What are the early signs of Parkinson disease Select all that apply?

A, B, C, D and E

The classic symptoms of Parkinson Disease are T-R-A-P for Tremor, Rigidity (rigid arms, legs, face), Akinesia/bradykinesia (lack of movement or slow initiation of movement) and Postural instability (poor balance, which can lead to frequent falls). Other signs that may be present include motor symptoms (freezing at initiation of movement, difficulty swallowing), autonomic symptoms (constipation, bladder incontinence, drooling, reduced eye blinking) and mental symptoms (depression, anxiety, insomnia).
Next

History of Present Illness: JG is a 78-year-old female resident of a skilled nursing facility. She has developed a rash with pruritus on both forearms. The skin on her arms is dry and scaly with slightly raised, red bumps. JG has developed a similar rash before; the cause remains unknown. Her chronic medical conditions include Parkinson disease and moderate dementia of the Alzheimer's type. JG has had two hospitalizations in the past 6 months for aspiration pneumonia. She required antibiotics during each admission.
Nursing notes: JG refused to be taken to the activity room several times times over the past week due to fears that someone would try to hurt her. A dinner knife was found hidden in her bed sheets that she said she took for protection. She continues to complain about diet.
Diet: thick liquid diet, no solids.
Allergies: NKA
Medications:
Exelon patch 9.5 mg/24 hour
Namenda solution 2 mg/mL 5 mg twice daily
Rytary 48.75/195 mg TID
Comtan 200 mg TID
Neupro patch 3 mg/24 hour
JG is complaining of worsening nausea since the Exelon patch strength was increased last month. The medical director has ordered lansoprazole suspension 15 mg once daily, which the pharmacist will prepare using a compounding kit:
300 mL lansoprazole 3 mg/mL suspension
Ingredients: lansoprazole 0.9 g, artificial strawberry flavor, FD&C Red #40, Magnasweet 100 (ammonium glycyrrhizate), poloxamer 188, propylene glycol, purified water, simethicone emulsion, sodium bicarbonate, sodium citrate, sucralose, benzoic acid and xanthan gum.
Question

At the skilled nursing facility, all of the medications are listed on the medication administration record (MAR) by generic name. Which of the following will be present on JG's MAR?
Answer

A
Amantadine
B
Pramipexole
C
Entacapone
D
Ropinirole
E
Tolcapone

Are you concerned that you, or someone you know, may have Parkinson’s? You or another person might have certain signs and symptoms of Parkinson’s, but it doesn’t mean that you or they have the condition. It’s always best to talk to your GP first and they can refer you to a specialist if your symptoms need further investigation.

Tremors, muscle stiffness and slowness of movement are all common early symptoms of Parkinson's – but there are also other signs to be aware of. 

1

Problems with your sleep

Sleep and night-time problems are common in Parkinson's. People with Parkinson’s are more likely to experience insomnia due to certain symptoms which can disrupt sleep. These include tremor, stiffness, pain and restless leg syndrome. If sleep is affected, people may also feel tired and drowsy during the day.

  • Learn more about sleep and Parkinson’s 

2

Losing your sense of smell

Someone with Parkinson’s may notice that their sense of smell may not be as strong as it was or has disappeared. For example, someone may struggle to smell their favourite foods. Loss of smell can sometimes start years before other symptoms develop.

  • “Losing my sense of smell to Parkinson's” - read Barrie’s story

3

Smaller handwriting

Because of changes in the brain, people with Parkinson’s can find that their movements become smaller and less forceful than before. This can lead to someone’s handwriting becoming smaller than it previously was or gradually getting smaller as they write.

  • Learn more about communication problems

5

Experiencing depression

You may have depression if you are experiencing feelings of extreme sadness or a sense of emotional 'emptiness' for a long time. In some cases you may experience depression months before you notice any other symptoms. Depression can also be a symptom of ‘non-motor fluctuations’. In other words, the non-motor symptoms of Parkinson’s can increase or decrease depending on when you take your medication. This happens when the effects of levodopa ‘wear off’ before the next dose is due.

  • Learn about depression and Parkinson’s

6

Experiencing anxiety

People with Parkinson's may experience anxiety, including feelings of unease, such as worry or fear, particularly in the early stages of the condition. Any concerns that someone has about living with a long-term condition may cause anxiety. Common symptoms of anxiety include: a sense of dread, constant worry or difficulty concentrating, sweating, pounding or racing heart (palpitations), feeling breathless, dizziness or trembling. 

  • Learn more about anxiety with Parkinson’s

7

Feeling fatigued

Fatigue is a tiredness that doesn’t just go away with rest. It affects up to half of people with Parkinson’s. You may feel quite fit and able one day and then too fatigued to do much the following day. Fatigue in Parkinson’s is thought to be caused by chemical changes in the brain. It may also be related to other symptoms or features of the condition, such as tremor, stiffness or feelings of stress. Mental (cognitive) fatigue can be another symptom of Parkinson’s. Some people may find it hard to concentrate for a long time without a break.

  • Learn more about fatigue and tiredness

8

Noticing tremor and uncontrollable movement

Tremor is an uncontrollable movement that affects a part of the body. A Parkinson’s tremor typically starts in the hand before ‘spreading’ to affect the rest of the arm, or down to the foot on the same side of the body. There is no cure for a tremor, but there are ways to manage the symptom with support from a specialist or Parkinson’s nurse.

  • Learn about tremor in Parkinson’s

9

Slowness of movement

Slowness of movement, also known as ‘bradykinesia’, may mean that it takes someone with Parkinson's longer to do things. For example, you might struggle with coordination, walking may become more like a shuffle or walking speed may slow down. Everyday tasks, such as paying for items at a check-out or walking to a bus stop, might take longer to do.

  • Learn about slowness of movement

10

Stiffness, inflexibility and cramps

Parkinson’s causes stiff muscles, inflexibility and cramps. This is known as rigidity. This can make certain tasks such as writing, doing up buttons or tying shoe laces, harder. Rigidity can stop muscles from stretching and relaxing. It can be particularly noticeable, for example, if you struggle to turn over or get in and out of bed.

  • Learn about rigidity

Questions to ask your GP

Symptoms and the rate at which they develop will vary from person to person. The most important thing to do if you’re worried you have Parkinson’s is to speak to your GP.

If you think you might have Parkinson's, or are newly diagnosed, find out how best to prepare for your GP and what questions to ask.

More about Parkinson's symptoms

There are many potential signs and symptoms of Parkinson’s and each person may experience them differently. It’s important to note that the order and severity of these symptoms can vary from person to person.

What are the most common early signs of Parkinson's disease?

Here are early symptoms that can raise concern for Parkinson's disease:.
Smaller handwriting. The act of writing becomes slower, letters become smaller and the words crowd together..
Tremors. ... .
Muscle stiffness. ... .
Slowing of movement. ... .
Stooped posture. ... .
Lack of facial expression. ... .
Decreased arm swing. ... .
Soft or low voice..

What are the 4 major symptoms of Parkinson's disease?

Parkinson's has four main symptoms:.
Tremor in hands, arms, legs, jaw, or head..
Muscle stiffness, where muscle remains contracted for a long time..
Slowness of movement..
Impaired balance and coordination, sometimes leading to falls..

What does the beginning of Parkinson's look like?

A common, early symptom of Parkinson's disease is a decrease in the natural swing of one or both arms when walking. Later, steps may become slow and small, and a shuffling gait (festination) may appear.