Other Clinical features
Beyond the well known cardinal features of Parkinson's Disease there are numerous other clinical features. As explained earlier, Bradykinesia can involve decreased gesturing, drooling, impaired swallowing, dysarthria, loss of facial expression, reduced blinking, and decreased arm swing during ambulation (Jankovic, 2008). Micrographia, another clinical feature, is characterized by handwriting that becomes smaller over time (Sawle, 2002).
Cognitive and affective symptoms of Parkinson's Disease can be equally as disabling as motor features (Jankovic, 2008). Most individuals with Parkinson's Disease develop Lewy bodies in the cerebral cortex as well as the substantia nigra (Sawle, 2002). Prevalence statistics vary across studies; however, most individuals with Parkinson's Disease demonstrate cognitive decline with many meeting the diagnostic criteria for dementia late in the disease course (Sawle, 2002). Parkinson's Disease Dementia has also been associated with neuropsychiatric and behavioural conditions including depression, apathy, anxiety, hallucinations, obsessive-compulsive behaviour, disordered eating, hypersexuality, pathological gambling, and compulsive shopping (Jankovic, 2008). Cognitive and behavioural symptoms are not well understood; however, pharmacological management of the disorder may contribute to their presence (Jankovic, 2008). Depression is a common symptom of Parkinson's Disease and may be a reaction to the disabling nature of the condition as well as neurochemical changes (Sawle, 2002).
Individuals with Parkinson's Disease often experience gait impairment including increased cadence (steps per minute), decreased stride length, decreased velocity, and freezing of gait (Spaulding, Barber, Colby, Cormack, Mick, & Jenkins, 2013). Gait impairment often remains despite medication use; therefore, occupational therapy can play an essential role in management. Freezing of gait is one of the most disabling features of Parkinson's Disease and is typically characterized by a sudden, yet transient, inability to move (Jankovic, 2008). Freezing of gait can occur when beginning to walk, turning, or in specific situations such as walking through a narrow hallway. Freezing of gait can have social consequences as well as contribute to increased fall risk (Jankovic, 2008).
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