Parkinson's disease (PD) is a neurodegenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra.
Symptoms generally develop slowly over years. The progression of symptoms is often a bit different from one person to another due to the diversity of the disease. People with PD may experience:
Tremor, mainly at rest and described as pill rolling tremor in hands. Other forms of tremor are possible
Gait and balance problems
The cause remains largely unknown. Although there is no cure, treatment options vary and include medications and surgery. While Parkinson’s itself is not fatal, disease complications can be serious. The Centers for Disease Control and Prevention (CDC) rated complications from PD as the 14th cause of death in the United States.
The first step to living well with Parkinson’s disease is to understand the disease and the progression:
It is possible to have a good to great quality of life with PD. Working with your doctor and following recommended therapies are essential in successfully treating symptoms by using dopaminergic medications. People with PD need this medication because they have low levels or are missing dopamine in the brain, mainly due to impairment of neurons in the substantia nigra.
It is important to understand that people with PD first start experiencing symptoms later in the course of the disease because a significant amount of the substantia nigra neurons have already been lost or impaired. Lewy bodies (accumulation of abnormal alpha-synuclein) are found in substantia nigra neurons of PD patients.
Scientists are exploring ways to identify biomarkers for PD that can lead to earlier diagnosis and more tailored treatments to slow down the disease process. Currently, all therapies used for PD improve symptoms without slowing or halting the disease progression.
In addition to movement-related (“motor”) symptoms, Parkinson’s symptoms may be unrelated to movement (“non-motor”).People with PD are often more impacted by their non-motor symptoms than motor symptoms. Examples of non-motor symptoms include: apathy, depression, constipation, sleep behavior disorders, loss of sense of smell and cognitive impairment.
In idiopathic Parkinson’s disease, progression tends to be slow and variable. Doctors often use the Hoehn and Yahr scale to gauge the progression of the disease over the years. The scale was originally implemented in 1967 and it included stages zero to five, where zero is no signs of Parkinson’s and five is advanced PD. It was later changed to become the modified Hoehn and Yahr scale.
Page reviewed by Dr. Ahmad Elkouzi, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.
Learn how Parkinson's disease is diagnosed, and the tests your doctor may perform to arrive at a diagnosis.
It has been estimated that, especially in its early stages, nearly 40% of people with Parkinson’s Disease may not be diagnosed, and as many as 25% are misdiagnosed.
A positron emission topography (PET) scan is a test used to give you and your doctors more information about how the cells in your body are functioning.
CT, or computed tomography, uses X-rays and computers to produce images of inside the body, including the brain. This test is used to look for signs of disease like Parkinson's.
MRI, or magnetic resonance imaging, is a test that produces very clear images of the human body without the use of X-rays.
While there is no cure for Parkinson’s at this time, there are a number of treatments that can ease symptoms. Parkinson’s medications are the mainstay of treatment, but modalities are often used in combination. Physical, occupational and speech therapy can be critical to the treatment plan. Surgical options also have an important role for a subset of patients with Parkinson’s disease. Finally, complementary therapies can be used to treat some Parkinson’s disease symptoms. Your physician and other healthcare professionals can help you determine the best treatment plan for your symptoms.
Managing your symptoms with medication
Almost all patients with Parkinson’s disease eventually need to take medication to help with their motor symptoms. Several classes of medications are available and can be viewed here. Carbidopa/Levodopa remains the most effective symptomatic therapy and is available in many strengths and formulations. It also may be used in combination with other classes of medications including Dopamine Agonists, COMT Inhibitors, MAO Inhibitors, and Anticholinergic agents. Treatment is highly individualized and adjusted over time based on symptoms and side effects.
Physical, occupational and speech therapy
Physical, occupational and speech therapists can be important partners in the treatment of Parkinson’s disease. Physical therapy can improve your gait and direct you to the right exercise regimen. Occupational therapy can be helpful to maximize your fine motor skills. Speech therapy can be useful to address speech and language barriers that may arise with Parkinson’s disease.
The surgical option: Deep Brain Stimulation
Some patients with Parkinson’s disease may benefit from deep brain stimulation (DBS), a surgical therapy that has been FDA approved for over a decade. DBS involves implanting an electrode into a targeted area of the brain, usually the subthalamic nucleus (STN) or the globus pallidus interna (GPI). The implants can be done on one side or both sides of the brain as needed. The electrodes are stimulated through a connection to a pacemaker-like device located under the skin in the chest. Patients that are considered good candidates for this procedure are those with a robust response to Levodopa, no significant cognitive or psychiatric problems, and no significant problems with balance. The procedure can help patients with medication-resistant tremors. It can also help patients who have significant motor fluctuations in which medication response varies during the day and dyskinesias or extra movements may occur as a side effect of medication.
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