Pill-rolling

It is often the first symptom, usually starting from the distal end of one upper limb. It appears or is obvious when in a static position, reduces or stops during voluntary movement, intensifies when nervous or excited, and disappears after falling asleep.

cogwheel rigidity

Lead-pipe rigidity

flexion posture

Early days

Late stage

Voluntary movements are reduced and movements are slow and clumsy.

Early days

Late stage

Early days

middle and late stage

Common clinical symptoms include constipation, hyperhidrosis, seborrheic dermatitis (grey surface), etc. Decreased swallowing activity can lead to abortion. Sexual dysfunction, urinary dysfunction, or orthostatic hypotension may also occur in the later stages of the disease.

Nearly half of the patients suffer from depression, often accompanied by anxiety. About 15% to 30% of patients develop cognitive impairment or even dementia in the late stages of the disease, as well as hallucinations, of which visual hallucinations are common.

trihexyphenidyl

Procyclidine, benztropine mesylate, scopolamine, cyclopentanol, and biperiden.

Anticholinergic effect and maintain DA-choline balance

It is contraindicated in patients with angle-closure glaucoma and prostatic hypertrophy.

The main symptoms include dry mouth, blurred vision, constipation, and difficulty urinating, which affect cognition. In severe cases, hallucinations and delusions may occur.

benserazide levodopa, carbidopa levodopa

Directly supplement DA in the brain

People with active peptic tract ulcers should use it with caution, and patients with angle-closure glaucoma and mental illness should not use it.

There are two types of side effects: peripheral and central. The former includes nausea, vomiting, hypotension, and arrhythmia (occasionally); the latter includes symptom fluctuations, dyskinesias, and psychiatric symptoms.

Silagilan, Rasagilan

Reduce DA degradation in the brain and increase content

Use with caution in patients with gastric ulcers. In principle, it is forbidden to use it in combination with serotonin reuptake inhibitors (SSRIs).

The mechanism is still unclear, but it may be related to the fact that amantadine promotes the release of DA from striae, strengthens the effects of dopamine and catecholamines in the central nervous system, and increases the dopamine content of neurons.

Side effects include livedo reticularis on lower limbs, ankle edema, restlessness, confusion, etc.

Patients with renal insufficiency, epilepsy, severe gastric ulcer, and liver disease should use with caution, and lactating women should not use it.

entacapone, entacapone

Inhibits the degradation of L-DA in the periphery and/or brain and increases the amount of L-DA entering the brain. It is often used in combination with L-DA.

Side effects include diarrhea, headache, sweating, dry mouth, elevated transaminase, abdominal pain, yellow urine, etc. Tolcapone may cause liver function damage, and liver function must be closely monitored, especially 3 months before use.

Non-ergot

Ergots (use sparingly if side effects occur)

Stimulate DR receptors and increase their sensitivity

Symptom fluctuations and dyskinesias were low, whereas orthostatic hypotension and psychiatric symptoms were high.