Neal Hermanowicz (Director of the Movement Disorders Program) gives expert video advice on: How is dexterity affected by Parkinson's?; How does Parksinson's affect the skin?; How does Parkinson's affect body weight? and more...
What is 'parkinsonism'?
Parkinsonism is a broad term. Parkinsons Disease refers to one kind of disorder that causes Parkinsonism. There are other things that can cause Parkinsonism. Parkinsons Disease infers a very specific process in the brain leading to that problem of Parkinsonism, meaning slowness of movement, maybe stiffness of movement, and a change in walking. Parkinsonism is the constellation of symptoms or findings that look like Parkinsons Disease. There are many things that can cause Parkinsonism, including Parkinsons Disease. Sometimes medications can do that. Medications such as metoclopramide, also called Reglan, or prochlorperazine, known as Compazine, these things can, in some people, some sensitive people, mimic the findings of Parkinsons Disease or cause Parkinsonism. Parkinsonism could be caused by multiple small strokes accumulated over time. In certain parts of the brain when it's injured by a stroke, that can lead to the same sort of constellation of symptoms and signs. Specifically, a shuffling type of walking, or alteration of walking, slowness of movement, a sense of stiffness of movement. Parkinsonism may also include tremor, but not necessarily. Parkinsonism broadly refers to slowing of movement and alteration of walking.
What is 'tremor,' in relation to Parkinson's?
Tremor is the single most common symptom that drives people to see the doctor in the first place, where they ultimately receive a diagnosis of Parkinsons disease. Tremor is a rhythmic shaking, usually of a limb, and in Parkinsons disease initially usually of a hand or both hands. The head is rarely affected in terms of shaking. The tremor - and this is an important point - refers to a rhythmic movement, a shaking - not necessarily to any involuntary movement, but this rhythmic movement.
What is the difference between 'internal tremor' and 'external tremor'?
Internal tremor is what people feel, but we can't as a clinician see it. People will say, I feel as if I am shaking inside myself, but it is not visible to the patient nor to the clinician. I suspect that's simply a subtle tremor that's not visibly detectible either by the clinician or by the patient. It's a manifestation of the same process. It's just not obvious.
What is 'bradykinesia'?
Bradykinesia simply refers to slowness of movement. In medicine, we like words that have multiple syllables, but bradykinesia means slow movement.
What is 'akinesia'?
Akinesia is a reduction of movement, a reduction of spontaneous movements. All of us move naturally when we're seated or talking or we adjust our posture or we have change in our facial expressiveness. Akinesia literally means an absence of movement, but we use it to refer to a reduction of spontaneous movements.
How is dexterity affected by Parkinson's?
Dexterity, or an alteration of dexterity, is often a very early finding in Parkinsons disease. People will notice, for example, that they're having difficulty with their handwriting. It's a very indication that something might be wrong. Handwriting becomes less legible and perhaps smaller in size, and other small movements of the fingers, just this sort of finger tapping type of movement, is often affected early in the course of Parkinsons disease. It can be showing itself in the daily routines in subtle ways, such as fastening buttons or doing other small motor movements.
What is 'rigidity' in relation to Parkinson's?
Rigidity is an important point. It's a change in tone. Many of us who are not in health care or are not physicians or clinicians, don't think about tone, but it's a very important concept to neurologists. Tone is simply the sense of resistance that people have in the movement of their limbs. I check this routinely on the examination of my patients, looking for alterations in tone. Sometimes its quite subtle, but I can detect it, and somebody who does this a lot in the daily routine of their work develops a sensitivity to change of tone. People with Parkinsons, or Parkinsons Disease, do have a change in the tone of their limbs, which can be detected on a clinical examination. Moreover, patients may complain about it in a way that theyll express as, I feel stiff, I feel rigid, not necessarily at the outset but at a later time during the course of Parkinsons Disease, people may develop a sense of stiffness. However, early on it can often be detected by a clinician whos sensitive to it.
What is 'frozen shoulder' and how does it relate to Parkinson's?
Frozen shoulder is increasingly being recognized as sometimes a very early presenting complaint in Parkinsons disease. People will come in talking to their doctor, complaining to their doctor that they feel stiff or have a sense of pain in their shoulder. And it may be, when it's early, not recognized for what it is, meaning a symptom or manifestation of Parkinsons disease. People thought maybe they have a rotator cuff problem, or they're having some sort of orthopedic or arthritic problem in their shoulder, when in fact it's a consequence of the stiffness that's occuring on that limb. Again, in Parkinsons disease, it usually shows up first just on one side, so people will come in complaining of "my shoulder is stiff", or "I'm slow", or "I have this sense of pain in my shoulder", and with Parkinsons disease it actually improves.
What is 'dyskinesia'?
Dyskinesia literally means abnormal movement but in the setting of Parkinson's disease, it refers to movements that are actually induced by the treatment of Parkinson's disease. These are things that are not in natural part of Parkinson's disease unless it is treated. Dyskinesia, I can probably best demonstrate it this sort of squirming movements, involuntary, restless-looking movements that are elicited or brought on by the treatment of Parkinson's disease.
How does Parksinson's affect the skin?
There are skin changes associated with Parkinson's disease. It is an intriguing point because we really don't know why. People can get a ruddy red rash on their face or their scalp or even other body parts. They may have a sense of increased oiliness on their face as well.
How does Parkinson's affect body weight?
Maintence of weight is a problem that occurs with Parkinsons disease. People tend to lose weight without even trying. It doesn't neccessarily correlate to the severity of the disease but people can drop 20, 30, 50 pounds in the course of a year or two without even trying. The source of this is not entirely clear. It may be due to changes in sense of appetite. It may be related to the difficulty with swallowing that people are less likely to eat and drink food and water. But people can lose weight. Also, as people are sedentary they tend to have a reduction of muscle mass as well which is associated with weight loss.