Question 1390
{"accessible":false,"alternatives":[{"id":6929,"text":"anosmia"},{"id":6930,"text":"bradykinesia"},{"id":6931,"text":"postural instability"},{"id":6932,"text":"rigidity"},{"id":6933,"text":"tremor"}],"archived":false,"correctAlternativeId":6929,"explanation":"\u003cp\u003eThe classically taught four cardinal clinical\u0026nbsp;features of \u003ca href=\"/articles/parkinson-disease-1\"\u003eParkinson disease\u003c/a\u003e\u0026nbsp;are:\u003c/p\u003e\u003cul\u003e\n\u003cli\u003ebradykinesia, typically decrementing in nature and accompanied by hypokinesia\u003c/li\u003e\n\u003cli\u003etremor, typically a 5 Hz 'pill-rolling' resting tremor\u003c/li\u003e\n\u003cli\u003erigidity, typically described as 'cog-wheel' in nature in the limbs due to superimposed tremor\u003c/li\u003e\n\u003cli\u003epostural instability, generally a late feature due to impairment of centrally-mediated postural reflexes; however this may be a relatively\u0026nbsp;early sign in other parkinsonian\u0026nbsp;syndromes such as progressive supranuclear palsy and multiple system atrophy (MSA-P)\u003c/li\u003e\n\u003c/ul\u003e\u003cp\u003eDespite not being a cardinal clinical feature of Parkinson disease,\u0026nbsp;anosmia (or hyposmia) is thought to be an under-appreciated early non-motor symptom of the disease. Similarly, constipation is another early non-motor symptom. These symptoms can pre-date the cardinal motor symptoms by many years, and are thought to manifest so early due to the hypothesized pathological progression of Parkinson disease - the Braak hypothesis (or Braak staging). This hypothesis\u0026nbsp;proposes that Lewy bodies first appear in the olfactory bulb and brainstem, potentially via the vagus nerve from the enteric nervous system, before spreading to the basal ganglia.\u003c/p\u003e","id":1390,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/1390","nextQuestionPath":null,"relatedArticles":[],"alsoUsedIn":[],"stem":"\u003cp\u003eWhich of the following is\u0026nbsp;\u003cstrong\u003eNOT\u003c/strong\u003e\u0026nbsp;a cardinal clinical feature of Parkinson disease?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1390"}],"attemptsPercentages":[{"alternativeId":"6929","percentage":88},{"alternativeId":"6930","percentage":3},{"alternativeId":"6933","percentage":1},{"alternativeId":"6932","percentage":1},{"alternativeId":"6931","percentage":6}],"promptToLogin":false,"questionManager":false,"articleId":"parkinson-disease"}