What are the characteristics of Parkinson's disease?

Parkinson's disease begins with insidious attacks and progresses slowly. The first symptom is usually tremor or clumsiness in one limb, and then the other limb is affected. The main clinical manifestations are static tremor, bradykinesia, myotonia and postural gait disorder. In recent years, more and more people have noticed that non-motor symptoms such as depression, constipation and sleep disorder are also common complaints of patients with Parkinson's disease, and their impact on patients' quality of life even exceeds motor symptoms.

Static tremor (static tremor)

About 70% of patients take tremor as the first symptom, which mostly starts at the distal end of one upper limb, appears or is obvious at rest, lightens or stops at voluntary movement, aggravates when nervous, and disappears after falling asleep. The static tremor of the hand is aggravated when walking. Typical performance is "rubbing pill-like" tremor with frequency of 4 ~ 6 Hz. Some patients may be complicated with postural tremor. The patient's typical complaint is: "My hands often shake, and the more I stand still, the more I shake, but I don't shake when I am working to get things." When you meet a stranger or get excited, you will shake badly, and you will not shake when you fall asleep. "

Muscle stiffness

When the examiner moves the patient's limbs, neck or trunk, he can feel obvious resistance, and the increase of this resistance presents the characteristics of uniformity in all directions, which is similar to the feeling of bending a soft lead tube, so it is called "lead tube rigidity". When the patient is complicated with limb tremor, he can pause intermittently in uniform resistance, such as turning gears, so it is called cogged rigidity. The patient's typical complaint is "my limbs are stiff." In the early stage of the disease, sometimes myotonia is not easy to find. At this time, the patient can actively move one limb, and the muscle tension of the passive limb will increase.

Bradykinesia (bradykinesia)

Bradycardia refers to slow movement, difficulty in starting and loss of active movement. The patient's range of motion will be reduced, especially during repeated exercise. According to the different parts of the disease, bradykinesia can be manifested in many aspects. Facial expressions and movements are reduced, and blinking is called mask. The voice is monotonous and low, and the words are unclear. Writing will slow down and become smaller, which is called "microfilming". Fine movements such as washing and dressing may seem clumsy and inflexible. When the walking speed is slow, the swing amplitude of the arm will gradually decrease or even disappear. The pace becomes smaller. Drooling is because you can't take the initiative to swallow saliva. It's hard to turn over at night. At the early stage of onset, patients often mistake bradykinesia for weakness, and often misdiagnose it as cerebrovascular disease or cervical spondylosis because of weakness of one limb. Therefore, we should be alert to the possibility of Parkinson's disease when patients gradually develop weakness of one limb accompanied by increased muscle tension. The typical complaint of early patients is: "I recently found that my right hand (or left hand) is not very strong, not as neat as before, and my writing is not as beautiful as before." When I beat eggs, I feel that my right hand is not good, not as flexible as my other hand. " When walking, I feel that my right leg (or left leg) is heavy, which seems to be a bit procrastinating. "

Postural gait disorder

The disappearance of posture reflex often occurs in the middle and late stage of the disease, and it is difficult for patients to keep their balance, and they may fall down on a slightly uneven road. The patient's typical complaint is, "I'm afraid to walk alone." If someone touches me or there are stones on the road, I will trip. I have fallen several times recently, so that I am very careful when walking now. " Postural reflex can be detected by pull-back test. The examiner stood behind the patient and told him to get ready and pull his shoulder. Normal people can return to normal upright posture within one step back. Patients whose postural reflexes disappear often have to step back more than three steps, or need help to stand upright. PD patients tend to walk faster and faster, which is called panic gait. The patient's typical complaint is: "I often walk faster and faster and can't stop." Patients with advanced Parkinson's disease may be frozen, which is characterized by sudden inability to step for a short time when walking, and feet seem to stick to the ground, and it takes a few seconds to move on or start again. Freezing is common when starting to walk (difficult to start), turning around, approaching a target, or worrying about not being able to cross a known obstacle (such as crossing a revolving door). The patient's typical complaint is: "When you get up and walk, you often have to pause for a few seconds before you get up. Sometimes you can't walk a step, especially when you turn a corner or see something blocking the road in front. "

Non-motor symptoms

In addition to motor symptoms such as tremor and bradykinesia, patients with Parkinson's disease may also have non-motor symptoms such as depression, anxiety, sleep disorder and cognitive impairment. Fatigue is also a common non-motor symptom of Parkinson's disease. The patient's typical complaint is: "I feel very tired and weak;" Poor sleep, often unable to sleep; Dysdefecation, once every few days; When you are in a bad mood, you are always unhappy; Poor memory and slow brain response. "