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Movement Symptoms

Parkinson’s disease (PD) symptoms are different from person to person and change over time. A PD diagnosis will only be considered when two of the four main motor symptoms occur:

  1. Slowness of movement (bradykinesia). Bradykinesia refers to an overall reduction of spontaneous movements, difficulty initiating movements and/or slowness in physical actions. It may give the appearance of abnormal stillness or a decrease in facial expression. This translates into difficulty performing everyday functions, such as buttoning a shirt, cutting food or brushing your teeth.
  2. Tremor. The typical tremor of PD is one that occurs mostly at rest or when engaged in another task, such as walking, and lessens when the body part is actively in use. It tends to occur in the hands – usually affecting one side of the body more than another - but it can also appear in other parts of the body, including the lower lip, jaw or leg. It can be exacerbated by stress or excitement.
  3. Rigidity. Rigidity or stiffness can occur on one or both sides of the body. It can contribute to a decreased range of motion and lead to problems with achiness or pain in the muscles or joints affected. Many people with PD will have a reduced arm swing when walking, moreso on the most effected side.
  4. Trouble with balance and falls (postural instability). A person with postural instability will have problems with walking, balance and turning around. They may fall when they turn or adjust their center of gravity, but can also fall without a clear reason. Some develop a tendency to sway backwards when rising from a chair, standing or turning. This is called retropulsion and may result in a backwards fall.

Additional Symptoms

  • Micrographia: small, untidy and cramped handwriting due to bradykinesia.
  • Shuffling gait: accompanied by short steps and often a stooped posture.
  • Freezing: gives the appearance of being stuck in place, especially when initiating a step, turning or navigating through doorways. Potentially serious problem as it may increase risk of falling.
  • Masked face (Hypomimia): results from the combination of bradykinesia and rigidity.
  • Soft speech (Hypophonia): soft, sometimes hoarse, voice that can occur in PD.
  • Festination: short, rapid steps taken during walking. May increase risk of falling and often seen in association with freezing.
  • Drooling (Sialorrhea): while not always viewed as a motor symptom, excessive saliva or drooling may result due to a decrease in normally automatic actions such as swallowing.
  • Cramping (Dystonia): sustained or repetitive twisting or tightening of muscle.

Dyskinesias

Dyskinesias are involuntary, erratic writhing movements of the face, arms, legs or trunk. Levodopa therapy is typically the cause of dyskinesias, but other drugs such as dopamine agonists, COMT inhibitors and MAO-B inhibitors can worsen dyskinesias.

They usually occur one to two hours after a dose of levodopa has been absorbed into the bloodstream and is at its peak levels in the brain. Dyskinesias usually begin after a few years of treatment with levodopa. They can often be alleviated by adjustments in medications.

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.

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