It is important to recognize that PD signs and symptoms are diverse and, in most circumstances, they begin subtly and progress gradually over time. Providers may initially notice a person’s body is stiff and unsteady or their face lacks expression and animation.3 As the disease progresses, providers may observe individuals with PD begin to exhibit the four cardinal symptoms that commonly characterizing PD (Figure 3).
Symptoms of PD may begin on one side of the body or in just one limb. As the disease progresses, symptoms will occur bilaterally and individuals may develop parkinsonian gait. Postural instability and gait disturbances can result in orofacial injuries.23 Independence with the activities of daily living (Figure 4) may become compromised.3,24 Individuals may also experience motor, non-motor, and neuropsychiatric symptoms such as compulsive behaviors (sex addiction, gambling addiction, eating addiction).3,7,11,22,25,26 Impairments from PD vary from individual to individual and many are interrelated.27