Parkinson’s Disease

Definition

Parkinson’s disease (PD) is a progressive neurological condition. It leads to difficulty with movement and coordination — among other symptoms. Parkinson’s is caused by decreased levels of dopamine in deep parts of the brain responsible for movement, decision-making, behavior, and emotions. But the effects on the person can be even more wide-ranging.  

Dopamine is a chemical that affects the way neurons work, and it can affect anything from mood to blood pressure, digestion, and more. In PD, low levels of dopamine lead to problems like tremors, trouble with balance and walking, slowing of movements, and rigidity (stiffness). Almost 1 million people in the U.S. have PD, more men than women. Parkinson’s typically develops after the age of 60, although some people can develop it at younger ages.

There’s no cure for PD. But there are many treatments that help lessen the symptoms, from medications to physical therapy. While PD tends to gradually progress over time, it isn’t fatal. Many people live for decades with PD, so it’s helpful to learn about the ways to live a healthy life with Parkinson’s. 

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Causes

Parkinson’s disease happens when nerve cells (neurons) in deep parts of the brain (the basal ganglia) decrease in number. These neurons produce an important chemical called dopamine. Researchers haven’t yet pinpointed a definite cause for why these neurons die. But they have discovered that both genes and environmental factors are associated with an increased risk of PD. 

There are certain inherited genes that can increase someone’s risk for developing PD. And there are nongenetic risk factors, too, such as:

• Exposure to certain pesticides (like paraquat and rotenone)

• Living in a rural area

• Working in agriculture

• Drinking well water 

• A history of head injury

• Using beta blocker medications

Some of these may have a common cause linked to toxin exposure. But researchers are still trying to understand how and why these factors may contribute to the development of PD.

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Symptoms

When most people think about the symptoms of Parkinson’s disease, hand tremor and slow movements may come to mind first. 

But Parkinson’s disease has many symptoms. And, you’re more likely to develop other nonmovement symptoms first. Some of the earliest symptoms of PD often include:

• Impaired sense of smell

• Constipation

• Sleep problems 

Because these are common symptoms anyone can have, many people don’t realize they have PD until their movement becomes affected. Movement symptoms of Parkinson’s include:

• Slowness 

• Difficulty starting a movement, like standing up

• Muscle stiffness or rigidity 

• Tremors — repetitive, involuntary movements that are more noticeable at rest 

After movement symptoms begin, you may notice additional symptoms like:

• Problems with walking, like shuffling gait with small steps

• Trouble swallowing or speaking

• Urinary incontinence

• Problems with focus, concentration, or memory

• Depression

• Sudden dizziness upon standing (caused by a drop in blood pressure)

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Diagnosis

PD is diagnosed based on your symptoms and a physical exam. Because earlier symptoms of Parkinson’s can feel similar to symptoms caused by other conditions, many people with PD aren’t diagnosed until they develop more noticeable movement symptoms. In fact, researchers have found that people can experience PD symptoms for up to 15 years before their diagnosis.

There are no blood or imaging tests that can diagnose PD. But sometimes tests can help to rule out other conditions that could be causing symptoms. An evaluation by a brain specialist — or neurologist — can help with the diagnosis. 

Getting a PD diagnosis usually takes time. This is because your care team will need to observe how your symptoms change over time, or respond to treatment. And, ruling out other causes can be a multistep process. 

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Medications

While there’s no cure for Parkinson’s disease, there are medications that can help to manage the symptoms. Medications that treat PD aim to increase dopamine in the brain in a few different ways. 

• Replacing dopamine: This is the most common starter treatment. The main example is carbidopa/levodopa (Sinemet), an immediate-release formulation. An extended-release version of this medication may be appropriate for bedtime, or to reduce daily doses. Carbidopa/levodopa comes in pill, inhaler, and intestinal-infusion forms. 

• Mimicking dopamine (dopamine agonists): These activate the receptors in the brain that make dopamine. These medications come in the form of pills, patches, and injections. Examples include medications like mirapex (Pramipexole), ropinirole (Requip), rotigotine, and apomorphine.

• Slowing down the natural breakdown of dopamine: There are two different classes of these medications called monoamine oxidase type B (MAO-B) inhibitors and catechol-O-methyltransferase (COMT) inhibitors.

Commonly, these medications need to be adjusted or increased over time. They can also be combined with other types of medications to manage all symptoms of Parkinson’s. Examples include:

• Amantadine (which can also be used alone)

• Anticholinergic medications for tremor and muscle stiffness

• Antidepressants for mood symptoms

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Treatments

Aside from medications, there are many different treatments that can help people live safer, more functional lives with PD. These treatments can be used in combination with medications or if medications are no longer effective. 

Treatments to improve quality of life with Parkinson’s include:

• Physical therapy: This can help people with their balance and mobility. It can be particularly helpful in preventing falls, which are common in the later stages of PD.

• Occupational therapy: This helps people develop ways to continue to perform their daily activities, like eating or dressing themselves. It can also include finding ways to make these activities safer at home and using devices like shower chairs or grab bars.

• Speech and swallowing therapy: These therapies are helpful for people who have difficulty with speaking or swallowing while eating or drinking. 

• Deep brain stimulation: This is a treatment in which small electrodes are placed in specific areas of the brain that PD affects. The electrodes then supply continuous stimulation to those areas to help with movement symptoms like tremor.  

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Living with Parkinson’s disease

Many people live with PD for decades. And while it’s a condition that can affect your everyday life, it doesn’t have to restrict daily activities. Part of living a healthy and independent life with PD means finding the treatments and activities that are most helpful for your individual symptoms and your individual life. It also helps to understand how to advocate for yourself at the doctor’s office. 

Finding a good support system can be helpful for both the person living with PD and their friends and family who care for them. It’s important for everyone to address their emotional needs and mental health. There are many different kinds of support groups for the people and families affected by PD.

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