Skip to main content
Log in

Parkinson’s disease: clinical aspects

  • Review
  • Published:
Cell and Tissue Research Aims and scope Submit manuscript

Abstract

Parkinsonism is a clinical syndrome characterized by akinesia, muscular rigidity, and resting tremor. The most frequent cause of parkinsonism is Parkinson’s disease (PD). Progressive loss of substantia nigra neurons together with the occurrence of Lewy bodies are considered essential neuropathological features of PD. Recent neuropathological studies suggest that nigral degeneration is only part of a more extended brain degeneration that starts in the medulla oblongata and then spreads to the mesencephalon and cerebral cortex. Correspondingly, the clinical symptoms occurring in PD go far beyond parkinsonism. Depending on the disease stage, autonomic dysfunction, olfactory disturbances, depression, and dementia are frequently encountered in PD. These neuropathological and clinical observations have major implications for future research in PD. In particular, the analysis of the properties that the neuronal cell types involved in PD have in common and that might make them susceptible to degeneration is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Benabid AL, Pollak P, Seigneuret E, Hoffmann D, Gay E, Perret J (1993) Chronic VIM thalamic stimulation in Parkinson’s disease, essential tremor and extra-pyramidal dyskinesias. Acta Neurochir Suppl (Wien) 58:39–44

    CAS  Google Scholar 

  • Benecke R, Rothwell JC, Dick JP, Day BL, Marsden CD (1986) Performance of simultaneous movements in patients with Parkinson’s disease. Brain 109:739–757

    PubMed  Google Scholar 

  • Benecke R, Rothwell JC, Dick JP, Day BL, Marsden CD (1987) Disturbance of sequential movements in patients with Parkinson’s disease. Brain 110:361–379

    PubMed  Google Scholar 

  • Berardelli A, Dick JP, Rothwell JC, Day BL, Marsden CD (1986) Scaling of the size of the first agonist EMG burst during rapid wrist movements in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 49:1273–1279

    Google Scholar 

  • Berendse HW, Booij J, Francot CM, et al (2001) Subclinical dopaminergic dysfunction in asymptomatic Parkinson’s disease patients’ relatives with a decreased sense of smell. Ann Neurol 50:34–41

    Article  CAS  PubMed  Google Scholar 

  • Bergman H, Deuschl G (2002) Pathophysiology of Parkinson’s disease: from clinical neurology to basic neuroscience and back. Mov Disord 17(Suppl 3):S28–S40

    Google Scholar 

  • Boose A, Spieker S, Jentgens C, Dichgans J (1996) Wrist tremor: investigation of agonist–antagonist interaction by means of long-term EMG recording and cross-spectral analysis. Electroencephalogr Clin Neurophysiol 101:355–363

    Article  CAS  PubMed  Google Scholar 

  • Botzel K, Schulze S (1996) Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson’s disease subjects. Brain 119:1045–1048

    PubMed  Google Scholar 

  • Braak H, Del Tredici K (2004) Poor and protracted myelination as a contributory factor to neurodegenerative disorders. Neurobiol Aging 25:19–23

    Article  CAS  PubMed  Google Scholar 

  • Braak H, Del Tredici K, Rub U, Vos RA de, Jansen Steur EN, Braak E (2003a) Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 24:197–211

    Article  PubMed  Google Scholar 

  • Braak H, Rub U, Gai WP, Del Tredici K (2003b) Idiopathic Parkinson’s disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen. J Neural Transm 110:517–536

    Google Scholar 

  • Brown VJ, Schwarz U, Bowman EM, Fuhr P, Robinson DL, Hallett M (1993) Dopamine dependent reaction time deficits in patients with Parkinson’s disease are task specific. Neuropsychologia 31:459–469

    Article  CAS  PubMed  Google Scholar 

  • Burn DJ (2002) Depression in Parkinson’s disease. Eur J Neurol 9(Suppl 3):44–54

    Google Scholar 

  • Cody FW, MacDermott N, Matthews PB, Richardson HC (1986) Observations on the genesis of the stretch reflex in Parkinson’s disease. Brain 109:229–249

