Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The three key signs of Parkinson's disease are tremor (shaking) at rest, rigidity, and slowness in the initiation of movement (called bradykinesia). Of these features, two are required to make the diagnosis. Postural instability is the fourth key sign, but it happens late in the disease, usually after having PD 8 years or more.
Tremor at rest
Tremor usually begins in one arm and may start and stop.
Some people experience a subtle decrease in dexterity and may notice a lack of coordination with activities such as golf, dressing, or climbing stairs.
Some people complain of aching or tightness in the calf or shoulder region.
The first affected arm may not swing fully when walking, and the foot on the same side may scrape the floor.
Over time, posture becomes progressively flexed and the gait becomes shorter, leading to a shuffling gait.
Decreased swallowing may lead to excess saliva and ultimately drooling.
Symptoms of problems with the involuntary nervous system are common and may include constipation, sweating abnormalities, and sexual dysfunction.
Sleep disturbances are also common.
Symptoms are usually progressive in their severity over time. However, not every symptom described may be apparent in each individual PD patient. However, the older the age of initial onset of PD, usually the more rapid development of motor and cognitive decline symptoms.
Reviewed by Melissa Conrad Stöppler, MD on 4/12/2013