Pathophysiology and Clinical Assessment ofParkinsonian Symptoms and Signs
Baylor College of Medicine, Houston,Texas, U.S.A.
In his 1817 ‘‘An Essay on the Shaking Palsy,’’ James Parkinson recordedmany features of the condition that now bears his name (1). Parkinsonemphasized the tremor at rest, ﬂexed posture, festinating gait (Fig. 1),dysarthria, dysphagia, and constipation. Charcot and others later pointedout that the term paralysis agitans used by Parkinson was inappropriate,because in Parkinson’s disease (PD) the strength was usually well preservedand many patients with Parkinson’s disease did not shake.Although traditionally regarded as a motor system disorder, PD isnow considered to be a much more complex syndrome involving the motoras well as the nonmotor systems. For example, oily skin, seborrhea, pedaledema, fatigability, and weight loss are recognized as nonspeciﬁc butnevertheless typical parkinsonian features. The autonomic involvement isresponsible for orthostatic hypotension, paroxysmal ﬂushing, diaphoresis,problems with thermal regulation, constipation, and bladder, sphincter, andsexual disturbances. The involvement of the thalamus and the spinal
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