Parkinson’s is a progressive nervous system disorder that affects movement.
Symptoms may start gradually, as a barely noticeable tremor in just one hand or stiffness or slowing of movement. In the early stages, you or your loved one’s face may show little or no expression. Your arms may not swing when you walk. Your speech may become soft or slurred. Over time, these symptoms worsen as the condition progresses.
Although Parkinson’s can’t be cured, medications might significantly improve your or your loved one’s symptoms. Occasionally, your doctor may suggest surgery for your symptoms.
Clinical research is growing our understanding of Parkinson’s and how to treat it. Read on to learn more.
If you are living with Parkinson’s, we would like to hear from you.
- Please tell us about your experience living with Parkinson’s in our brief online survey.
- At the end of the survey, you can sign up to be considered for an upcoming clinical trial.
- We also invite you to join our Parkinson’s Team online patient community and connect with others about the condition.
Thank you for sharing with us.
What are the signs and symptoms of Parkinson’s?
Parkinson’s signs and symptoms can be different from one person to the next. Early signs may be mild and go unnoticed at first. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides.
Common Parkinson’s signs and symptoms include:
- Tremor - A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it’s at rest.
- Slowed movement (bradykinesia) - Over time, Parkinson’s may slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
- Rigid muscles - Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion.
- Impaired posture and balance - Your posture may become stooped, or you may have balance problems as a result of Parkinson’s.
- Loss of automatic movements - You may have a reduced ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
- Speech changes - You may speak softly, quickly, slur or hesitate before talking. Your speech may become more monotone rather than with the usual inflections.
- Writing changes - It may become difficult to write, and your writing may appear small.
What causes Parkinson’s?
In Parkinson’s, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in the brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms.
The cause of Parkinson’s is unknown, but several factors are believed to play a role, including:
- Genetics - Researchers have identified specific genetic mutations that can cause Parkinson’s. In some cases, several family members may be affected by Parkinson’s. Certain genetic variations appear to increase the risk of Parkinson’s, but any single known marker can only be identified in 5-10% of patients.
- Environmental triggers - Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s, but the risk is relatively small.
Researchers have found that many changes occur in the brains of people with Parkinson’s, although it’s not clear why these changes occur. These changes include:
- The presence of Lewy bodies - Clumps of specific substances within brain cells are microscopic markers of Parkinson’s. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson’s.
- Alpha-synuclein is found within Lewy bodies - Although many substances are found within Lewy bodies, scientists believe an important one is the natural and widespread protein called alpha-synuclein (a-synuclein). It’s found in all Lewy bodies in a clumped form that cells can’t break down. This is currently an important focus of Parkinson’s research.
What are the key risk factors for Parkinson’s?
- Age - Parkinson’s usually begins in middle age or later in life, and the risk increases with age. People usually develop Parkinson’s around age 60 or older.
- Heredity - Having a close relative with Parkinson’s increases a person’s chances of developing it. However, the risks are still small unless several family members have Parkinson’s.
- Gender - Men are more likely to develop Parkinson’s than women.
- Exposure to toxins - Ongoing exposure to herbicides and pesticides may slightly increase a person’s risk of developing Parkinson’s.
What are the possible complications of Parkinson’s?
Parkinson’s has many possible complications, such as:
- Thinking difficulties Cognitive problems (dementia) and thinking difficulties usually develop in the later stages of Parkinson’s and may be difficult to treat with medication.
- Depression and emotional changes – Depression may occur even in the very early stages. Getting treatment for depression can make it easier to cope with the other challenges of Parkinson’s. Other emotional changes may include fear, anxiety or loss of motivation. Doctors may treat these symptoms with medication.
- Swallowing problems – Saliva may accumulate in the mouth due to slowed swallowing, leading to drooling.
- Chewing and eating problems - Late-stage Parkinson’s affects the muscles in the mouth, making chewing difficult, which can lead to choking and poor nutrition.
- Sleep problems and sleep disorders – Sleep problems may include waking up frequently throughout the night, waking up early or falling asleep during the day. Another related problem is rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help with some of these sleep problems.
- Bladder problems - such as being unable to control urine or having difficulty urinating.
- Constipation - mainly due to a slower digestive tract.
Other complications may include:
- Blood pressure changes - Feeling dizzy or lightheaded when standing due to a sudden drop in blood pressure (orthostatic hypotension).
- Smell dysfunction - Problems with the sense of smell, such as difficulty identifying certain odors or telling the difference between odors.
- Fatigue - Many people with Parkinson’s lose energy and have fatigue, especially later in the day.
- Pain - Some people with Parkinson’s have pain, either in specific areas of the body or throughout their bodies.
- Sexual dysfunction - Some people with Parkinson’s notice a decrease in sexual desire or performance.
How is Parkinson’s diagnosed?
There is no specific test for Parkinson’s. A neurologist (a specialist doctor trained in nervous system conditions) can diagnose Parkinson’s by reviewing your or your loved one’s medical history, signs and symptoms, and conducting a neurological and physical examination.
- Your doctor may suggest a specific single-photon emission computerized tomography SPECT scan called a dopamine transporter (DAT) scan. Although this can help support the suspicion that you have Parkinson’s disease, your symptoms and neurologic examination will ultimately determine the correct diagnosis. Most people do not require a DAT scan.
- Lab tests, such as blood tests, may be used to rule out other conditions that may be causing symptoms.
- Imaging tests — such as MRI, CT, ultrasound of the brain, and PET scans — may also be used to help rule out other disorders. Imaging tests aren’t particularly helpful for diagnosing Parkinson’s.
