Condition Basics

What is Parkinson's disease?

Parkinson's disease occurs when there is a problem with certain nerve cells in the brain that control movement. The disease affects the way you move. The most common symptom is tremors. Parkinson's disease gets worse over time. But usually this happens slowly, over many years.

What causes it?

Low levels of dopamine, a brain chemical that helps control movement, cause symptoms of Parkinson's disease. Low levels happen when nerve cells in a part of the brain that makes dopamine break down. The exact cause of this breakdown isn't known. Scientists are studying possible causes, such as aging and poisons in the environment.

What are the symptoms?

The main symptoms of Parkinson's are tremors, stiff muscles, slow movement, problems with balance or walking, and pain. Symptoms differ from person to person. In time, the disease affects muscles all through your body. This can lead to problems like trouble swallowing or constipation.

How is it diagnosed?

Your doctor will ask questions about your symptoms and your past health and will do a neurological examination. This examination checks to see how well your nerves are working. There are no lab or blood tests that can diagnose Parkinson's. But you might have tests to find out what's causing symptoms.

How is Parkinson's disease treated?

At this time, Parkinson's disease can't be cured. But you may not need treatment if your symptoms are mild. Medicines can help control the symptoms. You may also get occupational, physical, or speech therapy to help you function better. Brain surgery, for example deep brain stimulation, may be an option.

Cause

Parkinson's disease happens when there is a problem with certain nerve cells in the brain.

Normally, these nerve cells make an important chemical called dopamine. Dopamine sends signals to the part of your brain that controls movement. It lets your muscles move smoothly and do what you want them to do. When you have Parkinson's, these nerve cells break down. Then you no longer have enough dopamine, and you have trouble moving the way you want to.

No one knows for sure what makes these nerve cells break down. But scientists are doing a lot of research to look for the answer. They are studying many possible causes, including aging and poisons in the environment.

Symptoms

Symptoms of Parkinson's disease differ from person to person. Tremor (shaking) may be the first symptom you notice. It's one of the most common signs of the disease, although not everyone has it.

Tremor often starts in just one arm or leg or on only one side of the body. It may be worse when you're awake but not moving the affected arm or leg. It may get better when you move the limb or you're asleep.

Other common symptoms include:

• Stiff muscles.
• Slow movement.
• Problems with balance or walking.
• Pain.

In time, Parkinson's affects muscles all through your body. It can lead to problems like trouble swallowing or constipation.

Some people with Parkinson's have depression. In the later stages of the disease, they may have a fixed or blank expression, trouble speaking, and other problems. Some people also lose mental skills (dementia).

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What Happens

Early stage

Tremor is often the first symptom. It appears in just one arm or leg or on only one side of the body. With time, the tremor usually—but not always—spreads to both sides of the body. Joint pain, weakness, and fatigue may occur.

Moderate stage

As the disease gets worse, some people may have slow movement, stiff muscles, and poor coordination. They may have problems with tasks such as writing, shaving, or brushing teeth. Changes in handwriting are common.

Problems with posture and balance develop. A person with Parkinson's tends to walk in a stooped manner with quick, shuffling steps. Sometimes the person may freeze. This is a sudden, brief inability to move. It most often affects walking.

The disease can affect many of the muscles used for chewing and swallowing. This can lead to problems with eating, drooling, and choking. It can also affect the muscles that are used for speech. This can lead to low or soft speech, unclear speech sounds, and other problems.

Problems with sexual function are common in people with Parkinson's disease. It can affect arousal in both men and women. Muscle stiffness may make sexual activity difficult. Men may have trouble getting or keeping an erection.

Advanced stage

After several years, as muscle stiffness and tremors increase, the person may need more care and may be confined to a wheelchair or bed.

People who take medicine for several years may notice that their symptoms get worse. And they may have other movement problems. These problems can get somewhat better by making changes to the person's medicine. But medicine can be hard to manage and can make treatment more difficult.

Dementia may develop in many people who have late-stage Parkinson's disease. Dementia symptoms may include confusion and memory loss. Treatment for Parkinson's disease can also make this problem worse.

When to Call a Doctor

If you develop a tremor

Urgent medical care isn't needed if you've had a tremor—shaking or trembling—for some time. But you should discuss the tremor at your next doctor's appointment.

If a tremor is affecting your daily activities or if it's a new symptom, see your doctor sooner.

A written description will help your doctor make a correct diagnosis. In writing your description, consider the following questions:

• Did the tremor start suddenly or gradually?
• What makes it worse or better?
• What parts of your body are affected?
• Have there been any recent changes in the medicines you take or how much you take?

If you have Parkinson's disease

If you have been diagnosed with Parkinson's, call your doctor if:

• You notice any significant change in your symptoms, such as severe episodes of freezing—a sudden loss of mobility—which may affect walking.
• Your response to your medicine changes.
• Any other symptoms occur, such as constipation, sexual problems, or incontinence.
• You have symptoms of depression, such as feeling sad or losing interest in daily activities.
• You or your family notice that you have problems with memory and thinking ability.

Examinations and Tests

Your doctor will ask questions about your symptoms and your past health and will do a neurological examination. This examination includes questions and tests that show how well your nerves are working. For example, your doctor will watch how you move, check your muscle strength and reflexes, and check your vision.

Your doctor also may check your sense of smell and ask you questions about your mood.

In some cases, your doctor will have you try a medicine for Parkinson's disease. If that medicine helps your symptoms, it may help the doctor find out if you have the disease.

There are no lab or blood tests that can help your doctor diagnose Parkinson's. But you may have tests to help your doctor rule out other diseases that could be causing your symptoms. For example, you might have an MRI to look for signs of a stroke or brain tumour.

