressionless, blinking eyelids rarely (amimie).
On the other hand, for a movement that requires a power and a major motivation, the patient spends a lot of energy, which leads to fatigue more important. Some neurologists, it is a real stuttering because the patient walking and trampling small steps, feet dragging on the ground, sometimes staying stuck.
If you ask a Parkinson's patient, during his March to change something, such as through a door, it freezes in a position hangs. The English called this the freezing (frozen). Then, after crossing a barrier that should not be the individual but only restarts after a few seconds of hesitation, reintroducing trampling and gait characteristic of a Parkinson's patient leaning forward as if to catch its center of gravity. This is called festination.
The autonomic nervous system, that is to say, that regulating the activity of internal organs and vital functions, is sometimes disrupted after the disease. The heartbeat, the functioning of the digestive tract, the secretion of sweat, body temperature, respiration, urinary excretion. .... are automatic, or if you prefer vegetative.
Excessive secretion of saliva, also called hypersalivation, is one of the most common symptoms occurring in Parkinson's disease. This saliva, which stagnates inside the oral cavity tends to take a labial (that is to say, the corner of the mouth). This does not mean that saliva is secreted in large quantities in this patient, but movements that allow it to swallow (swallowing) and thus remove the saliva in the digestive tract are abnormal. In contrast, dry mouth, as occurs among others in taking certain neuroleptics that cause the recall parkinsonism, is not common in Parkinson's disease, or absent. In general, there is a slowdown in the digestive tract.
Constipation is relatively common in Parkinson's disease. This seems to be explained by akinesia (a: absence and kinesis movement) and more specifically the general slowdown that promoted bowel movements normally transit (progression of the bolus) tract.
Weight loss is probably the result of poor nutrition. This usually occurs early and is quite important. Weight loss can range from a few hundred grams to a few kilos per month. In this regard, it is necessary not to confuse a malfunction, that is to say; a malfunction of the thyroid gland may also lead to weight loss with Parkinson's disease.
Urinary difficulties characterized by urination, that is to say, the emission of urine, slow and inadequate emptying of the bladder and the urge to urinate early (frequency), the other symptoms are occurring course of Parkinson's disease.
Sexual difficulties linked to other dopamine deficiency and motor disorders associated with Parkinson's patients are experiencing symptoms of the patient.
Malfunction of the autonomic nervous system explains the onset, the patient parkinsonism, hot flushes, particularly the face. This forces the patient, to the dismay of his family more often to live the same window open in the winter.
On the skin, there is the occurrence of a condition named seborrheic dermatitis, which is characterized by increased secretion of seborrhea typically associated with excessive secretion of sweat, which gives the appearance parkinsonian patient erythematosus (skin red) fat and shiny. To this is usually associated pruritus, that is to say, itching, scabs and sometimes white.
When examining a patient with Parkinson's disease, there is a face frozen and expressionless. The patient gives the impression of not being able to perform gestures, as if dazed.
The rest of the review highlights the most presence of edema of the lower limbs. This can be explained partly by the circulatory stasis (lack of blood flow) due to akinesia. This concerns both akinesia whole body as the heart itself, which penalizes the return of venous blood. Taking care to take blood pressure, it is especially low when it passes from the supine to standing position (orthostatic hypotension) and may lead to the onset of dizziness or discomfort.
The Parkinson's patient is not suffering from intolerable pain. However, because of stiff neck, headache (headache) appeared. In some cases, spinal ankylosis is likely to cause the appearance of painful symptoms.
The Parkinson's patient cognitive impairment (intellect)? No, it was already described by James Parkinson. However, more recently have been described small subtle mental changes. The Parkinson's patient is characterized by a particular profile. Indeed, this patient is most often ordered shy but ambitious. It is therefore, the most introverted personality.
Other psychological disorders may occur more frequently are depression, which is installed in a few weeks at any time of the development of Parkinson's disease. It is necessary to know that depression can worsen motor disability. This depression is like any depression, and it has no particular specificity. There is a sadness of mood is associated with fatigue, irritability, anxiety, decreased tension, impaired concentration, pessimism, dissatisfaction and ruminations (being dwelt). This type of psychological symptoms is sometimes treatment with antidepressant drugs. Patients most often have what is called emotional lability. What is it? Sometimes, an individual with Parkinson's disease, desiring to speak, especially to say something of interest at the highest point, emits a grin reflecting some pain. It is not sadness but the difficulties accompanying the issuance of the emotions felt by the patient him look crying when he speaks so happy. All this is put down to an exaggerated anxiety.
All these psychological symptoms can be summarized under the term bradyphemia, which refers specifically neuropsychological difficulties and slowing down the process of thought, which does not interfere unduly parkinsonian patients.
Sleep tends to fragment, which occurs naturally during aging in patients without Parkinson's disease.
The writing is shaky. It begins at the words of normal size and eventually becomes small (micrograph).
The rest of the Parkinsonian patient examination shows:
Parkinsonian rigidity is internal when passively stretched muscles are mobilized or submissively (that is to say, the examiner, physician among other moves a member of the patient); we find throughout the duration of the stretching and mobilizing a constant resistance.
Neurologists use the lead pipe rigidity. This means that patients are malleable nature of the stiffness, which is opposite to the elastic stiffness as seen in the pyramidal syndrome is another neurological disease. If we mobilize passive member of a patient, we find that the rigidity parkinsonian patient presents hereby assign to successive blows, which gives rise to the occurrence of a phenomenon called gear. This phenomenon is explained as follows. We know that in Parkinson's disease, the antagonistic muscles do not relax when the agonist muscles contract. It is this phenomenon, which induces that of the gear. Neurology specialists call this type of movement: extrapyramidal rigidity type plastic. This tends to fix muscular hypertonia attitudes.
Another phenomenon can also be demonstrated during the examination of the patient parkinsonism. It is explained by the tendency to flexion that persists when the patient is supine, that is to say, lying. Thus, if we remove the pillow behind the patient's head, it tends to fall back slowly.
There is secondly an exaggeration of reflexes, slurred speech named dysarthria, a contrast between bright eyes and expressionless face.
During the examination, it is possible to perform the following test. If the patient is pushed back and forth, which imbalance thereof slightly, this movement does not usually raise the toes, is associated with the phenomenon of a Parkinson's patient foot glued to the floor.
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