Parkinson’s Disease (PD), "the shaking palsy" first described by James Parkinson in 1817, is a progressive neurodegenerative disorder which affects in upwards of 1.5 million Americans. The disease begins to occur around age 40 and has incidence with patient age. One survey found that PD may affect 1% of the population over 60. Incidence seems to be more prominent in men, and tends to progress to incapacity and death over one or two decades.
Clinical diagnosis of PD is currently solely dependent on the presentation of the symptoms by the patient which reflect a deficiency of striatal dopamine caused by the destruction of the cells in the substantia nigra. Imaging and other laboratory techniques can be used to rule out other disorders, but are not necessary for the actual diagnosis of PD. The first sign of PA is usually bradykinesia. Movements are usually quite slow. Routine activities may require deliberate planning and thought for execution. Difficulty initiating movements or akinesia, may also be present. Rigidity in the flexors is also present. This is due to an exaggerated response to normal proprioceptive return from the somatic musculature. A resting tremor of 3-6 Hz is also a prominent feature of PD. This may cause difficulties in handwriting as a symptom. Impaired postural reflexes is also a presenting feature in PD. Patients can easily lose their balance when pushed slightly, and may need to be caught to keep from falling. These signs can be tested by observing the patients walking, getting out of deep chairs, and performing rapid repetitive movements. Increased disturbances in cognitive abilities can also show evidence of PD. Even with all these signs of PD, it may be present and undiagnosed for years.
Autonomic nervous system disturbances often times accompany the other symptoms of PD. Patients may present with difficulties in salivation, micturition, and gastrointestinal function, as well as defective control over the cardiovascular system and temperature regulation. Gastrointestinal dysfunction is probably the most common autonomic problem in PD. Sialorrhea, excessive production of saliva, is a common late symptom seen in Parkinson’s. This is probably due to the lack of autonomic swallowing and is therefore regarded as being due to hypokinesia (Korczyn, 464). In more advanced cases, difficulties in swallowing may need to be alleviated by administration of drugs which liquefy the saliva. Constipation is also a common clinical autonomic symptom. This is often made worse by the use of the anti-Parkinsonian drugs. Weight loss to varying degrees can also accompany the disease. Cardiovascular problems can be seen in PA patients, but these are to a lesser extent than the gastrointestinal problems. Cardiac arrhythmia’s were found in a number of patients, but the most incapacitating cardiovascular symptom is orthostatic hypotension. Interestingly, the hypotension in PD is more common following meals. This...