The symptoms of Parkinson’s disease often start on one side of your body first and then affect both sides. The main symptoms are listed below.
- Shaking (muscle tremor) is usually one of the first symptoms and affects most people with Parkinson’s disease. It often starts in your hand with circular movements – as if rolling a marble or pill between your thumb and forefinger. It usually affects your fingers, or thumbs first but can start in your wrist or forearm, before worsening to affect other parts of your body. The shaking is most obvious when you’re at rest, and is reduced when you’re moving or sleeping.
- Stiffness (rigidity) is a common symptom of Parkinson’s disease. This can make it difficult to move your limbs.
- Slowness of movement is common in people with Parkinson’s disease.
- Walking problems. You may start to walk with a slow shuffle.
As different muscles become affected you may develop:
- problems with your posture and balance – you may have difficulty turning in bed or getting out of a chair and as the disease progresses you may have falls
- speech changes – your speech may become quiet, faster or slower, or shaky and people may find it harder to understand you
- loss of facial expression – you may smile less, frown more and blink slowly
- small handwriting
You may also get other symptoms that aren’t related to movement. These can include:
- mental health problems, such as depression, memory loss, difficulty reasoning and increased anxiety
- bowel and bladder problems such as constipation and the need to urinate often
- problems with swallowing, which can lead to increased saliva and drooling
- reduced appetite, leading to weight loss
- low blood pressure, causing dizziness when you stand up
- increased or reduced sweating
- problems sleeping and tiredness
These symptoms aren’t always caused by Parkinson’s disease but if you have them, see your GP.
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.
Your GP may refer you to a neurologist (a doctor who specialises in conditions of the nervous system) or a geriatrician (a doctor who specialises in treating older people).
There is no single test for Parkinson’s disease. A diagnosis will be based on your symptoms and your doctor will rule out other conditions that cause similar symptoms.
You may have blood tests and imaging tests such as an MRI scan (which uses magnets and radiowaves to produce images of the inside of your body) if your doctor needs to rule out other conditions. You may have a test called a SPECT (single photon emission computed tomography) scan to help your doctor distinguish between Parkinson’s disease and another condition called essential tremor.
Treatment for Parkinson’s disease is aimed at restoring the levels of dopamine in your brain and controlling your symptoms. The symptoms and progression of Parkinson’s disease are different for each person. Your doctor will help you to decide which treatment is best for you depending on your symptoms and your individual needs. Your GP or your specialist, or both, will see you regularly to review your condition and treatments. Healthcare professionals, such as a Parkinson’s disease specialist nurse, will be allocated to you to give you help and assistance in the longer term.
Several types of medicine are available.
Medicines that replace dopamine are the most common. Dopamine replacement medicines can provide long-term improvement, although there are some side-effects such as headaches, feeling sick and tiredness. They can also cause long-term problems such as unwanted movements of your face and limbs (dyskinesia). They may become less reliable over time, with symptoms fluctuating suddenly so you get “off” periods when you can’t move well. Examples of medicines include co-beneldopa and co-careldopa.
Medicines that mimic the action of dopamine (dopamine agonists) are commonly taken alone or together with levodopa. Examples include pramipexole, ropinirole and rotigotine. These have side-effects such as feeling sick or sudden sleepiness, and can make you do impulsive things such as gambling or binge eating. Your doctor will start you off at a low dose. If you have had Parkinson’s disease for a long time and have unpredictable “off” periods you may be prescribed apomorphine, which is an injection.
Monoamine oxidase B inhibitors prevent the breakdown of dopamine. You can use these alone to delay the need for levodopa, or in combination with levodopa to reduce the on-off syndrome. Examples include selegiline and rasagiline.
Catechol O-methyl transferase (COMT) inhibitors are a type of medicine that stops the breakdown of dopamine. They are given alongside levodopa, usually if you have had Parkinson’s disease for some time and dopamine replacement medicines have started to lose their effectiveness. Entacapone is an example of this type of medicine.
Amantadine acts like a dopamine replacement medicine but works on different sites in your brain. It has few side-effects, but is only used in the early stages of the disease and has a limited effect so isn’t a first choice drug.
Anticholinergic medicines block the action of the brain chemical acetylcholine. They help to correct the balance between dopamine and acetylcholine. These medicines only help with tremor and are less effective than the medicines that replace dopamine, so doctors don’t use them very often.
Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
Sometimes, if medicines are no longer helping you, your doctor may recommend that you have surgery. Deep brain stimulation is the most common procedure. Electrodes are placed in your brain in the areas that are important in controlling movement. The electrodes are connected to a pulse generator, which is placed under the skin in your chest. Tiny electrical currents are sent from the pulse generator to your brain and this may help to reduce your symptoms of Parkinson’s disease.