    PubMed  Google Scholar 

  • Delwaide PJ, Pepin JL, Maertens dN (1991) Short-latency autogenic inhibition in patients with Parkinsonian rigidity. Ann Neurol 30:83–89

    CAS  PubMed  Google Scholar 

  • Deuschl G, Lucking CH (1990) Physiology and clinical applications of hand muscle reflexes. Electroencephalogr Clin Neurophysiol Suppl 41:84–101

    CAS  PubMed  Google Scholar 

  • Doty RL, Stern MB, Pfeiffer C, Gollomp SM, Hurtig HI (1992) Bilateral olfactory dysfunction in early stage treated and untreated idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 55:138–142

    Google Scholar 

  • Evarts EV, Teravainen H, Calne DB (1981) Reaction time in Parkinson’s disease. Brain 104:167–186

    CAS  PubMed  Google Scholar 

  • Freed CR, Greene PE, Breeze RE, Tsai WY, DuMouchel W, Kao R, et al (2001) Transplantation of embryonic dopamine neurons for severe Parkinson’s disease. N Engl J Med 344:710–719

    Article  CAS  PubMed  Google Scholar 

  • Gibb WR, Lees AJ (1989) The significance of the Lewy body in the diagnosis of idiopathic Parkinson’s disease. Neuropathol Appl Neurobiol 15:27–44

    CAS  PubMed  Google Scholar 

  • Hague K, Lento P, Morgello S, Caro S, Kaufmann H (1997) The distribution of Lewy bodies in pure autonomic failure: autopsy findings and review of the literature. Acta Neuropathol (Berl) 94:192–196

    Article  CAS  Google Scholar 

  • Hallett M, Khoshbin S (1980) A physiological mechanism of bradykinesia. Brain 103:301–314

    CAS  PubMed  Google Scholar 

  • Henderson JM, Yiannikas C, Morris JG, Einstein R, Jackson D, Byth K (1994) Postural tremor of Parkinson’s disease. Clin Neuropharmacol 17:277–285

    CAS  PubMed  Google Scholar 

  • Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184

    Google Scholar 

  • Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 57:1497–1499

    CAS  PubMed  Google Scholar 

  • Jahanshahi M, Jenkins IH, Brown RG, Marsden CD, Passingham RE, Brooks DJ (1995) Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson’s disease subjects. Brain 118:913–933

    PubMed  Google Scholar 

  • Koller WC (1992) When does Parkinson’s disease begin? Neurology 42:27–31

    CAS  PubMed  Google Scholar 

  • Koller WC, Vetere-Overfield B, Barter R (1989) Tremors in early Parkinson’s disease. Clin Neuropharmacol 12:293–297

    CAS  PubMed  Google Scholar 

  • Kruger R, Kuhn W, Muller T, et al (1998) Ala30Pro mutation in the gene encoding alpha-synuclein in Parkinson’s disease. Nat Genet 18:106–108

    CAS  PubMed  Google Scholar 

  • Lee RG, Tatton WG (1975) Motor responses to sudden limb displacements in primates with specific CNS lesions and in human patients with motor system disorders. Can J Neurol Sci 2:285–293

    CAS  Google Scholar 

  • Lees AJ (1992) When did Ray Kennedy’s Parkinson’s disease begin? Mov Disord 7:110–116

    CAS  PubMed  Google Scholar 

  • Lees AJ, Smith E (1983) Cognitive deficits in the early stages of Parkinson’s disease. Brain 106:257–270

    PubMed  Google Scholar 

  • Levy G, Schupf N, Tang MX, et al (2002) Combined effect of age and severity on the risk of dementia in Parkinson’s disease. Ann Neurol 51:722–729

    Article  PubMed  Google Scholar 

  • Litvan I, Bhatia KP, Burn DJ, et al (2003) Movement Disorders Society Scientific Issues Committee report: SIC task force appraisal of clinical diagnostic criteria for parkinsonian disorders. Mov Disord 18:467–486

    Article  PubMed  Google Scholar 

  • Marder K, Tang MX, Cote L, Stern Y, Mayeux R (1995) The frequency and associated risk factors for dementia in patients with Parkinson’s disease. Arch Neurol 52:695–701

    Google Scholar 

  • Marsden CD, Rothwell JC, Day BL (1983) Long-latency automatic responses to muscle stretch in man: origin and function. Adv Neurol 39:509–539

