Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. In the early stages of Parkinson’s disease, your face may show little or no expression. Your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson’s disease symptoms worsen as your condition progresses over time.
While Parkinson’s disease can’t be cured, medications might significantly improve your symptoms. Occasionally, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms.
What are the symptoms of Parkinson’s disease?
The four primary symptoms of Parkinson’s disease are:
- 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 tremble when it’s at rest.
- Slowed motion (bradykinesia). Over time, Parkinson’s disease 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 disease. Balance problems may also increase your risk of falls.
You may also have secondary symptoms, such as:
- Loss of automatic movements. You may have a decreased 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 be more monotone than normal.
- Writing changes. It may become hard to write, and your writing may appear small.
What causes Parkinson’s disease?
Parkinson’s disease occurs when nerve cells (neurons) in the brain gradually break down or die. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As Parkinson’s disease progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.
The cause of Parkinson’s disease is unknown, but several factors appear to play a role, including:
- Your genes. Researchers have identified specific genetic mutations that can cause Parkinson’s disease. However, these are uncommon except in rare cases with many family members affected by Parkinson’s disease.
- Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is relatively small.
- A combination of genetics and environment. Several other factors appear to increase the risk of Parkinson’s disease, including age and sex.
In many cases, the cause of Parkinson’s disease is unknown, and likely involves a complex combination of genetics and environmental factors that lead to the death of dopamine-generating neurons.
What conditions can be mistaken for Parkinson’s disease?
Parkinson’s disease can sometimes be difficult to diagnose because many conditions have similar symptoms. Conditions that may sometimes be mistaken for Parkinson’s disease include:
Essential tremor
Essential tremor is a nerve disorder characterized by uncontrollable shaking, most commonly in the hands. Unlike Parkinson’s disease, essential tremor usually doesn’t cause other problems beyond shaking. Tremor is most noticeable when reaching for or holding objects, such as when drinking from a glass. Essential tremor typically begins in late middle age.
Dystonia
Dystonia involves involuntary muscle contractions that cause slow repetitive movements or abnormal postures and positions. Dystonia can affect any part of the body including the arms, legs, trunk, neck and eyelids. A common dystonia affecting the foot is called dystonic toe curling. Unlike Parkinson’s disease, dystonia does not cause slowness, weakness or balance problems.
Multiple system atrophy (MSA)
MSA is a rapidly progressive neurological disorder that affects movement, blood pressure, and other body functions. Some of the symptoms of MSA are similar to Parkinson’s disease such as slowed movement, rigid muscles, impaired balance and tremors. MSA symptoms tend to progress more rapidly than Parkinson’s. MSA also causes other problems like dizziness, fainting and urinary issues that do not occur in Parkinson’s.
Progressive supranuclear palsy (PSP)
PSP involves the gradual loss and dysfunction of nerve cells in certain parts of the brain. PSP can cause symptoms similar to Parkinson’s disease including stiffness, difficulty walking, balance problems and slurred speech. Unlike Parkinson’s, PSP often causes eye movement problems and significant difficulty moving the eyes up and down. PSP tends to progress more rapidly than Parkinson’s.
Lewy body dementia (LBD)
LBD is a brain disorder that causes a progressive decline in mental abilities. Symptoms include issues with memory, judgment, movement, sleep disorders and behavior. Some people with LBD develop muscle stiffness, slowness of movement and tremors similar to Parkinson’s disease. Visual hallucinations are also common in LBD but rare in Parkinson’s.
Normal pressure hydrocephalus
This condition causes difficulty walking, urinary issues and memory loss. It happens when excess cerebrospinal fluid builds up in the brain’s ventricles (cavities). The fluid puts pressure on the brain tissue that can potentially cause symptoms resembling Parkinson’s disease, including slow movement and impaired balance.
Medication side effects
Certain medications can produce side effects that mimic Parkinson’s disease symptoms such as tremor, muscle stiffness and movement problems. Examples include antidepressants, antipsychotics, and drugs for nausea or high blood pressure. Evaluating medication history helps identify drug-induced parkinsonism. Discontinuing the medication causing side effects leads to improvement in symptoms.
Stroke
A stroke that damages the basal ganglia part of the brain can result in permanent symptoms resembling Parkinson’s disease, including tremor, stiffness and trouble walking. Strokes in other parts of the brain usually do not cause these specific movement problems. Diagnostic imaging tests like MRI can help distinguish a stroke from Parkinson’s.
