Parkinson’s Disease

Parkinson’s Disease Overview

What Is Parkinson’s Disease?

Parkinson’s disease mostly affects older people but can also occur in younger adults. The symptoms are the result of the gradual degeneration of nerve cells in the portion of the midbrain that controls body movements. The first signs are likely to be barely noticeable — a feeling of weakness or stiffness in one limb, or a fine trembling of one hand when it is at rest. Eventually, the shaking (tremor) worsens and spreads, muscles become stiffer, movements slow down, and balance and coordination deteriorate. As the disease progresses, depression, cognitive issues, and other mental or emotional problems are common.

Parkinson’s disease usually begins between the ages of 50 and 65, striking about 1% of the population in that age group; it is slightly more common in men than in women. Medication can treat its symptoms and decrease the disability.

What Causes Parkinson’s Disease?

Body movements are regulated by a portion of the brain called the basal ganglia, whose cells require a proper balance of two substances called dopamine and acetylcholine, both involved in the transmission of nerve impulses. In Parkinson’s, cells that produce dopamine begin to degenerate, throwing off the balance of these two neurotransmitters. Researchers believe that genetics sometimes plays a role in this cellular breakdown. In rare instances, Parkinson’s disease may be caused by a viral infection or by exposure to environmental toxins such as pesticides, carbon monoxide, or the metal manganese. But in the great majority of Parkinson’s cases, the cause is unknown.

Parkinson’s disease is a form of parkinsonism. This is a more general term used to refer to the set of symptoms that is commonly associated with Parkinson’s disease but sometimes stems from other causes. The distinction is important because some of these other causes may be treatable, while others do not respond to treatment or medication. Other causes of parkinsonism include:

  • An adverse reaction to prescription drugs
  • Use of illegal drugs
  • Exposure to environmental toxins
  • Stroke
  • Thyroid and parathyroid disorders
  • Repeated head trauma (for example, the trauma associated with boxing and multiple concussions)
  • Brain tumor
  • An excess of fluid around the brain (called hydrocephalus)
  • Brain inflammation (encephalitis) resulting from infection

Parkinsonism may also be present in persons with other neurological conditions, including Alzheimer’s, Lewy body disease, Creutzfeldt-Jakob disease, Wilson’s disease, and Huntington’s disease.

Parkinson’s disease may be something you don’t notice suddenly. Early symptoms can be mild. You may feel tired or uneasy. You may notice your hands or other body parts shaking slightly, or find it hard to stand. Your speech might become softer or slurred, or your handwriting looks different or smaller. You may forget a word or a thought and feel depressed or anxious.

Usually, your friends and family may spot the changes before you do. It might be easier for them to notice your tremors, stiff movements, or lack of expression on your face.

As your symptoms grow, you might have trouble with everyday activities. But most people with Parkinson’s can manage the condition, often with medications.

Common Symptoms

Stiff muscles​:​ Most people with Parkinson’s have some rigidness that makes it hard to move parts of the body. That’s because your muscles can’t relax normally. This may also cause you pain.

Tremor​:​ This uncontrolled shaking usually starts in the hands and arms, although it can happen in the jaw or feet, too. You often notice your thumb and forefinger rubbing together, especially when you’re resting your handor feeling stressed.

In the beginning, tremor usually affects only one side of your body or one limb. Over time, the shaking may spread to other parts of your body, although not everyone gets tremor.

Slow movements​:​ Actions like walking, getting out of bed, and even talking become harder and slower. Doctors call this bradykinesia. It happens because your brain’s signal to specific parts of the body slows down. Bradykinesia can give your face an expressionless, mask-like look.

Changes in walking​:​ A common early sign is that your arm or arms stop swinging naturally when you walk. Your steps might become short and shuffling. You may have trouble walking around corners, or feel as if your feet are glued to the floor.

