What is Parkinson disease?
Parkinson disease (or Parkinson) is
the most common form of Parkinsonism, a group of motor system disorders. It is a disease
that slowly gets worse over time. It is caused by the loss of brain cells that make
dopamine. Dopamine is a substance that helps with smooth and coordinated muscle
movement. Parkinson often has these symptoms:
Tremor or trembling of the arms, jaw, legs, and face
Stiffness or rigidity of the limbs and trunk
Slowness of movement (bradykinesia)
Problems with balance and
What causes Parkinson disease?
The cause of Parkinson is unknown.
Experts believe the symptoms are linked to a chemical imbalance in the brain caused by
brain-cell death. Parkinson is chronic. Symptoms grow worse over time.
This disease may appear in younger
people (even teenagers). But it often affects people in late middle age. It is not
Experts think that in most people
the cause of Parkinson is a mix of genetics and environmental exposure. Studies have
shown that rural living, exposure to well water, and exposure to agricultural pesticides
and herbicides are linked to Parkinson. But these factors do not guarantee you will get
the disease. Nor does their absence prevent it.
In the other forms of Parkinsonism,
either the cause is known or suspected. Or the disorder occurs as a secondary effect of
some other neurological problem. These forms are sometimes called Parkinson syndrome,
atypical Parkinson, or, simply, Parkinsonism. They may be caused by:
Tumors in the brain
Repeated head trauma, such as from
Long-time use of certain medicines, such as phenothiazines, butyrophenones, or
reserpine for mental health problems, and metoclopramide for stomach upset
Toxins, such as manganese and carbon monoxide
Postencephalitic Parkinsonism, a viral disease that causes
Striatonigral degeneration, a disease that affects the
part of the brain called the substantia nigra
Parkinsonism may also occur with other nervous system problems. These include:
Progressive supranuclear palsy
Dementia with Lewy bodies
Who is at risk for Parkinson disease?
The biggest risk factor for Parkinson is advancing age. The average age for Parkinson symptoms to start is 60 years. Men are affected more than women. But the reason for this is unclear.
Family history is another key risk factor. A person with an affected parent or sibling has a 4% to 9% higher chance of getting Parkinson. This higher risk is most likely because of a mix of environmental and genetic factors. Having 1 or more close relatives with Parkinson raises the risk of the disease. But unless the person has a known genetic change (mutation) for Parkinson, the increased risk is 2% to 5%.
What are the symptoms of Parkinson disease?
These are the most common symptoms of Parkinson:
Rigid muscles. Stiffness when the arm, leg, or neck is moved back and forth.
Resting tremor. Tremor (involuntary movement from contracting muscles) that is most obvious at rest.
Bradykinesia. Slowness in starting movement.
Postural instability. Poor posture
and balance that may cause falls or gait problems.
Symptoms of Parkinson vary from
person to person. The symptoms may appear slowly and in no certain order. Early symptoms
may be subtle. They may slowly get worse over many years before reaching a point where
they mess with normal daily activities.
Other symptoms are divided into motor (movement-related) and non-motor symptoms.
Slow movement (bradykinesia)
Rigidity and freezing in place
Decreased arm swing when walking
Trouble getting up from a chair
Small, cramped handwriting (micrographia)
Lack of facial expression
Slowed activities of daily living (for example, eating, dressing, and bathing)
Trouble turning in bed
Staying in a certain position for a long period of time
Diminished sense of smell
Low voice volume (hypophonia)
Trouble speaking (dysarthria)
Painful foot cramps
Emotional changes (fearful and insecure)
Urinary frequency or urgency
Male erectile dysfunction
As the disease gets worse, walking
may become affected. It may cause the person to stop in mid-stride or "freeze" in place,
and maybe even fall over. People also may start walking with a series of quick, small
steps as if hurrying forward to keep balance. This is known as festination.
The symptoms of Parkinson may look
like other health problems. Always see your healthcare provider for a diagnosis.
How is Parkinson disease diagnosed?
Diagnosing Parkinson in the early stages can be hard. At first, signs and symptoms may look like other health problems or the effects of normal aging. For this reason, your healthcare provider may want to watch your symptoms for some time until they are consistently there.
Right now, there are no blood or lab tests to diagnose Parkinson. Diagnosis of Parkinson is based mainly on a health history and nervous system exam. Brain scans or lab tests may be done to help rule out other diseases or conditions. But brain scans generally will turn out to be normal with Parkinson.
You may need:
Neurological exam. This includes looking at symptoms and how serious they are.
Trial test of medicines. When symptoms are severe, a trial test of medicines (mainly levodopa or L-dopa) may be used. If symptoms are eased from the use of levodopa, this suggests Parkinson.
CT scan. An imaging test that uses X-rays and a computer to make images ) of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
MRI. A test that uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body.
How is Parkinson disease treated?
So far, there is no cure for
Parkinson. But your healthcare provider can plan treatment based on the severity of the
symptoms and other factors. You may need:
Complementary and supportive
therapies, such as diet, exercise, counseling, stress management, physical therapy,
occupational therapy, and speech therapy
Once the diagnosis has been made,
the next decision is whether medicine is an option. This depends on:
How much the disease has affected
your physical activities and thinking
Ability to tolerate
The advice of the healthcare provider
and your preferences
No 2 people react the same way to a
given medicine. It takes time and patience to find the right medicine and dose to ease
In some cases, your healthcare
provider may advise surgery. Surgery may help with symptoms. But it does not cure the
disease or stop it from getting worse.
It may help the tremor or rigidity
that comes with the disease. In some people, surgery may decrease the amount of medicine
needed to control the symptoms of Parkinson.
There are 2 types of surgeries for
Lesion surgery (scarring of tissue).
In this procedure, small lesions or scars are made in the deep parts of the
brain that help control movement. The surgery may be done while you are awake to help
find the exact placement of the lesion. The lesion is placed to help control, or
stop, the area of the brain causing the tremor.
Deep brain stimulation (DBS). With
this type of surgery, a small electrode is placed in the deep parts of the brain that
help control movement. The electrode is attached to a small battery in the chest
wall. It is connected by wires that are placed under the skin. The stimulator is then
turned on. It interrupts the normal flow of information in the brain and can help to
decrease symptoms of Parkinson.
Living with Parkinson disease
Parkinson is a chronic disease that
gets worse over time. Treatment can help ease symptoms. You can also do a lot to stay
independent, such as:
Also talk with your healthcare provider about depression, anxiety, or other mental
health issues that may come up.
Key points about Parkinson disease
Parkinson is a motor system disorder.
It slowly gets worse over time.
The most common symptoms are muscle
rigidity, resting tremor, slowness in starting movement, and postural
There is no known cure for Parkinson.
But medicines and surgery can help control symptoms.
Healthy diet, regular exercise,
physical therapy, occupational therapy, and speech therapy can promote
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
Online Medical Reviewer:
Anne Fetterman RN BSN
Online Medical Reviewer:
Joseph Campellone MD
Online Medical Reviewer:
Raymond Kent Turley BSN MSN RN
Date Last Reviewed:
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