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Other Motor Symptoms

Key Points

  • Cardinal symptoms are necessary to diagnose parkinsonism but other motor symptoms can help you in making the right diagnosis.
  • Evaluation of other motor symptoms is important for management of PD.
  • Some of the non cardinal motor symptoms may affect treatment. 

Clinical Best Practices

  • Reconsider the PD diagnosis at every visit.
  • Conduct a full medical examination. Neurological examination in not sufficient.
  • Tailor treatment to each patient based on individual needs and preferences.

As all cardinal symptoms in PD (tremor, bradykinesia, rigidity, postural instability), the following motor symptoms are due to loss of dopaminergic neurons:

  • Masked face
  • Reduced blink rate
  • Hypophonia
  • Drooling
  • Micrographia
  • Hypokinetic dysarthria
  • Reduced spontaneous gesturing while talking
  • Stooped posture
  • Difficulty turning over in bed
  • Dystonia 

These symptoms can be present at any stage of the disease but are not specific of PD. Most of these symptoms can be addressed from the moment you start talking to your patient and should be addressed throughout the physical examination.

UK PDS Brain Bank Diagnosis Criteria

PD: The Basics

Information on Dyskinesia

What You and Your Family Should Know

Medications

Guide to DBS

Medications Schedule Form

References: 

Ahlskog, JE. Clinical diagnosis of PD. In: Ahlskog, JE. Parkinson’s Disease Treatment Guide for Physicians. New York, NY: Oxford University Press; 2009:20-27.

Ahlskog JE. The Parkinson’s Disease Treatment Book: Partnering with Your Doctor to Get the Most from Your Medications. New York, NY: Oxford University Press; 2005:25-47