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Cardinal Manifestations
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Cardinal Manifestations

Bradykinesia, hypokinesia, and akinesia. Motor disturbances include slow initiation of movement (akinesia), sluggishness of movement (bradykinesia) and diminished spontaneous movement (hypokinesia); these terms are often used nearly interchangeably, as these disturbances all tend to occur together. Spontaneous fluctuations of mobility are not uncommon. The motor disturbances are often more pronounced on one side of the body, especially in the early stages of disease. They affect the craniofacial musculature to produce a masklike facies (hypomimia), defective mouth closure, reduced blinking, dysphagia, salivation (drooling), and speech that is diminished in volume (hypophonia), hoarse, poorly enunciated, and monotonous in pitch (dysarthrophonia). It may be hard to initiate speech, or repeat syllables. Postural changes include stooped posture, a mildly flexed and adducted posture of the arms, and postural instability. Gait disturbances appear in the early stages of disease and typically consist of a small-stepped gait, shuffling, and limping, with reduced arm swing. Difficulty initiating gait comes about in the later stages of disease, along with episodes of “freezing” - complete arrest of gait when the patient is confronted by doorway or a narrow path between pieces of furniture. It becomes difficult for the patient to stand up from a seated position, or to turn over in bed. Festinating gate - an involuntary quickening of gait, as in some persons with Parkinson's disease. Impairment of fine motor control impairs activities of daily living such as fastening buttons, writing (micrographia), eating with knife and fork, shaving, and hair-combing. It becomes difficult to perform two activities simultaneously, such as walking and talking.



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