How does it progress?
Initially the symptoms are mild, usually on one side of the body, and may not require medical treatment. Resting tremor is a major characteristic of PD, and the most common presenting symptom, but some patients never develop it. Tremor may be the least disabling symptom, but is often the most embarrassing to the patient. Patients may keep their affected hand in their pocket, behind their back, or hold something to control the tremor, which may be more psychologically distressing than any physical limitation that it imposes.
Over time, initial symptoms become worse. A mild tremor becomes more bothersome and more noticeable. Difficulties may develop with cutting food or handling utensils with the affected limb. Bradykinesia (slowness in movement) becomes a significant problem and the most disabling symptom. Slowness may interfere with daily routines; getting dressed, shaving or showering may take much of the day. Mobility is impaired and difficulty develops in getting into or out of a chair or a car, or turning over in bed. Walking is slower and there is a stooped posture, with the head and shoulders hanging forward. The voice becomes soft and monotone. A disturbance of balance may lead to falls. Handwriting becomes small ("micrographia") and illegible. Automatic movements, such as arm swing when walking, are reduced.
Symptoms may originally be restricted to one limb, but will typically spread over time to the other limb. Generally this progression is gradual, but the rate of progression varies in different patients.
It is not possible to predict with any confidence the likely course of the disease in an individual patient. The rate of progression and resulting level of disability vary from patient to patient. Some indication of the likely outcome in individual patients is provided by its progression since first being diagnosed, but this is only suggestive of the future course.
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