Move often

Psychiatry, Psychosomatics & Psychotherapy

Disease picture, symptoms and complaints of Parkinson's syndrome

As Parkinson's disease progresses, four main symptoms come to the fore. The neurologist / neurologist speaks of these main symptoms as cardinal symptoms. These are:

  1. Sedentary lifestyle (akinesia)
  2. Muscle stiffening (rigor)
  3. Tremor (tremor)
  4. Disorders of postural stability (postural instability)

Often the disorders are initially only or predominantly on one side of the body.

The sedentary lifestyle (technical term: akinesia) is the most important sign of Parkinson's syndrome for the doctor. The patient can only perform movements more slowly. Only after a certain delay does he manage to get his arm or leg going. The patient perceives this as a loss of spontaneity, which is also a psychological burden. Akinesia is often unpredictable. In one moment the patient can still move freely, in the next moment he no longer succeeds in movement routines. What used to be done quickly, such as putting on and taking off, now takes a long time, sometimes hours. The range of motion is also reduced, the gait in small steps, the writing smaller.

2. Muscle stiffness

Rigor (technical term: muscle stiffness) is present in most Parkinson's patients and severely impedes them. Normally, when a muscle is tensed, the opposing muscle automatically relaxes. In Parkinson's disease, this fine balance is disturbed. The result is felt as stiffness all over the body. At the same time, the patients feel weak because the force of movement has to overcome the stiffness of the opposing muscles. The rigor becomes particularly clear when a second person passively bends or extends the arm of the person with Parkinson's disease. Even if the patient tries to relax and move his arm, it is not easier to move.

3. tremors

The tremor occurs especially at rest and is usually unmistakable. Even if the patient tries to keep his hands still, the thumb and phalanx of the fingers move back and forth in a steady rhythm. Often there are four to six, sometimes up to nine movements per second! Some patients move their thumbs and fingers towards each other as if they were moving a ball inside of them. Doctors also refer to this as "pill-rolling".

Tremor often begins in the hand, but it can also begin in the feet and jaw first. Any attempt to suppress the tremor will fail. When the patient is under stress, the tremor increases even further.

4. Disturbances in postural stability

One of the most noticeable signs of Parkinson's syndrome is postural instability (technical term: postural instability). The reflexes that normally ensure that we can automatically balance our body even when moving are disturbed in Parkinson's sufferers. A disruption of these reflexes means that the affected person can no longer easily “catch” himself in the event of a sudden, unforeseen movement. There is an unsteady gait. The lack of balance and coordination in movement means that patients often fall.

Patients often have a stooped posture with knees slightly bent. As the disease progresses, walking becomes increasingly difficult. Some shuffle or take a series of small steps as if they had to hurry (technical term: festination). Changes in direction are difficult, and minor obstacles (such as a stick lying in the way) can often hardly be overcome. Once you are walking, you cannot stop moving and you shoot over the target.

More symptoms

In addition to these four main symptoms, a number of other signs of illness are possible, but these can vary from patient to patient. All of these symptoms are typical of the disease, but do not have to be present. Their severity varies from person to person and individual symptoms can also be completely absent.

These include, for example:

  • Paresthesia or pain in the neck, back, or extremities;
  • Changes in emotional life;
  • Decline in mental abilities in general - but not to be confused with the slowdown in physical agility, which can simulate a loss of mental abilities;
  • Speech disorders (soft, slurred speech);
  • Difficulty swallowing, possibly with increased salivation;
  • Skin problems, partly oily or oily areas of the face (ointment face) or dry skin and scalp dandruff, sweating disorders;
  • Trouble sleeping.

In the advanced stage, further complaints can arise that can be traced back to disorders of the autonomic nervous system, such as bladder weakness or constipation, fluctuations in blood pressure and body temperature, and erectile dysfunction in male patients.

Technical support: Prof. Dr. Alfons Schnitzler and Priv.-Doz. Dr. Martin Südmeyer, Düsseldorf (DGN)