Wilson’s disease
This inherited disorder causes copper to accumulate in organs like the brain and liver. Excess copper in the brain can produce Parkinson’s-like symptoms including tremors, trouble walking, rigid muscles, and trouble with speech and swallowing. Measuring copper levels and other blood tests help identify Wilson’s disease.
How is Parkinson’s disease diagnosed?
Doctors diagnose Parkinson’s disease based on a thorough medical history and neurological examination. There are no specific tests that can absolutely confirm the diagnosis in life. Imaging and blood tests may help rule out other disorders. Evaluation of symptoms over time is important to confirm the Parkinson’s diagnosis, since many symptoms are shared with other disorders. The examination may reveal:
- Slowed movements (bradykinesia)
- Resting tremor
- Muscle rigidity
- Impaired balance and posture
- Loss of automatic movements
Looking for other potential causes of Parkinson’s-like symptoms is an important part of the diagnosis. Your doctor may recommend brain imaging tests like MRI or CT scan to rule out conditions like an atypical Parkinson’s syndrome, stroke or brain tumor. Blood tests help identify thyroid problems, liver disease, vitamin deficiencies and infections that could potentially contribute to symptoms.
Response to medication also helps confirm the diagnosis. People with Parkinson’s disease typically show substantial improvement in symptoms after starting medications that increase brain dopamine levels. A lack of response to dopamine medications makes the diagnosis of Parkinson’s less likely.
When should you see a doctor for possible Parkinson’s disease symptoms?
You should see a doctor right away if you notice any unexplained neurological symptoms such as tremor, movements that are abnormally slow, muscle stiffness or problems with posture, walking or balance. Parkinson’s disease is most often diagnosed in people over age 60. However, young-onset Parkinson’s can occur in people in their 40s or even younger. The sooner Parkinson’s disease is diagnosed, the sooner treatment can begin to help manage symptoms.
See your doctor promptly if you have any persistent signs suggesting a neurological problem including:
- Tremor or shaking of a limb at rest
- Stiffness, rigidity or decreased range of motion in arms, legs or trunk
- Slowness of movement
- Stooped posture or balance problems
- Difficulty gripping things or buttoning shirts
- A shuffling walk with short steps
- Trouble swallowing or excess saliva
- Soft, mumbled speech or monotone voice
- Writing that becomes very small and hard to read
- Lack of facial expressions or decreased eye blinking
What tests help diagnose Parkinson’s disease?
There is no single test that can diagnose Parkinson’s disease. Doctors rely on medical history, neurological exam and tests to rule out other possible causes. Tests that may help diagnose Parkinson’s include:
Brain imaging
MRI and CT scans of the brain can detect tumors, strokes or other conditions that could cause symptoms resembling Parkinson’s disease. While imaging doesn’t confirm Parkinson’s, it can aid the diagnosis by ruling out other disorders. Functional imaging like SPECT scan that measures brain activity can also help but is not definitive.
Blood and lab tests
Blood tests may include:
- Kidney, liver and thyroid tests to exclude medical causes of symptoms
- Complete blood count (CBC) to rule out infection or other issues
- Vitamin B12 levels to check for deficiencies
- Tests for syphilis or HIV if your medical history warrants them
- Drug screen if medication side effects are suspected
Other tests like heavy metal screens for copper or lead levels can help identify contributing medical problems. In some cases genetic testing may be recommended.
Neuropsychological testing
Also called cognitive testing, this involves a battery of written and oral tests of memory, problem-solving, attention, counting and language abilities. These help identify and distinguish potential thinking and reasoning problems from Parkinson’s and dementia symptoms.
Response to medication
Most people with Parkinson’s disease will have significant improvement in symptoms after starting Parkinson’s medications. A lack of response to dopaminergic therapy makes the diagnosis less likely.
What medications treat Parkinson’s disease?
While there is no cure for Parkinson’s disease, medications can provide dramatic relief from symptoms. Parkinson’s medication works by increasing dopamine levels in the brain or mimicking dopamine’s effects. Commonly used Parkinson’s drugs include:
Carbidopa-levodopa
The cornerstone treatment for Parkinson’s disease is levodopa, which is converted to dopamine in the brain. Carbidopa-levodopa (Sinemet, Parcopa, others) contains both levodopa and carbidopa, which helps prevent nausea and vomiting side effects. This medication improves tremor, slow movement, stiffness and walking ability.
