Nonmotor, or prodromal/premotor symptoms, may arise up to 10 years before the emergence of motor symptoms. These signs include hyposmia, anosmia, depression, constipation, rapid eye movement sleep behavior disorder, visual changes, anxiety, and other autonomic disturbances. Olfactory testing may reveal hyposmia, which precedes motor signs by several years, thus providing evidence that points toward Parkinson's disease. However, olfactory loss is not specific and can also occur in Alzheimer's disease.
When motor signs do arise in Parkinson's disease, they are typically asymmetric. The most common initial finding is a resting tremor in an upper extremity. As the disease progresses, patients experience bradykinesia, rigidity, and gait difficulty. Axial posture becomes more flexed and strides become shorter. Postural instability is also a hallmark of Parkinson's disease but develops later in the disease course.
Soft voice and sweating with other thermoregulatory abnormalities are typical presenting symptoms of Parkinson's disease. Aphasia is not a typical symptom of the condition and can represent an absolute exclusion during diagnosis.
Learn more about the physical examination in Parkinson's disease.
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Cite this: Rajesh Pahwa. Fast Five Quiz: Signs and Symptoms of Parkinson's Disease - Medscape - Jan 13, 2022.