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Parkinson’s disease

Parkinson’s disease is a condition that affects the brain and nervous system. The main symptoms relate to the body’s movements.

Dopamine is a chemical messenger – or ‘neurotransmitter’ – that helps certain parts of your brain co-ordinate movement properly. Parkinson’s disease occurs when the nerve cells that produce dopamine die, resulting in low levels of dopamine in your brain.

Parkinson’s disease affects around one to two out of every 1,000 people. The chances of getting Parkinson’s disease increase with age. It affects one to two out of every 100 people over 65, and around one in 10 people over 80.

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Details

  • Symptoms Symptoms of Parkinson's disease

    Parkinson’s disease has many potential symptoms. They often come on gradually. Physical symptoms typically start on one side of your body first, and then affect both sides.

    Movement symptoms

    The most common and noticeable symptoms of Parkinson’s disease relate to the movement of your body. The main ones are listed below.

    • Shaking (muscle tremor) is usually one of the first symptoms. It often starts in your hand; it can sometimes look like you’re rolling a marble or pill between your thumb and forefinger. It could instead start in your wrist or forearm. The tremor may worsen and start to affect other parts of your body. The shaking is most obvious when you’re at rest, is reduced when you’re moving, and stops when you’re asleep.
    • Rigidity is common, where you find it difficult to move your limbs. You may also move your muscles with slight hesitations.
    • Slow movements are common. Parkinson’s disease can cause your body’s movements to slow down. You may be slow to start muscle movements, and find that repeated motions – like knocking on a door – become slower.
    • Problems with walking and balance are something you may experience. You might walk slowly or with a shuffle, become stooped, and be prone to falls. You may have difficulty turning in bed or getting out of a chair.

    As different muscles become affected, other symptoms may develop.

    • Speech changes – Your speech may become quiet, shaky or monotonous. Others may find it harder to understand you.
    • Face changes – Your face may become less expressive, and you might not blink so often.
    • Difficulty with fine movements – You may struggle to button up clothes or do other fiddly tasks. Your handwriting may become smaller.

    Non-movement symptoms

    You may also get other symptoms that aren’t related to movement. These can include:

    • mental health problems, such as anxiety and depression, memory loss, difficulty reasoning, and (in the later stages) dementia
    • bowel and bladder problems such as constipation and the need to urinate often
    • problems with swallowing, which can lead to increased saliva and drooling
    • sexual problems such as erectile dysfunction (in men) and low libido (in women)
    • low blood pressure, causing dizziness when you stand up
    • increased sweating
    • exhaustion, tiredness and problems sleeping

    This is not a complete list of symptoms, and the ones outlined here aren’t always caused by Parkinson’s disease. However, if you are worried about any of these symptoms, contact your GP.

    Some of these symptoms may be more easily spotted by a spouse or partner, such as changes in the way someone speaks. If you are worried that you have noticed these symptoms in a loved one, you should discuss this with them and encourage them to contact their GP.

    Care as unique as you

    Find out more about how some Bupa care homes can provide 24-hour support for you or your loved ones living with Parkinson’s.

  • Diagnosis Diagnosis of Parkinson's disease

    There is no single test to see if someone has Parkinson’s disease. A diagnosis will be based on your symptoms; doctors will try and rule out other conditions that cause similar symptoms. There is a very  wide range of other conditions that can cause similar symptoms, including conditions of the nervous system, heart and circulation, bones and joints, and infections. Symptoms can also be a reaction to certain drugs.

    In the earlier stages of Parkinson’s disease, it can be harder to give a certain diagnosis.

    Your GP will ask about your symptoms, and about you and your family’s medical history. They may also carry out a physical examination.

    If they suspect that you have Parkinson’s disease, your GP will refer you to a specialist. This may be a neurologist (a doctor who specialises in conditions that affect the brain and nervous system) or a geriatrician (a doctor who specialises in treating older people).

