1 Parkinson Disease: Symptoms and Medical Management ANDREW BLITZERMITCHELL F. BRINMIODRAG VELICKOVIC   Parkinsonism is a neurologic syndrome with the following cardinal features: (a) bradykinesia, (b) postural instability, (c) rigidity, (d) rest tremor, and (e) freezing (motor blocks) (Fahn, 1986, 1989). At least two of these five cardinal features should be present, with one of them being either tremor or rigidity. As a syndrome, parkinsonism can be caused by: (a) idiopathic Parkinson disease -- 2 Neuropathologic Bases for Communication and Swallowing Disorders in Parkinson Disease GERALYN SCHULZ   From the time that James Parkinson published his seminal "Essay on the Shaking Palsy" in 1817 (Parkinson, 2002) the cardinal signs of Parkinson disease (PD) have been described as resting tremor, muscle stiffness (rigidity) and weakness, with reduced and slow movements (hypokinesia and bradykinesia). In his original essay Parkinson described speech and swallowing impairments as appearing when -- 3 Speech Disorder in Parkinson Disease DEBORAH THEODOROS   Speech disturbance is a hallmark of Parkinson disease (PD) and has been identified in up to 90% of people, with the severity of the disorder generally increasing over time (Hartelius & Svensson, 1994 -- Logemann, Fisher, Boshes, & Blonsky, 1978). The decline in communication skills has a significant impact on the quality of life of the person with PD, and their families. Considerable personal effort and healthcare resources are required to -- 4 Assessment and Treatment of the Speech Disorder in Parkinson Disease SHIMON SAPIRLORRAINE RAMIGCYNTHIA FOX   As discussed in Chapter 3, speech disorders associated with PD may include: reduced vocal loudness (hypophonia), with a tendency for the voice to decay or fade out -- reduced prosodic pitch inflection (monotone, hypoprosodia).

breathy, harsh, or hoarse voice -- imprecise articulation of consonants and vowels -- and dysfluent, hesitant, or mumbled speech. Collectively, these speech abnormaliti -- 5 Cognitive-Linguistic Disorder in Parkinson Disease ADRIENNE HANCOCKLEONARD LAPOINTEBROOKE-MAI WHELAN   Communication barriers for people with Parkinson disease (PD) are embedded in the speech production of their hypokinetic dysarthria as well as their masklike affect and facial expression. Yet, most people with PD will face cognitive-linguistic impairment as well. Less is known about the latter, but it is not unexplored. Even as recently as 20 years ago, the communication difficulty of people -- 6 Assessment and Treatment of Cognitive-Linguistic Disorder in Parkinson Disease BROOKE-MAI WHELAN   As outlined in Chapter 5, cognitive deficits associated with Parkinson Disease (PD) largely have been attributed to dysfunctional striatofrontal circuitry (Dubois & Pillon, 1991), and include impairments of visuospatial functioning -- free recall memory -- working memory -- effort demanding tasks (e.g., rapid processing and complex problem solving) -- set formation and set shifting entailing the internal -- 7 Swallowing Disorders in Parkinson Disease MICHELLE CIUCCI LESLIE MAHLER DAVID H. MCFARLAND1   Swallowing is a complex sensorimotor process requiring coordinated activity in many muscles distributed across several subsystems, including respiratory, laryngeal, oral-facial, and gastrointestinal. The neural control of swallowing involves a widespread network including brainstem, basal ganglia and other subcortical structures as well as the cortex. Parkinson Disease (PD) involves the degeneration o.