Symptoms - Bradykinesia (Slowed Movement)
Bradykinesia, which means slow movement, is one of the characteristic motor symptoms of PD. Bradykinesia is noticeable as the gradual loss and slowing down of spontaneous movement, which may appear as a decrease in facial expressions and a chronic, abnormal stillness. Not every patient with PD experiences the symptoms of the disease in the same way; however, bradykinesia is present in all patients with PD.1,2
How bradykinesia may appear
Patients with PD experience symptoms in varying severities, and with the progression of the disease, the severity of the symptoms changes over time. Bradykinesia may show up in a variety of ways, including:
- Difficulty with repetitive movements, like tapping a finger
- Trouble with everyday functions, like dressing themselves, cutting their food, or brushing their teeth
- Walking with short, shuffling steps
- Reduced swinging of the arm when walking
- Difficulty or hesitation in initiating movement
- Monotonous speech (speech that is one tone without the usual ups and downs in pitch)
- Soft speech (hypophonia)
- Reduced facial expressions (hypomimia)1,2
Why does Parkinson’s disease cause bradykinesia?
PD damages many areas of the brain. Scientists believe that PD’s effects on the basal ganglia and the cortex of the brain cause bradykinesia. The basal ganglia are a group of neurons (nerve cells) located deep in the brain that process information on movement and play an important role in planning actions to achieve specific goals, such as using hands to catch a ball. The basal ganglia work in cooperation with the cortex (the outer, convoluted portion of the brain) to signal and activate muscles. As PD progresses, the impulses from the basal ganglia are insufficient to prepare and execute the commands to move. Several additional factors that contribute to bradykinesia in people with PD include muscle weakness, rigidity, tremor, movement variability (movements are less accurate than normal), and slowing of thought.3,4
Treating bradykinesia in Parkinson’s disease
Currently, no cure exists for PD, and there are no known treatments to stop or slow the progression of the disease. Treatments are available that help manage the symptoms and may include medications, surgery (deep brain stimulation), and complementary or alternative medicine.
Most patients with PD are started on medication to help manage their symptoms. Initial therapy is usually levodopa (administered with carbidopa), dopamine agonists, and/or monoamine oxidase-B (MAO-B) inhibitors. The combination of levodopa and carbidopa is the most effective treatment available for the management of motor symptoms of PD. However, it can cause a side effect known as dyskinesia, which are abnormal involuntary movements. Dopamine agonists are less effective on the motor symptoms of PD but have a lower rate of causing dyskinesia, although they have other side effects. MAO-B inhibitors are less effective than levodopa or dopamine agonists, however they have fewer side effects. Choice of therapy should be customized to the individual patient with an understanding of the risks and benefits of each class of medication.5
In addition to medication, physical therapy can help with muscle cramps, and regular exercise and stretching are beneficial to strengthen muscles and maintain flexibility. Assistive devices such as walkers or canes can be helpful.
For some people with PD whose symptoms are not adequately controlled with medication, surgery to perform deep brain stimulation may be an option. As with medication, surgery does not cure or change the course of the disease progression, but it may help with the symptoms of PD.6