    The specialist will look again at your symptoms and do a physical examination. They will often be able to diagnose Parkinson’s based on these, but if they need to rule out other conditions they may carry out some scans. These may include:

    • MRI (magnetic resonance imaging) scan, which uses magnets and radio waves to produce images of the inside of the body
    • CT (computed tomography) scan, which uses X-rays to make a three-dimensional image of the body or part of the body
    • SPECT (single photon emission computed tomography), a kind of CT scan

    In unclear cases with unusual symptoms, a doctor may carry out a special kind of SPECT called dopamine transporter (DAT) imaging. This can help to give a clearer diagnosis.

    The specialist may try giving you a course of a Parkinson’s disease medicine called levodopa (see ‘Medicines’ section below) to see if it improves your symptoms. If it does, this may help to confirm a diagnosis of Parkinson’s disease.

  • Treatment Treatment of Parkinson's disease

    There is no cure for Parkinson’s disease. Treatment is mainly aimed at controlling your symptoms for as long as possible and improving your quality of life. Treatment often involves medicines alongside other things like exercise and lifestyle changes.

    Your specialist nurse or doctor should 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.

    Medicines

    There is a very wide range of medicines available for treating Parkinson’s disease. We can’t provide detail about all of them here. Some of the main groups of medicines are explained below, and there is a table that lists the most common medicines in those groups.

    Not everyone with Parkinson’s disease will be given the same medicine. Your doctor will help you to decide which is best for you depending on your symptoms, lifestyle and preferences. They will also give you more detailed information about the medicines if they prescribe them for you.

    Medicines that restore levels of dopamine are the most common and are very effective in the early stages of Parkinson’s disease.

    Levodopa is the most common of these medicines. The body converts levodopa into dopamine when you take it. As well as normal tablets, it is also available in a dissolvable form, and as a ‘controlled release’ version that lets the medicine into your body slowly rather than all at once.

    Dopamine agonists, such as ropinirole, act like dopamine. You may take them on their own, or together with levodopa. Your doctor will start you off at a low dose. They do have some side-effects.

    Amantadine acts like a dopamine replacement medicine and is usually used for specific symptoms. 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.

    Monoamine oxidase B inhibitors (MAO-B inhibitors) prevent dopamine from being broken down. They relieve symptoms well and side-effects tend not to be too bad. They might be used before levodopa, or together with it.

    Catechol O-methyl transferase inhibitors (COMT inhibitors) can’t be used on their own. They’re given alongside levodopa to make the levodopa more effective. They’re often used if you’ve had Parkinson’s disease for some time and the levodopa has started to lose its effectiveness.

    Anticholinergic medicines block the action of the brain chemical acetylcholine. They only help with tremor and can produce serious side-effects. They’re not used very often and only in the early stages of the condition.


    Medicines group Common medicines Common brand names Common side effects
    - levodopa
    • Madopar
    • Caramet
    • Duodopa
    • Sinemet
    • Lecado
    • involuntary movements
    • sickness
    • dizziness
    • headache
    • confusion
    • hallucinations / delusions
    - amantadine
    • Symmetrel
    • confusion
    • hallucinations
    • sickness
    • headache
    • dizziness
    • insomnia
    Dopamine agonists

    pramipexole

    • Mirapexin
    • sleepiness
    • sickness
    • hallucinations
    • low blood pressure when standing up
    • swollen ankles
    • impulsive behaviour
    ropinirole
    • ReQuip
    • Adartrel
    • Spirico
    • Ralnea
    rotigotine
    • Neupro
    apomorphine
    • APO-go

    cabergoline

    • Cabaser
    MAO-B inhibitors rasagiline
    • Azilect
    • nausea / flu-like symptoms
    • headaches
    • dizziness
    • indigestion
    • depression
    • involuntary movements

    selegiline

    • Eldepryl
    • Zelapar
    COMT inhibitors
    entacapone
    • Comtess
    • involuntary movements
    • sickness / vomiting
    • stomach pain
    • diarrhoea
    • discoloured urine