Other therapies that are important for managing and living with Parkinson’s disease include physiotherapy, speech therapy and occupational therapy. If you have Parkinson’s disease, you will be cared for by health professionals with a range of different skills. They will make sure you have access to therapies that are right for your stage of the disease.
Research is ongoing to find new treatments for Parkinson’s disease. Gene therapy, which involves delivering normal genes directly to your brain to help prevent the death of brain cells is one example. Other research is looking at whether nerve cells that are lost in people with Parkinson’s disease can be replaced with new healthy cells from stem cells grown in the laboratory.
However, these therapies are still at an experimental stage and may not be available for some time.
Parkinson’s disease is caused by a loss of nerve cells in the part of your brain that produces dopamine. This can happen gradually and the level of dopamine in your brain can fall over time. The exact reasons why the nerve cells die aren’t fully understood at present.
Rarely, Parkinson’s disease runs in families. How these inherited factors play a role isn’t currently known but research has shown a link between a number of different genes and the development of the condition.
Certain chemicals in the environment that may be harmful to your brain, called neurotoxins, have also been linked to Parkinson’s disease. It's possible that people who are exposed to more of these neurotoxins are more likely to develop the condition.
Research is ongoing to try to find the exact reasons why some people get Parkinson’s disease.
Most people stay reasonably active and symptoms may progress no further than a slight tremor. However, some people do become debilitated and may need help with daily living, such as washing, eating and dressing. You may find it helpful to talk to other people who are affected by Parkinson’s disease.
How quickly does Parkinson's disease progress?
The rate at which Parkinson's disease progresses varies from person to person.
Parkinson’s disease is a progressive disease, meaning that your symptoms will gradually get worse over time. It’s caused by a reduction in the number of cells that make a chemical transmitter in your brain called dopamine. This causes a reduction in the amount of dopamine in your brain. The amount of dopamine in your brain will continue to fall very slowly, and as this happens the symptoms of the disease will get worse. Everyone is different, and the rate at which this happens will be individual to you.
Is there a cure for Parkinson's disease?
No, there is currently no cure for Parkinson’s disease. However, there are medicines that can help to treat the symptoms of the disease.
Several types of medicine can be used to control the symptoms of Parkinson’s disease. They do this by increasing the amount of dopamine in your brain, stimulating the areas of the brain where dopamine works or blocking the action of other chemicals that reduce the effectiveness of dopamine. Your doctor will prescribe medication that is suitable to control your symptoms.
Lots of research is being done to find more effective treatments for Parkinson’s disease, including gene therapy and stem cell therapy.
Gene therapy is a technique in which normal genes are delivered directly to the parts of your brain that are affected by Parkinson’s disease. This could help to protect your brain cells from the damage caused by Parkinson’s disease and help the cells produce more dopamine.
Stem cells are special cells that may help to repair the cells in your brain. It’s hoped that in the future it will be possible to use stem cells to replace the cells in your brain which have been lost because of Parkinson’s disease. The stem cells would be healthy and able to produce dopamine.
These therapies are still at a very experimental stage and may not be available for some time. They offer some hope to better control the symptoms of Parkinson’s disease or even cure the disease in the future.
Will doing exercise help to improve my symptoms?
Yes, doing suitable exercise can help to improve some of the symptoms of Parkinson’s disease. It’s also good for your general health and wellbeing.
One of the main symptoms of Parkinson’s disease is stiffness and rigidity of your muscles and joints. Doing some form of exercise can help to keep your muscles supple, reduce stiffness and rigidity and reduce your risk of falls. Exercising can also improve your mood and help relieve depression, which can sometimes develop as a result of Parkinson’s disease. Doing regular exercise will also help to improve your general health and fitness. This means that you may stay active for longer and therefore keep your independence for as long as possible.
People with Parkinson’s disease can participate in many sports and activities, including swimming, walking and cycling. Group exercise sessions can be particularly good as they also offer you the chance to socialise. But it’s important to only carry out exercise that is safe for you to do.
Ask your doctor for advice on what kind of exercise is suitable for you. He or she may refer you to a physiotherapist who will show you how to do some simple exercise routines that you can then do at home. A physiotherapist can also give you advice on how to move around your home more easily.
- Parkinson's disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2009
- Parkinson Disease. eMedicine. www.emedicine.medscape.com, published 11 March 2013
- Parkinson’s disease. Map of Medicine. www.mapofmedicine.com, published 16 July 2012
- Joint Formulary Committee. British National Formulary. 65th ed. London: BMJ Group and Pharmaceutical Press; 2013
- Deep brain stimulation for Parkinson's disease. National Institute for Health and Care Excellence (NICE), 2003. www.nice.org.uk
- Parkinson’s disease. Parkinson’s UK. www.parkinsons.org.uk, accessed 18 March 2013
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