- In addition to your examination, your doctor may give you carbidopa-levodopa (Rytary, Sinemet, others), a Parkinson’s medication. Significant improvement with this medication may confirm a diagnosis of Parkinson’s.
Sometimes it takes time to diagnose Parkinson’s. Doctors may recommend regular follow-up appointments with neurologists trained in movement disorders to evaluate your or your loved one’s condition and symptoms over time and reach a diagnosis.
How is Parkinson’s treated?
Parkinson’s can’t be cured, but medications can help control your or your loved one’s symptoms. In some situations, surgery may be advised. Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching is important. A speech-language pathologist may help improve speech problems.
Medications may be prescribed to help manage problems with walking, movement and tremor. Over time, however, the benefits of these medications may wear off or become less consistent. However, they are still usually somewhat helpful in controlling symptoms.
Commonly used medications for Parkinson’s include:
- Carbidopa-levodopa - Levodopa is a natural chemical that passes into the brain, where it is converted to dopamine. Levodopa is combined with carbidopa (Lodosyn), which protects levodopa from early conversion to dopamine outside the brain to lessen or prevent side effects such as nausea.
- Carbidopa-levodopa infusion - Duopa is a brand-name medication made up of carbidopa and levodopa. It is administered through a feeding tube that delivers the medication in a gel form directly to the small intestine. It is usually used for patients with more advanced Parkinson’s who are having fluctuations in their response to carbidopa-levodopa. The feeding tube is inserted with a surgical procedure.
- Dopamine agonists – These medicines mimic dopamine effects in the brain and tend to last longer. They may be used with levodopa to smooth the sometimes off-and-on effect of levodopa. Examples include pramipexole (Mirapex), ropinirole (Requip) and rotigotine (Neupro, given as a patch). Apomorphine (Apokyn), is a short-acting injectable dopamine agonist used for quick relief.
- MAO B inhibitors - These medications include selegiline (Eldepryl, Zelapar), rasagiline (Azilect) and safinamide (Xadago). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine. Side effects may include nausea or insomnia. Due to rare but potentially serious side effects, it is important to check with your doctor before taking any additional medications with an MAO B inhibitor.
- Catechol O-methyltransferase (COMT) inhibitors - Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.
- Anticholinergics - These medications were used for many years to help control the tremor associated with Parkinson’s. Several anticholinergic medications are available, including benztropine (Cogentin) or trihexyphenidyl.
- Amantadine - Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson’s. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s to control involuntary movements (dyskinesia) induced by carbidopa-levodopa.
Beyond medication, a surgical procedure called Deep brain stimulation (DBS) may be used. With this procedure, surgeons implant electrodes into a specific part of the brain. The electrodes are connected to a generator implanted in the chest near the collarbone that sends electrical pulses to the brain to reduce symptoms.
DBS is most often offered to people with advanced Parkinson’s who have unstable medication (levodopa) responses. DBS can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesia), reduce tremor, reduce rigidity, and improve slowing of movement.
If you or a loved one has received a diagnosis of Parkinson’s, it is important to work closely with your doctor on a treatment plan that’s right for you. Certain lifestyle changes also may help you cope with symptoms, including:
- Healthy eating - Eating foods high in fiber and drinking an adequate amount of fluids can help prevent constipation that is common in Parkinson’s disease. A balanced diet also provides nutrients, such as omega-3 fatty acids, that may be beneficial for people with Parkinson’s disease.
- Exercise - Exercising can help increase muscle strength, flexibility and balance. Exercise can also improve well-being and reduce depression or anxiety. A physical therapist can help develop an exercise program that works for you or your loved one, such as walking, swimming, gardening, dancing, water aerobics or stretching.
- Avoiding falls - In the later stages of the disease, you or your loved one may fall more easily. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:
- Make a U-turn instead of pivoting your body over your feet.
- Distribute your weight evenly between both feet, and don’t lean.
- Avoid carrying things while you walk.
- Avoid walking backwards.
- Daily living activities — such as dressing, eating, bathing and writing — can be difficult for people with Parkinson’s. An occupational therapist can show you or your loved one techniques that make daily life easier.
- Supportive therapies can help ease some of the symptoms and complications of Parkinson’s, such as pain, fatigue and depression. When performed in combination with treatments, these therapies might improve your or your loved one’s quality of life:
- Massage therapy to reduce muscle tension and promote relaxation
- Tai chi - An ancient form of Chinese exercise that uses slow, flowing motions that may improve flexibility, balance and muscle strength and can be tailored for any age or physical condition.
- Yoga - Gentle stretching movements and poses may help increase flexibility and balance and can be modified for different physical abilities.
- Alexander technique - which focuses on muscle posture, balance and thinking about how you use muscles — may reduce muscle tension and pain.
- Meditation – quietly reflecting and focusing the mind on an idea or image may reduce stress and pain and improve a sense of well-being.
- Pet therapy - Having a dog or cat may increase flexibility and movement and improve emotional health.
Clinical Trials - Learn More
Clinical trials are helping medical researchers better understand Parkinson’s and how to treat it. Finding these answers depends on people like you to take part.
Have you considered taking part in a clinical trial for people with Parkinson’s?
Potential benefits of participating in a clinical trial include:
- Close care and monitoring by a study doctor and staff throughout the study
- No cost for study treatment, related tests and procedures
- Contribute to our understanding of the treatment options for Parkinson’s
If you or your loved one would like to be considered for an upcoming clinical trial in Parkinson’s, take our survey.
Please take some time to answer a few questions and be considered for an upcoming clinical trial for people with Parkinson’s. We also invite you to join our Parkinson’s Team patient community.
Thank you for sharing with us.
If you or your loved one would like to be notified about an upcoming clinical trial in Parkinson’s, you may sign up at the end of our survey.