Parkinson’s disease is a chronic and progressive neurodegenerative disorder of the central nervous system which involves the loss of the dopaminergic neurones in the substantia nigra region of the brain and affects millions of people worldwide. This part of the brain is rich in dopaminergic neurons. Dopamine is a chemical neurotransmitter that is responsible for the transmission of signals from one part of the brain to another. It thereby helps in the muscular control and coordination of the body. Loss of the dopaminergic neurons lead to the deficiency of dopamine and hence various motor symptoms of the Parkinson’s disease manifest, which continue and worsen over time.
There is no definitive line of diagnosis or management for the Parkinson’s disease. The diagnosis is usually based on the neurological clinical examination conducted by a knowledgeable and experienced neurophysician. It is a very crucial part to understand and detect the early signs and symptoms of the disease which might eventually help in the administration of early treatment to the patient.
Parkinson’s disease is difficult to diagnose in the early stages. The first signs and symptoms of the disease are so subtle that are often missed. Often an observant family member or friend will notice the beginning of the changes in a person, which may be so vague that it is often dismissed as occurring due to old age. Diagnosis is frequently missed in younger people since the first signs and symptoms, even when noticed earlier, may be attributed to other conditions instead of Parkinson’s disease. Although the specific group of symptoms vary from individual to individual basis, primary motor signs of the Parkinson’s disease have been further discussed
Early Signs and Symptoms of Parkinson’s Disease
Although tremor, rigidity, bradykinesia (slowness of movement), and loss of postural reflex are considered to be the characteristic features of Parkinson’s. However, not all these symptoms are likely to be present in all patients in the early stages of Parkinson’s disease. Symptoms vary from person to person, and the onset may be so slow as to remain unnoticed for several years.
Some of the very first signs and symptoms likely to be observed are :
- A change in facial expression may be one of the earliest signs. Others may notice the expressionless face and fixed staring gaze without blinking of the eyes (“masked face”). Loss of animation is sometimes mistaken for depression.
- A barely noticeable tremor, usually on one hand, when the hand is at rest is among the first sign noticed by a person or their loved ones. It is also the first symptom which prompts many patients to seek medical help. The tremor may get worse when the person is agitated or stressed. Tremor of the lips, tongue, or chin may also be present. The typical “pill-rolling” tremor of Parkinson’s disease (repeated rolling of the thumb over the fingers) may be observed.
- Small Handwriting A sudden change in the handwriting is often an early sign of Parkinson’s disease. The writing can suddenly get much smaller and the words get comparatively crowded then it was in the past.
- Constipation is one of the manifested premotor symptoms if the dopamine producing cells located in the gastrointestinal tract are affected. A sudden loss of facial expression, tremors of one hand and the development of constipation might indicate the need to consult a neurophysician for the evaluation of Parkinson’s disease.
- Stooping or Hunching Over: If the patient is not being able to stand up straight as before and has simultaneously developed tremors, loss of facial expressions and constipation, it could be a sign of impending Parkinson’s disease.
However, some PD patients may not suffer from these symptoms, which may cause a delay in diagnosis or even misdiagnosis of the condition. Other features that may be noticed include :
- The symptoms are initially present on one side of the body.
- A feeling of internal trembling.
- A general feeling of fatigue and ill-health.
- Loss of arm swing while walking.
- Walking with short shuffling steps and a tendency to lean forwards or backwards while walking.
- Unsteady gait.
- Frequent falls.
- Unnatural posture.
- Walking in a stooped position.
- Slowness of movement, especially in initiating a movement, such as getting up from a chair and walking.
- Sudden freezing of movement while walking, with the person being unable to go forward without assistance.
- Soft, hesitant, slurred speech. The person may speak in a monotone.
- The handwriting may gradually become smaller and end off in a scrawl (micrographia).
- Muscle stiffness, often leading to pain, which may be mistaken for arthritis.
- Irritability, depression, or decreased concentration level may be noticed.
- Memory problems.
- Evidence shows that mood disorders and sleeping problems can start many years before the typical symptoms of PD become evident.
Detection of early symptoms of Parkinson’s disease can help to slow progression of the disease by starting treatment as soon as possible. However, many Parkinson’s patients are either embarrassed or in denial about the first signs and symptoms and often wait till they are unable to cope or pressurized by a loved one to seek medical help.
Pre-motor symptoms of Parkinson’s disease
The symptoms of the Parkinson’s disease usually manifest due to the loss of the dopaminergic neurons in the substantia nigra region of the brain. In addition to this, scientists all over the world, have recently identified the clumping of the protein, which is called as alpha-synuclein to be associated with the manifestation of the disease.
The clumping of this protein can be found in other regions of the brain, also in the gastrointestinal tract; all together it produces certain pre-motor symptoms which manifest years before the appearance of the common motor symptoms such as bradykinesia, tremors, rigidity etc.
These pre-motor symptoms include a decrease or a total loss in the sensation to smell and the sensation to taste which is also said as olfactory loss and gustatory loss in Parkinson’s disease. However these symptoms have also been associated with other neurodegenerative disorders who have a close resemblance to Parkinson’s disease, still they must not be overlooked as they play a crucial role in the early diagnosis and early treatment of this fatal neurodegenerative disorder.