Spontaneous wriggling or writhing movements which can occur when the medicine is working (i.e. the patient is 'on').
A rhythmic, oscillating movement, most commonly of the hands and or limbs.
When the patient is adequately treated and movements are reasonably fluent and spontaneous.
When when the patient's medication has worn off and movements are slow, deliberate and difficult. Other less visible symptoms of pain and distress may be a feature for some patients.
A noticeable transition from 'on' to 'off' occurring between doses of medication.
An umbrella term for the motor complications of more 'brittle' advanced disease. Patients can fluctuate from 'off', to 'on' and "on with dyskinesia." The change may be gradual or a sudden switch.

For Clinicians

Parkinson's Disease

Non-Motor Symptoms (NMS) of Parkinson's Disease

Parkinson's Disease is much more than a motor disorder

Neurodegeneration occurs more widely than the basal ganglia and many neurotransmitters are affected

NMS affect quality of life as much as the motor features, but are not well recognised.

  • Dementia
    often with visual hallucinations and a fluctuating course
  • Psychosis
    this is often a side effect of medication, or a feature of Parkinsons Disease Dementia [PDD], or both
  • Depression
    affects 40% of PD patients, and is probably part of the disease process rather than a simple response to it
  • Vivid dreams
  • REM sleep behaviour disorder
    people 'act out' dreams and can injure themselves or even others. The problem may pre-date the PD diagnosis by decades
  • Restless legs syndrome
  • Daytime hypersomnolence
    very common and often worsened by dopaminergic treatments, especially dopamine agonists
  • Postural instability and falls
    patients with advanced PD are at much higher risk of falls on the ward
  • Bladder dysfunction
    mainly urgency, but may have impaired emptying
  • Orthostatic hypotension
    check lying and standing blood pressure
  • Constipation
    almost universal and often pre-dates the motor disorder

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