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As the basal ganglia function is impaired in Parkinson’s Disease (PD), the major symptoms of PD are related to abnormal movement of the body: slowness of movement, stiffness and tremor. The presenting symptoms of 153 patients seen at University Malaya Medical Centre, Kuala Lumpur are summarized on Table 1 (Chew NK, Goh KJ and Tan CT, 1998).

a) Slowness of movement

The most common symptom that brings a patient to the doctor is slowness of movement. Patients often complain that their legs are getting slower or weaker when they try to walk or run. Others may notice that they cannot write or use a computer as fast as before. In addition to execution of body movement, sufferers of Parkinson’s also have difficulty in initiating body movement. Typically, they notice that they have difficulty starting to walk after sitting for some time.

It is important to note that patients have problem with both voluntary and automatic body movement. The latter is the spontaneous body movement that accompanies simple daily tasks such as changing facial complexion as one has a chat with a friend. One good example is the patient who does not look so “friendly” anymore. There is lack of facial expression such as smiling while joking, anger when getting irritated and sadness while talking about tragic stories.

b) Stiffness

Some patients complain that their body feels “stony hard” while walking and exercising. Others have difficulty sleeping because they cannot turn their body around on the bed to find the most comfortable position.

c) Tremor

Another common early symptom is tremor, which is usually absent during sleep and worsened by anxiety. It may occasionally involve the legs, jaw and tongue.

Even though both slowness of movement and tremor are equally common during presentation, many patients themselves usually notice the slowness of movement more often than tremor. This is because it is the slowness of movement rather than tremor that significantly affects the patients’ daily activities such as bathing, walking and eating.

d) Non-motor symptoms

Uncommonly, patients present with non-motor symptoms: those that are not related to body movement. An example is feelings of abnormal sensation such as cramps and “feeling pins and needles”.

Occasionally, depression can be the early symptom of PD. In these patients, other typical symptoms of PD such as stiffness and tremor develop later. Thus, at the early stage of illness, PD is sometimes mistaken for depression and patients end up getting referred to psychiatrists.

Case illustration

“Before I was diagnosed as having PD, I initially had severe depression for no obvious reason. I lost interest in my hobbies such as singing hymns in church. Soon, I started to have difficulty with movement. I was unable to climb up the stairs as fast as I could before. I felt very sad and almost shed tears especially at night. My wife often asked me why I was so depressed but I could not give any reason”.

Symptoms of PD Percentages
Slowness of movement 82.4%
Tremor 82.0%
Difficulty walking 77.1%
Difficulty writing 53.6%
Stiffness 50.0%
Difficulty speaking 34.0%
Muscle ache / cramps 11.3%
Falls 11.3%
Depression 6.0%
Abnormal sensation 4.7%
Weakness 4.7%

Table 1. Presenting symptoms of 153 patients with PD at University Malaya Medical Centre, Kuala Lumpur.