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Treatment Overview

There is no cure for Parkinson's disease. But there are many treatments that can help your symptoms and improve your quality of life. You may not need treatment if your symptoms are mild.

Your age, work status, family, and living situation can all affect decisions about when to start treatment, what types of treatment to use, and when to make changes in treatment. As your medical condition changes, you may need regular changes in your treatment to balance quality-of-life issues, side effects of treatment, and treatment costs.

You'll need to see members of your health care team regularly (every 3 to 6 months, or as directed) to adjust your treatment as your condition changes.

Treatments for Parkinson's include:

Medicines.

Levodopa and dopamine agonists are the most common treatment for Parkinson's disease. But these drugs can cause problems if you use them for a long time or at a high dose. So doctors sometimes use other medicines to treat people in the early stages of the disease.

Surgery.

Brain surgery, for example deep brain stimulation, may be an option. It may be used when medicine can't control symptoms of Parkinson's disease or causes severe or disabling side effects. For this treatment, a surgeon places wires in your brain. The wires carry tiny electrical signals to the parts of the brain that control movement. These little signals can help those parts of the brain work better.

Speech therapy.

Speech therapists use breathing and speech exercises to help you overcome speech problems like the soft, imprecise speech and monotone voice that develop in advanced Parkinson's disease. They can also help you improve problems with eating, swallowing, and drooling.

Physiotherapy.

Therapists may help you improve your walking and reduce your risk of falling. They can also give you exercises to improve your posture, strength, and flexibility.

Occupational therapy.

Therapists can help you learn new ways to do things for yourself so you can stay independent longer. For example, they can help you make simple changes so you can move around your house more easily. They can also help you make daily activities easier. These may include things like bathing and dressing.

Treatment for thinking problems.

You or your family members may notice that you start to have problems with memory, problem solving, learning, and other mental functions. When these problems keep you from doing daily activities, it is called dementia. There are medicines that can help treat dementia in people with Parkinson's.

Your doctor, other health professionals, or Parkinson's support groups can help you get emotional support and education about the illness. This is important both early and throughout the course of the disease.

Treatment for depression, anxiety, or sleep problems.

These conditions are common in people with Parkinson's disease. Being aware of them and getting help is important. There are medicines that can help with the symptoms of these problems. Parkinson's support groups can help you learn ways to cope with them as well.

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Self-Care

Early on, Parkinson's disease may not greatly disrupt your life. But for most people, the disease becomes more disabling over time. Home treatment can help you adjust as time goes on and help you stay independent for as long as possible. Home treatment may include making changes to your home and lifestyle, improving your motor skills, and improving your mood and memory.

Making changes to your home and lifestyle

• Modify your activities and your home. For example, simplify your daily activities and change the location of furniture so that you can hold on to something as you move around the house.
• Eat healthy foods. This includes plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products.
• Exercise and do physiotherapy. They have benefits in both early and advanced stages of the disease.

Improving your motor skills

• Work on your tremor. This may include things like putting a little weight on your hand to help reduce tremor and restore control.
• Improve speech quality by working with a speech therapist (also called a speech-language pathologist).
• Reduce problems with eating and drooling by changing how and what you eat.
• Practice overcoming "freezing" with various techniques, such as stepping toward a specific target on the ground.
• Be open about sexual function problems. Talk to your doctor about your specific issues. He or she may be able to suggest a change in your treatment, such as a change in your medicine or exercise.

Improving your mood and memory

• Talk to someone about depression. If you are feeling sad or depressed, ask a friend or family member for help. If these feelings don't go away, or if they get worse, talk to your doctor. He or she may be able to suggest someone for you to talk to. Or your doctor may give you medicine that will help.
• Be aware of dementia. Dementia is common late in Parkinson's disease. Symptoms may include confusion and memory loss. If you (or a family member) notice that you are confused a lot or have trouble thinking clearly, talk to your doctor. There are medicines that can help dementia in people with Parkinson's disease.

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Medicines

Medicines are the most common treatment for Parkinson's disease. The goal is to correct the shortage of the brain chemical dopamine. This shortage causes the symptoms of Parkinson's.

Medicine is often started when your symptoms become disabling or disrupt your daily activities. Symptoms change as the disease gets worse. Because of this, your doctor will adjust your medicine as symptoms appear.

Medicines often improve symptoms. But they also may cause side effects. It may take some time to find the best medicines for you.

Several medicines may be used at different stages of the disease. They include:

• Levodopa and carbidopa.
• Dopamine agonists.
• COMT inhibitors.
• MAO-B inhibitors.
• Amantadine.
• Anticholinergic agents.
• Apomorphine.

Levodopa is thought to be the most effective drug for controlling symptoms. But many doctors prescribe dopamine agonists in the beginning of the disease. That's because after a few years, levodopa can cause motor problems like uncontrollable jerking movements. It also may suddenly stop working.

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Surgery

Brain surgery to treat Parkinson's disease may be considered when drugs:

• Don't control symptoms.
• Cause severe or disabling side effects.

The types of surgery include:

• Deep brain stimulation. This uses electrical impulses to stimulate a target area in the brain. It's the preferred surgery for treating most cases of advanced Parkinson's.
• Pallidotomy. This involves the precise destruction of a very small area in a deep part of the brain that causes symptoms.
• Thalamotomy. This involves the precise destruction of a very small area in another part of the brain that causes symptoms.

Surgery isn't a cure. Drugs are usually still needed after surgery. But you probably won't need as much medicine as before. This means you may have fewer side effects.

People who have very advanced Parkinson's or who have other serious health problems usually aren't good candidates for surgery.

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