Parkinson’s disease

Parkinson’s disease is a brain condition that can make you shake (tremors), move more slowly and have stiff muscles. It happens when the nerve cells in certain parts of your brain become damaged. There’s no cure yet, but treatment like medication, physiotherapy, and sometimes surgery can help to manage your symptoms.

About Parkinson’s disease

Among medical experts, Parkinson’s disease is known as a progressive neurological disorder. Neurological means that it affects your brain and nervous system. Progressive means that your symptoms get worse over time.

There are over 40 symptoms of Parkinson’s disease, but the condition is best known for affecting the way you move. It can cause you to shake without meaning to, move very slowly, feel stiff, and lose your balance.

The symptoms are often mild to begin with, and you might not need any treatment or support in the early stages. But as Parkinson’s disease gets worse, you’ll likely need medication and care to help you manage.

Although anyone can get Parkinson’s disease at any age, it’s more common as you get older and in men. It’s estimated that 1 in every 100 people over 60 have Parkinson’s disease. Although there’s no cure yet, experts are working hard to find out more about the condition and develop treatments.

Parkinson’s disease isn’t fatal. But having the condition does make you more likely to develop other serious health issues such as having a bad fall or pneumonia. It’s hard to predict exactly how long you’ll live after diagnosis, because Parkinson’s disease affects everyone differently. On average, people live for about 10 years. But since the condition is usually diagnosed later in life, this is similar to the average life expectancy of other people the same age.

Types of Parkinson’s disease

You might sometimes hear doctors use the word ‘Parkinsonism’. This term describes a group of health conditions that have symptoms including tremors, muscle stiffness and balance problems. These can conditions include:

• Idiopathic Parkinson’s disease. This is the most common type of Parkinsonism. Most people just know this as ‘Parkinson’s disease’. The word idiopathic means that the exact cause isn’t known.
• Drug-induced Parkinsonism. This is when you develop symptoms that look like Parkinson’s disease because of a medication you’re taking. The symptoms usually go away once you stop taking it.
• Vascular Parkinsonism. This is when you develop Parkinson’s-like symptoms as a result of having small strokes in your brain that affect your movement.
• Atypical Parkinsonism. This is when you have another rare brain condition, and your symptoms resemble those of Parkinson’s disease. For example, if you have multiple system atrophy (MSA) or progressive supranuclear palsy (PSP).

Causes of Parkinson’s disease

The exact cause of Parkinson’s disease isn’t known. But it happens when some of the nerve cells (neurons) in a part of your brain called the ‘substantia nigra’ stop working. These nerve cells make an important chemical called dopamine. Dopamine sends signals around your body to control and co-ordinate movement. Over time, as more of these dopamine-producing cells die and your dopamine levels drop, the symptoms of Parkinson’s gradually appear.

No one knows why these nerve cells die exactly, but experts believe it could be a mixture of your age, genetics, and environment. Some evidence has suggested that toxins, insecticides, and herbicides could damage the nerve cells in your brain, but more research is needed to be sure. There’s also a very small chance that Parkinson’s disease could be passed down (inherited) if someone in your biological family has it.

Symptoms of Parkinson’s disease

The symptoms of Parkinson’s disease affect everyone differently. Which symptoms you get, and how quickly they develop will be unique to you. You might even find that your symptoms change from day-to-day.

Some of the earliest signs of Parkinson’s disease include:

• disturbed sleep
• smaller handwriting
• losing your sense of smell (anosmia)
• fatigue
• needing to pee more often or urgently
• anxiety
• depression

You might also hear doctors describe the symptoms of Parkinson’s disease as either motor or non-motor symptoms. Motor symptoms affect the way you move. Non-motor symptoms don’t involve movement but can still impact your daily life.

Some of the most well-known symptoms of Parkinson’s disease are motor symptoms. These include:

• shaking at rest (tremors)
• slow movements (bradykinesia)
• stiff muscles (rigidity)
• problems with your balance
• shuffling when you walk
• suddenly and temporarily not being able to move (freezing)
• a blank facial expression or blinking less often
• a soft, quiet voice

Non-motor symptoms of Parkinson’s disease include:

• constipation
• aches and pains in your muscles
• low blood pressure
• restless legs syndrome
• problems with your memory and concentration
• drooling or trouble swallowing
• feeling dizzy or faint
• losing interest in sex or struggling to get an erection or orgasm
• sweating too much
• problems with your vision
• mental health problems such as hallucinations or psychosis

Diagnosis of Parkinson’s disease

There’s no single test for Parkinson’s disease, but the following steps can help to confirm whether or not you have the condition.

Seeing a GP

If you’re concerned about the symptoms of Parkinson’s disease, make an appointment to see a doctor. If they suspect you could have Parkinson’s disease, they’ll refer you to a specialist who can investigate in more detail. This is usually a neurologist – a doctor who specialises in conditions affecting your brain and nervous system.

Seeing a specialist

Your neurologist will ask you about your symptoms, and your medical and family history in more detail. They’ll carry out a physical and neurological exam and may ask you to do a few simple tasks to check your movement, coordination and reflexes.

Brain imaging tests

Your specialist will recommend some investigations to help rule out other conditions similar to Parkinson’s disease.

These investigations could include:

• an MRI scan or CT scan to look at the structure of your brain
• a DaTSCAN (dopamine transporter scan) to see if you’ve lost any dopamine-producing brain cells

Depending on your symptoms, your specialist might also suggest other investigations such as blood and urine (pee) tests.

Trying out medication

Sometimes, your neurologist might recommend starting you on medication for Parkinson’s disease to see if it improves your symptoms. This can help to support a diagnosis. They’ll ask to see you regularly to review your symptoms and medication, and they can also help with any support you need.