Other Signs

Parkinson’s is a progressive disorder, which means your symptoms get more serious over time. It can affect your movements as well as things like your vision, sleep, and mental health. A person with Parkinson’s can get different symptoms at different times than someone else with the same condition. They include:

  • Trouble with balance
  • Forward or backward lean that can cause falls
  • Stooped posture, with bowed head and slumped shoulders
  • Head shaking
  • Memory problems
  • Trouble peeing or pooping
  • Tiredness
  • Drooling
  • Skin problems, such as dandruff
  • Difficulty swallowing and chewing
  • Trouble having an erection or orgasm
  • Lightheadedness or fainting when standing up
  • Fear and anxiety
  • Confusion
  • Dementia, or trouble with thinking and reasoning
  • Loss of smell
  • Too much sweating

Having these symptoms doesn’t always mean you have Parkinson’s. It could be something else. See your doctor if you notice changes in yourself. If you might have Parkinson’s, working with a movement-disorders specialist could help.

If you have Parkinson’s disease (PD), you may wonder how your condition will unfold. You might want to know what symptoms you might have, when they’ll start, and how they’ll affect your life.

These are basic questions. But Parkinson’s is not a basic disease. It doesn’t move in a straight line, and it’s hard to pin down exactly how it’ll progress.

What Makes PD Hard to Predict

Parkinson’s comes with two main buckets of possible symptoms. One affects your ability to move and leads to motor issues like tremors and rigid muscles. The other bucket has non-motor symptoms, like pain, loss of smell, and dementia.

You may not get all the symptoms. And you can’t predict how bad they’ll be, or how fast they’ll get worse. One person may have slight tremors but severe dementia. Another might have major tremors but no issues with thinking or memory. And someone else may have severe symptoms all around.

On top of that, the drugs that treat Parkinson’s work better for some people than others. All that adds up to a disease that’s very hard to predict.

What You Can Expect

Parkinson does follow a broad pattern. While it moves at different paces for different people, changes tend to come on slowly. Symptoms usually get worse over time, and new ones probably will pop up along the way.

Parkinson’s doesn’t always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.

Motor Symptoms

You might break these into mild, moderate, and advanced stages. But any stage can have lots of gray areas. A tremor in your right arm may sound mild, but if you’re right-handed and it’s severe, it can affect your quality of life.

Mild stage​:​ Symptoms are a bother, but they usually don’t stop you from doing most tasks. And drugs usually work well to keep them in check.

You might notice:

  • Your arms don’t swing as freely when you walk
  • You can’t make facial expressions
  • Your legs feel heavy
  • Posture becomes a little stooped
  • Handwriting gets smaller
  • Your arms or legs get stiff
  • You have symptoms only on one side of your body, like a tremor in one arm

Moderate stage​: ​Often within 3 to 7 years, you’ll see more changes. Early on, you might have a little trouble with something like buttoning a shirt. At this point, you may not be able to do it at all.

You might also find that the medicine you take starts to wear off between doses.

You can expect:

  • Changes in how you speak, like a softer voice or one that starts strong, but trails off
  • Freezing when you first start to walk or change direction, as if your feetare glued to the ground
  • Trouble swallowing
  • Falls to be more likely
  • Trouble with balance and coordination
  • Slower movements
  • Small, shuffling steps

Advanced stage. Some people never reach this stage. This is when medication doesn’t help as much and serious disabilities set in.

At this point, you likely:

  • Are limited to bed or a wheelchair
  • Can’t live on your own
  • Have severe posture issues in your neck, back, and hips
  • Need help with daily tasks

Non-Motor Symptoms

Almost everyone with Parkinson’s gets at least one of these. When severe, they’re more likely than motor issues to lead to a disability or make you move into a nursing home. These symptoms can show up almost any time, but they follow a general trend.

What may show up early. You may have these issues years before any classic motor symptoms like tremors:

  • Constipation
  • Depression
  • Loss of smell
  • Low blood pressure when you stand up
  • Pain
  • Sleep issues

You also might get these symptoms later in the disease. And even if you have them, it doesn’t mean you have Parkinson’s. Scientists are still trying to understand the link.

You might also have mild issues with thinking and planning, like forgetfulness, a shorter attention span, and a hard time staying organized. Drooling and a more urgent need to pee are also common.

What may show up later. Dementia and psychosis are two serious mental health issues that usually take a while to show up. Psychosis is a serious condition where you see or hear things that aren’t there, or believe in things that aren’t based in reality. Dementia means you can no longer think, remember, and reason well enough to carry on your normal life.

As you age, you’re more likely to have both conditions the longer you have Parkinson’s.​

For more information, please visit our LEARN section.​

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