Parkinson's - Clinical Presentation

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Basal Ganglia Function

The basal ganglia control well-learnt, long and complex movement sequences by co-ordinating or ensuring certain actions, including:
Pre-movement planning and preparation
Initiation of movement
Sequencing and timing of movement
Maintaining cortically selected movement amplitude i.e. the frontal cortex is involved in the choice of movement, after which the basal ganglia take over and communicate with the other areas of the brain. The scale of a required movement is then calibrated the through sensorimotor integration. For example, a person may start to walk with normal step length, but if amplitude is incorrectly executed, their steps soon become shorten, progressing to a shuffling gait.

Basal Ganglia Dysfunction

Basal ganglia dysfunction affects the automatic nature of our movements. This includes:
Impaired performance of well-learnt motor skills and movement sequences
Problems maintaining sufficient movement amplitude
Difficulty in performing more than one task simultaneously (dual-tasking)
Difficulty in shifting motor and cognitive sets
Slower mental processing
Perseveration (repetition) in thought and action
For a person to perform activities of daily living, the basal ganglia need to be working properly. Impairment affects both mental and physical agility as described by motor and non-motor symptoms.

Clinical Presentation

The main motor (movement) symptoms of Parkinson’s are:

1. Tremor (involuntary shaking of parts of the body) www.epda.eu.com/en/parkinsons/in-depth/pdsymptoms/tremor/tremor-parkinsons/
2. Rigidity (experienced as muscle stiffness) www.epda.eu.com/en/parkinsons/in-depth/pdsymptoms/rigidity/rigidity-and-parkinsons/
3. Bradykinesia (experienced as slow movement) www.epda.eu.com/en/parkinsons/in-depth/pdsymptoms/bradykinesia/bradykinesia-and-parkinsons/
   

Progression of Parkinsons

The Hoehn and Yahr scale is commonly used to describe how the motor symptoms of Parkinson’s progress.

The original scale was published in a 1967 article by Melvin Yahr and Margaret Hoehn, and included stages 1 to 5.

Since then, a modified Hoehn and Yahr scale has been proposed with the addition of stages 1.5 and 2.5 to help describe the intermediate course of the disease.

File:PPHYscaleParkinsons.pdf

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