I was really amazed by the number of vision problems that Parkinson's can cause. I had no idea of the association but will definitely bring the list with me next time I visit the ophthalmologist.
MOTOR
We begin with the four tenets of Parkinson's Disease:
Musculoskeletal
- Micrographia - my writing is nearly illegible now. Makes writing out cards nearly impossible
- Dystonia - a disease in itself however Parkinson's and especially Parkinson's meds exacerbate the condition
- Myoclonus-a quick, involuntary muscle jerk. I get these occasionally and they can happen anywhere in my body. I've had them most while drifting off to sleep.
- Stooped posture -Camptocormia - typically seen in later stages
- Kyphosis - exaggerated rounding of the back
- Scoliosis - twisting of the spine
- Difficulty turning in bed
- difficulty standing from chair/car
- Dysphagia - difficulty swallowing
- Sialorrhea -increased saliva production leading to drooling - I've seen this placed in the non-motor group but it seemed a better fit for my list here.
- Hypomimia (masked facial)
Gait
- Shuffling, short-stepped, drag
- Freezing - one of the many symptoms that I am least looking forward to and probably most worried about
- Festination of gait
- Decreased arm swing
- Turning en bloc rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and trunk rigid, requiring multiple small steps to accomplish a turn.
Vision
- Impaired contrast sensitivity - ability of the visual system to distinguish bright and dim components of a static image
- Colors appear duller loss of retinal cells that rely on dopamine to process color
- Hypometric saccades - mis-targeted eye movements
- Impaired vestibuloocular reflex - visual acuity lost when moving such as walking
- Lid apraxia - inability to open the eyes voluntarily.
- Glabellar reflex - tap on forehead causes continued blinking
- Decreased blink rate - which causes dry eye
- Irritation of the eye surface - from reduced blink rate
- Alteration in the tear film - reduction of tears
- Visual hallucinations
- Decreased eye convergence - eyes moving together like while reading
- Blepharospasm - excessive blinking
- Abnormalities in ocular pursuit, ocular fixation and saccadic movements Limitations in the upward gaze
- Blurred vision
- Diplopia (double vision), produced by a reduced eye convergence
Speech
Speech disturbances (hypokinetic dysarthria)
Hypophonia: soft speech.
Monotonic speech: Speech quality tends to be soft, hoarse, and monotonous
Festinating speech: excessively rapid, soft, poorly-intelligible speech.
Urinary
difficulty holding - I hate that sudden 'attack' of I have to go NOW!
difficulty emptying
Other Akathisia: an unpleasant desire to move. restless leg?