    tolcapone

    • Tasmar
    Anticholinergic medicines trihexyphenidyl
    • Broflex
    • memory problems
    • confusion
    • hallucinations
    • constipation
    • dry mouth
    • blurred vision
    procyclidine
    • Arpicolin
    • Kemadrin

    orphenadrine

    • Biorphen
    • Disipal

    Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Other therapies

    Because Parkinson’s disease is a long-term condition, there are a range of other therapies designed to help you live well and cope with your symptoms. If you have Parkinson’s disease, health professionals with a range of different skills will help care for you. They will make sure you have access to therapies that are right for your stage of the disease.

    • Physiotherapy may help improve your balance, flexibility and mobility.
    • Occupational therapy may help you to continue daily activities and look after yourself.
    • Speech and language therapy may help with any speech problems, and can also address difficulties with swallowing.

    Health professionals will explain these services to you in more detail before treating you.

    Surgery

    Sometimes, if medicines are no longer helping to control your symptoms, but you are otherwise fit and well, your doctor may recommend that you have surgery.

    Deep brain stimulation (DBS) is the most common procedure. It tends to be used in the later stages of the condition. A surgeon places electrodes 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. The pulse generator sends small electrical currents to your brain. This may help to reduce your symptoms of Parkinson’s disease. DBS does have possible side-effects and complications. Your doctor will discuss these, and the procedure in general, in detail with you before recommending it.

    Future treatments

    Research is ongoing to find new treatments for Parkinson’s disease. One example is gene therapy, which involves delivering normal genes directly to your brain to help prevent the death of brain cells. 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.

  • Care for Parkinson’s disease

    At a Bupa care home, we aim to give you the best level of care and support for you or your loved one.

  • Causes Causes of Parkinson's disease

    Parkinson’s disease is caused by nerve cells dying 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. At the moment, scientists don’t fully understand the exact reasons why the nerve cells start to die.

    Rarely, Parkinson’s disease runs in families. Scientists don’t fully understand these inherited factors, but research shows 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, but the evidence is inconclusive.

    Research is ongoing to try to find the exact reasons why some people get Parkinson’s disease.

  • Living with Living with Parkinson's disease

    Most people with Parkinson’s disease stay reasonably active and symptoms may progress no further than a slight tremor. However, for others the symptoms can be more severe, and they may become debilitated, needing help with daily living, such as washing, eating and dressing. There are plenty of practical steps you can take to help you live well with the condition.

    Driving

    Because Parkinson’s affects your movements, this may have an impact on your ability to drive safely. If you have a diagnosis, your doctor will tell you to inform the Driver and Vehicle Licensing Agency (DVLA) and your car insurer. It’s important that you do so. To inform the DVLA you can download a form from the gov.uk website.

    You won’t necessarily have to stop driving (though this is a possibility). The DVLA’s decision won’t be based on your diagnosis of Parkinson’s disease, but on your specific symptoms. The DVLA may say you need a new licence, and it may be that this lasts for a shorter period than usual (maybe one or two years).

    Eating and drinking

    To stay healthy, it is important that you enjoy a balanced diet.

    Depending on your specific symptoms, you may need to make changes to your diet to help you live well with Parkinson’s disease. If you have constipation, your doctor will advise increasing your intake of fibre and fluids. If you have low blood pressure, you may need to increase your salt and fluid intake and avoid caffeine and alcohol. If you are losing weight, possibly because of swallowing problems, your doctor may refer you to a dietitian, who may prescribe you supplements.

    If you are taking levodopa, there is a chance that protein in your diet may affect how well it works. Some people find that if they have a protein-rich meal, their next dose of levodopa is not as effective as usual. This may especially be the case in later stages of the condition. It’s important not to cut down on protein, as it’s an essential part of a balanced diet. You may find that it helps to take your levodopa around 45 minutes before meals. Discuss this with your doctor.