Parkinson’s disease treatments

There’s no cure for Parkinson’s disease yet, and you can’t stop your symptoms from getting worse over time. But there are lots of treatments, lifestyle changes and therapies that can help you to manage the symptoms and improve your quality of life. Some of these are discussed below.

Medication

Parkinson’s disease happens when nerve cells in your brain die and stop making a chemical called dopamine. Medicines for Parkinson’s disease work in one of three ways:

• some boost dopamine levels
• some act like dopamine to stimulate your brain
• some block substances that break down dopamine

There are many different medicines to treat Parkinson’s disease, but the three main types you might hear about are discussed here.

• Levodopa is the most common treatment for Parkinson’s disease. It works by converting to dopamine in your brain. Levodopa is usually prescribed alongside other medications that help it to work better and reduce the side-effects. Most people respond well to levodopa at first and find it helps their movements. But as your condition gets worse and there are fewer nerve cells in your brain to absorb the medicine, levodopa might not work as well.
• Dopamine agonists work by mimicking the effects of dopamine in your brain. You might take them on their own during the early stages of Parkinson’s disease or in combination with levodopa during later stages. Because dopamine agonists can cause side-effects, you’ll usually be prescribed a small dose to begin with, which can gradually be increased.
• MAO-B inhibitors stop your body from breaking down dopamine, so it can stay in your brain for longer. They do this by inhibiting an enzyme called monoamine oxidase B. MAO-B inhibitors can be used alone in the early stages or with other Parkinson’s medications later and can help to make your movements feel easier.

Like all medicines, Parkinson’s drugs may have side-effects. So, a team of healthcare professionals will regularly review your symptoms. They will adjust your medication as necessary to give you the combination of treatments and therapies that works best for you. As your condition progresses, you’ll have ongoing reviews to ensure your treatment is still working.

Levodopa-carbidopa intestinal gel (LCIG)

If you have advanced Parkinson’s disease and your medication isn’t working well or causes too many side-effects, your doctor might suggest levodopa-carbidopa intestinal gel (LCIG). This gel is delivered directly into your small intestine through a tube connected to a pump you wear. It helps the medicine to absorb more evenly and improves your movements.

Surgery

If medication isn’t working, you might be offered a type of surgery called deep brain stimulation (DBS). If you’re eligible, your surgeon will place a device called a pulse generator into your chest and connect it to your brain with small wires. It sends an electrical current to the part of your brain affected by Parkinson’s and helps to ease tremors, rigidity and slow movements.

Therapies

There are three main types of therapy that can help manage the symptoms of Parkinson’s disease.

• Physiotherapy. A physiotherapist can help to improve your walking, posture, balance, flexibility and stiff muscles.
• Speech and language therapy. A speech and language therapist can help you with talking, swallowing and writing so you can eat safely and communicate.
• Occupational therapy. An occupational therapist can teach you practical ways to manage daily tasks like cooking and dressing. They can also help to make adjustments to your home so that’s it’s accessible for you.

Living with Parkinson’s disease

Help and support

It’s normal to experience a range of emotions after a Parkinson’s diagnosis. This means it’s helpful to build a strong support network. Start by talking to loved ones or your healthcare team. If you find it difficult to open up to the people close to you, speaking with a trained counsellor may help. Many people also find comfort by connecting with others who have Parkinson’s. The Parkinson’s UK website offers information on local support groups and has a free, confidential helpline.

Physical activity

Even though movements can feel harder with Parkinson’s disease, it’s really important to keep active with the condition. Regular exercise can boost your energy, mood and health. It can also help to ease stiff muscles and reduce your risk of falls. Experts recommend doing 2.5 hours of exercise every week. The key is to find an activity you enjoy, start slowly and gradually build up how much you do. Once you feel fit enough, keep increasing how much you do so it feels like you’re challenging yourself.

Nutrition

There’s no specific diet for Parkinson’s disease but a balanced diet will help you get all the nutrients you need and maintain a healthy weight. Over time, you might find some of your symptoms make eating more difficult. For example, you might have trouble swallowing or holding cutlery. Or you might develop low blood pressure or constipation. If this happens, your healthcare team can refer you to a dietitian for advice that’s tailored to you.

Complications of Parkinson’s disease

As Parkinson’s disease advances, there’s a chance you could develop other health complications. These include the following.

• Parkinson’s disease dementia. Around 1 in 4 people with Parkinson’s develop dementia, leading to memory problems, confusion, and difficulty making decisions.
• Aspiration pneumonia. Difficulty swallowing can cause food or liquids to enter your lungs, leading to aspiration pneumonia. This is a leading cause of death in advanced Parkinson’s.
• Having a bad fall. Around 2 in every 3 people with Parkinson’s fall every year. Trouble with balance and movement increases your chance of a fall, which can lead to serious injuries especially in older adults.
• Impulse control disorder. Some Parkinson’s medications can cause compulsive behaviours, like gambling, overeating or excessive shopping, which can disrupt your daily life.
• Anxiety and depression. The emotional impact of Parkinson’s can lead to anxiety or depression. Treatments like cognitive behavioural therapy (CBT) or medication can help.
• Motor fluctuations and involuntary movements. As Parkinson’s progresses, medications may become less effective, causing “on” periods (when symptoms are controlled) and “off” periods (when symptoms like jerking, writing or twisting return).
• Delusions and hallucinations. Some people with Parkinson’s may experience false beliefs (delusions) or see/hear things that aren’t there (hallucinations). This is more likely in the later stages or as a side-effect of medication.