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Early Phases Of Parkinson's

Early Phases Of Parkinson's

Neal Hermanowicz (Director of the Movement Disorders Program) gives expert video advice on: How does early phase Parkinson's affect the voice?; What are the sexual effects of early Parkinson's?; What emotional problems are common during early phase Parkinson's? and more...

What signs of tremor do people have in the early phases of Parkinson's?

RIn the course, people may have a Tremor that comes and goes, or it may be just one finger of one hand that's intermittently shaking. That's not to say that everybody who has that is developing Parkinson's Disease; I want to be clear about that. But the Tremor initially can be intermittent, or fleeting, and not a persistent problem, and quite subtle.

What signs of rigidity do people have in the early phases of Parkinson's?

In the early phases of Parkinson's disease, rigidity is not often a complaint that people have. I may be able to detect it on their examination, but it's not something that they sense specifically themselves. They may, in certain circumstances, have a sense of stiffness. This “frozen shoulder” concept may be a manifestation of rigidity in some people, but it's not across the board; it's not everybody.

How does early phases Parkinson's affect dexterity?

Dexterity is often changed in the early presentation of Parkinson's disease. People will notice that their handwriting has changed. The ability to fasten buttons can become a bit more difficult, especially those on the collars or sleeves; those tiny buttons that are hard for all of us get harder still when dexterity is impaired. People will notice that just their small movements of their fingers are more awkward in their daily routine.

How does early phase Parkinson's affect posture?

Posture may or may not be changed early in the course of Parkinsons disease. People may notice a little bit of a stoop or a little bit of a lean to one side, but not necessarily everyone. It's usually not a conspicuous finding in early Parkinsons disease, nor does it ever necessarily happen to everyone, even later in Parkinsons disease.

How does early phase Parkinson's affect body movement?

Bradykinesias happens in a slowing in movements. All of us, as we grow older, may get somewhat slower, but people with Parkinsons or even more likely their spouses or other people closer to them will recognize that they are slowing down. It is a little bit slower to get out of a car, a little bit slower or harder to get out of the bed or out of a chair. Slowness in other daily tasks may be evident to the person or to those around them.

How does early phase Parkinson's affect balance?

Balance may not be affected at all in early Parkinsons. Usually it's not. If people have a sense of unsteadiness, it is usually not at the initial presentation and occurs later.

How does early phase Parkinson's affect the face?

These are subtle changes, but may be noticeable to people around a person who is affected - a reduction of the spontaneous facial expressiveness that we all have. People may have the appearance of seeming thoughtful or even stern or angry. Or even depressed. But it's not really conveying mood, it's just a reduction of these normal facial expressions that we all have. It's sometimes called a masked face or a poker face, an appearance that people may develop.

How does early phase Parkinson's affect the voice?

This is an early manifestation in many people with Parkinsons disease that the voice may be a little bit more monotone in it's quality, less inflected. All of us, again, as we speak we have this sort of normal up and down to our voices, and that can be changed in people with Parkinsons disease. It's more of the same tone throughout. Also, volume can be affected so that a person's speech can be reduced in volume, and they're asked to repeat things more often.

What are the sexual effects of early Parkinson's?

Sexual problems are quite common in Parkinsons disease and it's been studied mostly in men, I suppose because it's simply easier to study this in men. But it can be manifested as erectile dysfunction or lack of, or reduction of, sexual interest as well.

What emotional problems are common during early phase Parkinson's?

Depression and anxiety, which often go hand in hand, can be another very early occurance in Parkinsons disease. There have been some studies focusing on exactly that question. Does that occur prior to the appearance of some of the motor findings in Parkinsons disease? It may be present early on in the course, and may be again, a clue that something is going on along the lines of Parkinsons disease. Not everybody with depression is developing Parkinsons disease, obviously, but it can be an early symptom with Parkinsons disease.

What kind of pain does a person feel in the early phases of Parkinson's?

Pain is increasingly recognised as being a feature of Parkinsons disease. Pain against a non-specific symptom, so somebody who has a limb pain does not necessarily develop Parkinsons disease. A frozen shoulder is often a painful symptom, or people may have aching or a vague sense of discomfort in their limbs, which is probably a manifestation of rigidity or this impaired mobility associated with Parkinsons disease that may improve with medication.

What are treatment goals during the early phases of Parkinson's?

The goal of therapy in Parkinson's disease, including early Parkinson's disease, is to help alleviate symptoms so that they're not so troubling on a daily basis, in terms of daily functioning including activities of daily living: eating, dressing, showering, that sort of thing. But also for people who are working, to try and relieve the symptoms during the work day as well. The goal is not to eradicate symptoms completely. The therapies that we have available includes medications, exercise and surgery in some cases. All are geared toward minimizing, but not eliminating symptoms.

What are the side effects of drug treatments during early phase Parkinson's?

There are a lot of side effects that can occur with the medications for Parkinsons disease. Most commonly, I would alert people to things like nausea or drowsiness, or in some cases a sense of light-headedness or dizziness as a consequence of blood pressure being reduced by some of these medications.