Dopamine agonists
These medications mimic dopamine effects in the brain. They include ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro), which are used alone or with levodopa. Apomorphine (Apokyn) is a fast-acting injectable dopamine agonist used to treat “off” episodes when levodopa wears off.
MAO-B inhibitors
These drugs including selegiline (Eldepryl, Zelapar) and rasagiline (Azilect) help prevent the breakdown of dopamine. They are used alone early in Parkinson’s disease or with levodopa in later stages.
Catechol-O-methyltransferase (COMT) inhibitors
Entacapone (Comtan) and tolcapone (Tasmar) prolong the effects of levodopa therapy by blocking dopamine breakdown. They help smooth out fluctuations in symptoms.
Anticholinergics
Medications like trihexyphenidyl decrease the activity of the neurotransmitter acetylcholine in the brain and help control tremors and muscle rigidity. Due to the risk of side effects like confusion, they are typically only used in younger people with Parkinson’s.
Amantadine
Amantadine (also called Symmetrel) boosts dopamine activity in the brain. It can be used alone early in the disease and also may help control dyskinesia that develops from long-term levodopa use.
What is deep brain stimulation?
For people with advanced Parkinson’s disease who aren’t responding well to medications, deep brain stimulation (DBS) may be an option. DBS uses surgically implanted electrodes to send electrical pulses to targeted areas in the brain involved with movement.
The electrode implants are connected by wires under the skin to a small generator device placed below the collarbone that controls the stimulation. The most common target areas stimulated are the subthalamic nucleus and globus pallidus brain regions.
DBS can dramatically improve motor symptoms like tremor, stiffness, slowed movement and walking problems. It does not help non-movement symptoms. Potential surgical risks include brain bleeding and infection. Side effects may include speech or cognitive issues.
Who is a candidate for DBS?
DBS tends to work best for people who:
- Have lived with Parkinson’s disease for 4 or more years
- Have motor fluctuations with significant “off” time when medication effects wear off
- Have tremor not adequately controlled by medication
- Do not have dementia or severe cognitive problems
- Are healthy enough to tolerate surgery
DBS can help people gain better control of their symptoms and improve their quality of life. Talk to your doctor to see if you might benefit.
What natural and lifestyle approaches help Parkinson’s disease?
In addition to medication, people with Parkinson’s disease can benefit from a variety of natural and lifestyle measures including:
Exercise
Regular exercise is very important to maintain mobility, flexibility, strength, balance and well-being. Walking, treadmill exercise, resistance training, tai chi and yoga are good options.
Physical, occupational and speech therapy
Working with therapists helps maintain everyday skills for activities like eating, dressing, writing, swallowing, and preventing falls. Voice therapy can improve speech volume and clarity.
Good sleep habits
Sleep problems are common with Parkinson’s. Following healthy sleep habits, keeping rooms dark and quiet, and avoiding alcohol improve nighttime sleep.
Avoiding triggers
Stress, anxiety, busy environments and fatigue can worsen Parkinson’s symptoms. Relaxation techniques help control stress.
Healthy eating
Eating plenty of fruits, vegetables, whole grains, beans, nuts, seeds and omega-3 rich foods is recommended. Constipation is also common, so increase fiber and water intake.
Support groups
Local Parkinson’s support groups and online communities connect people for mutual understanding, education and socializing.
What is the prognosis for Parkinson’s disease?
Parkinson’s disease itself is not fatal, but complications can be life-threatening. The prognosis varies from person to person depending on many factors including age of onset and overall health.
Parkinson’s is a progressive disease, meaning symptoms worsen over time. Early stages of the disease are marked by tremors and mild movement problems. Later stages may lead to falls, speech changes, dementia, anxiety and depression. Advanced Parkinson’s can cause significant disability requiring around-the-clock nursing care.
With treatment, most people with Parkinson’s disease can have a good quality of life for years after diagnosis. The average life expectancy is similar to people without the disease. Good control of symptoms and proactive health management are keys to living well with Parkinson’s disease.
Conclusion
Parkinson’s disease involves a gradual loss of movement control due to decreasing dopamine levels in the brain. It causes characteristic symptoms like tremor, slowed movements, rigid muscles and balance problems. Several other disorders can initially produce similar symptoms and be mistaken for Parkinson’s disease.
Getting an accurate diagnosis is important to guide appropriate treatment. If you notice any persistent neurological symptoms, see your doctor promptly for evaluation. While there is no Parkinson’s cure, a variety of medications and therapies can effectively manage symptoms. With proper care, most people can enjoy many years of productive living with Parkinson’s disease.