    Exercise

    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. Group exercise sessions can be particularly beneficial as they also offer you the chance to socialise.

    There is evidence that exercise can improve movement-related symptoms and may reduce your chances of falling. If you are experiencing pain, regular exercise may help to manage this. Increasing your exercise levels can also help to manage constipation, if this is a problem for you.

    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.

    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. They 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 you can continue to live safely in your home.

  • FAQ: Progression of the disease How quickly does Parkinson's disease progress?

    Parkinson’s disease is a progressive disease, meaning that your symptoms will gradually get worse over time. The amount of dopamine in your brain falls very slowly, and as this happens the symptoms of the disease will get worse. This means that in general the disease progresses slowly, but the exact rate of progression varies from person to person.

  • FAQ: Is there a cure? Is there a cure for Parkinson's disease?

    There is currently no cure for Parkinson’s disease. However, there are medicines that can help to treat the symptoms of the disease. See the ‘Treatment of Parkinson’s disease’ section above.

    There are research projects in progress that are looking for a way to try and cure Parkinson’s disease. For now, however, the emphasis is on managing people’s symptoms.

  • FAQ: Parkinson’s disease medicines and glaucoma I have glaucoma. Can I take Parkinson’s disease medicines?

    Glaucoma is an eye condition that is usually caused by a build-up of pressure in the eye. One specific type of glaucoma is narrow-angle glaucoma. There are some medicines that can increase this build-up of pressure and make narrow-angle glaucoma worse. Make sure your specialist doctor knows if you have glaucoma, so that they can take this into account when prescribing you medicines.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Parkinson's disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk revised December 2014
    • Parkinson Disease. The MSD Manuals. www.msdmanuals.com, reviewed September 2015
    • Neurology. Oxford Handbook of Geriatric Medicine (online, 2nd ed). Oxford Medicine Online. oxfordmedicine.com, published July 2012
    • Parkinson's disease. BMJ Best Practice. bestpractice.bmj.com, updated January 2016
    • Parkinson Disease. Medscape. emedicine.medscape.com, updated January 2015
    • Map of Medicine. Parkinson’s disease. International View. London: Map of Medicine; 2015 (Issue 1)
    • Levodopa. Parkinson's UK. www.parkinsons.org.uk, accessed 26 April 2016
    • Parkinson's Disease Management. PatientPlus. patient.info/patientplus, last checked February 2013
    • Glutamate antagonist. Parkinson's UK. www.parkinsons.org.uk, accessed 26 April 2016
    • Dopamine agonists. Parkinson's UK. www.parkinsons.org.uk, accessed 26 April 2016
    • MAO-B inhibitors. Parkinson's UK. www.parkinsons.org.uk, accessed 26 April 2016
    • COMT inhibitors. Parkinson's UK. www.parkinsons.org.uk, accessed 26 April 2016
    • Anticholinergics. Parkinson's UK. www.parkinsons.org.uk, accessed 26 April 2016
    • Deep Brain Stimulation for Parkinson Disease. Medscape. emedicine.medscape.com, updated November 2014
    • Medical conditions, disabilities and driving. www.gov.uk, updated February 2016
    • The Eatwell Guide. Department of Health. www.gov.uk, updated March 2018
    • Parkinson's medication, diet and supplements. Parkinson's UK. www.parkinsons.org.uk, accessed 9 May 2016
    • Depression. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised October 2015
    • Towards a cure for Parkinson's. Parkinson's UK. www.parkinsons.org.uk, accessed 9 May 2016
    • Glaucoma. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2016
    • Drug-Induced Glaucoma. Medscape. emedicine.medscape.com, updated July 2014
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    Reviewed by Nick Ridgman, Lead Editor, Bupa Health Content Team, June 2016
    Peer-reviewed by Dr Jeremy Rees, Consultant Neurologist
    Next review due June 2019

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