    CAS  PubMed  Google Scholar 

  • Mayeux R, Denaro J, Hemenegildo N, et al (1992) A population-based investigation of Parkinson’s disease with and without dementia. Relationship to age and gender. Arch Neurol 49:492–497

    Google Scholar 

  • McKeith IG, Galasko D, Kosaka K, et al (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the Consortium on DLB International Workshop. Neurology 47:1113–1124

    CAS  PubMed  Google Scholar 

  • McKeith IG, Burn DJ, Ballard CG, et al (2003) Dementia with Lewy bodies. Semin Clin Neuropsychiatry 8:46–57

    Google Scholar 

  • Micieli G, Tosi P, Marcheselli S, Cavallini A (2003) Autonomic dysfunction in Parkinson’s disease. Neurol Sci 24(Suppl 1):S32–S34

    Article  PubMed  Google Scholar 

  • Morita H, Shindo M, Ikeda S, Yanagisawa N (2000) Decrease in presynaptic inhibition on heteronymous monosynaptic Ia terminals in patients with Parkinson’s disease. Mov Disord 15:830–834

    Article  CAS  PubMed  Google Scholar 

  • Noth J, Podoll K, Friedemann HH (1985) Long-loop reflexes in small hand muscles studied in normal subjects and in patients with Huntington’s disease. Brain 108:65–80

    PubMed  Google Scholar 

  • Noth J, Schurmann M, Podoll K, Schwarz M (1988) Reconsideration of the concept of enhanced static fusimotor drive in rigidity in patients with Parkinson’s disease. Neurosci Lett 84:239–243

    Article  CAS  PubMed  Google Scholar 

  • Polymeropoulos MH, Lavedan C, Leroy E, et al (1997) Mutation in the alpha-synuclein gene identified in families with Parkinson’s disease. Science 276:2045–2047

    Article  CAS  PubMed  Google Scholar 

  • Rascol O, Goetz C, Koller W, Poewe W, Sampaio C (2002) Treatment interventions for Parkinson’s disease: an evidence based assessment. Lancet 359:1589–1598

    Article  PubMed  Google Scholar 

  • Sage JI, Miller DC, Golbe LI, Walters A, Duvoisin RC (1990) Clinically atypical expression of pathologically typical Lewy-body parkinsonism. Clin Neuropharmacol 13:36–47

    CAS  PubMed  Google Scholar 

  • Sakuma K, Nakashima K, Takahashi K (1996) Olfactory evoked potentials in Parkinson’s disease, Alzheimer’s disease and anosmic patients. Psychiatry Clin Neurosci 50:35–40

    CAS  PubMed  Google Scholar 

  • Sawle GV, Bloomfield PM, Björklund A, Brooks DJ, Brundin P, Leenders KL, et al (1992) Transplantation of fetal dopamine neurons in Parkinson’s disease: PET [18F]6-L-fluorodopa studies in two patients with putaminal implants. Ann Neurol 31:166–173

    CAS  PubMed  Google Scholar 

  • Schrag A, Jahanshahi M, Quinn N (2000) What contributes to quality of life in patients with Parkinson’s disease? J Neurol Neurosurg Psychiatry 69:308–312

    Article  CAS  PubMed  Google Scholar 

  • Siegert RJ, Harper DN, Cameron FB, Abernethy D (2002) Self-initiated versus externally cued reaction times in Parkinson’s disease. J Clin Exp Neuropsychol 24:146–153

    Google Scholar 

  • Spillantini MG, Schmidt ML, Lee VM, Trojanowski JQ, Jakes R, Goedert M (1997) Alpha-synuclein in Lewy bodies. Nature 388:839–840

    Article  CAS  PubMed  Google Scholar 

  • Xia R, Rymer WZ (2004) The role of shortening reaction in mediating rigidity in Parkinson’s disease. Exp Brain Res 156:524–528

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Klockgether.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klockgether, T. Parkinson’s disease: clinical aspects. Cell Tissue Res 318, 115–120 (2004). https://doi.org/10.1007/s00441-004-0975-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00441-004-0975-6

Keywords

Navigation