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Parkinson's disease


Expert reviewer, Dr Jeremy Rees, Consultant Neurologist
Next review due November 2021

Parkinson’s disease is a condition that affects your brain, leading to problems with your body’s movements and shaking and stiffness of your limbs. There are lots of treatments that can help to control your symptoms although it’s not possible to cure the condition at the moment.

Middle-aged woman drinking tea

About Parkinson's disease

Parkinson’s disease develops when a particular group of nerve cells in your brain die. They are cells that produce a chemical called dopamine. This results in lower than normal levels of dopamine in your brain, and this leads to problems with control of movement.

Parkinson’s disease is most common in older people although you can get it when you’re younger. Men are more likely to get Parkinson’s disease than women. Around one in every 37 people will be diagnosed with Parkinson’s disease at some point during their life.

Symptoms of Parkinson’s disease

Parkinson’s disease can cause many symptoms, which usually come on gradually. Physical symptoms tend to start on one side of your body, and then affect both sides as the disease progresses.

Movement symptoms

The most common and noticeable symptoms of Parkinson’s disease relate to control of your body’s movements. There are four main features of Parkinson’s disease.

  • Tremor (shaking). This often affects your thumb and forefinger at first – it can look like you’re rolling a pill, hence the term ‘pill-rolling tremor’. It may also affect your foot on the same side of your body. The shaking is most obvious when you’re resting. It rarely affects your ability to carry out fine motor tasks (like doing up buttons); it tends to stop when you’re moving or asleep.
  • Rigidity (muscle stiffness). Your muscles become stiff, making movement of your arms and legs more difficult. This is something you may not notice but the doctor examining you will be looking for.
  • Slow movements (bradykinesia). This can often be the most important aspect of Parkinson’s in terms of how it will affect you. It can take you longer to start moving, and your walking and other actions slow down.
  • Problems with walking and balance. You might walk slowly or with a shuffle, and your posture may become stooped. Parkinson’s disease can also affect your balance and, as the disease progresses, you may become prone to falls.

These problems can start to affect you in different ways as the disease progresses and different muscles become affected. The following are examples of common problems you may experience.

  • You may ‘freeze’ while you’re walking or find it difficult to stop.
  • Your speech may become quieter than it used to be, and you may slur your words. Other people may notice that your voice sounds more monotonous. These changes may make it harder to have conversations with people.
  • Your face may become less expressive and you might not blink so often. This is not something you will be aware of.
  • You may start to have difficulty with fine movements. You may struggle to do up buttons or do other fiddly tasks, and your handwriting may become smaller.

Many of the symptoms listed above can be caused by things other than Parkinson’s disease. But if you’re having any of these problems, it’s worth seeing your GP. If you notice symptoms like these in a friend or loved one, you should encourage them to contact their GP.

Non-movement symptoms (advanced disease)

As well as causing problems with movement, Parkinson’s disease can affect a number of other body functions as it progresses. This can lead to several problems but most people only get these symptoms when they’ve had the condition for a long time.

  • Bowel and bladder problems. You may get constipation and you may need to pass urine more often than normal, including at night.
  • Problems with swallowing, which can lead to increased saliva and drooling.
  • Sexual problems such as erectile dysfunction (in men) and low sex drive (in women).
  • Low blood pressure, causing dizziness when you stand up.
  • Increased sweating.
  • Problems sleeping. This can be for a number of reasons, including being uncomfortable if you’re not able to turn, and having to go to the toilet more often. You may also find it hard to sleep if you’re anxious or depressed.
  • Mental health problems. Depression is a common problem in people with Parkinson’s disease. Some people also develop dementia as the disease progresses.

Diagnosis of Parkinson’s disease

There’s no test for Parkinson’s disease. Instead, a doctor will make a diagnosis based on your symptoms. If your GP suspects your symptoms could be due to Parkinson’s disease, they’ll 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 doctor who specialises in treating older people.

The specialist will usually be able to make a diagnosis by asking about your symptoms, any medication you’re taking, and doing a physical examination. They may ask you to walk, speak and write or draw, as well as look at your face and limbs for signs of Parkinson’s disease. They may also suggest you have some scans to rule out other conditions. These may include an MRI scan, a CT scan or a DaTSCAN (dopamine transporter scan). A DaTSCAN is a special type of CT scan, which helps to show up any loss of dopamine-producing cells in your brain.

In the earlier stages of Parkinson’s disease, it can be hard to give a certain diagnosis. There are a number of other conditions that resemble Parkinson’s disease. For example, certain drugs you may take for mental illnesses can cause symptoms similar to those seen in Parkinson’s disease.

Your doctor may start you on Parkinson’s disease medicine and see how you respond to it, to help confirm a diagnosis. For more information about what medicines you may be offered, see our section on treatment of Parkinson’s disease.

Your specialist may ask to see you every six to 12 months, to review your diagnosis.

Treatment of Parkinson’s disease

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

You’ll usually be put under the care of a team of healthcare professionals, including a specialist in movement disorders and a Parkinson’s disease specialist nurse. They’ll provide you with ongoing support, and should review your care at least every six to 12 months.

Medicines

There is a very wide range of medicines available for treating Parkinson’s disease. Most work by restoring or supplementing the level of dopamine in your brain. Not everyone with Parkinson’s disease will have the same medicine. Which one is best for you will depend on many things including what stage of disease you have, how your symptoms are affecting you, and your own preferences. Your doctor will help you to weigh up the potential benefits and risks, and to decide which medicine to try.

Levodopa

Levodopa is often one of the first medicines you’ll be offered, as it is most effective at relieving symptoms. Levodopa is converted into dopamine in your brain. It’s combined with other medicines such as benserazide (co-beneldopa) or carbidopa (co-careldopa), to help it get into your brain. Levodopa often gives a more noticeable improvement in your symptoms at first than many of the other medicines. But over time it can start to wear off, so you start getting symptoms again more regularly. It’s also more likely to cause involuntary movements.

Dopamine agonists

Dopamine agonists such as ropinirole, act as a substitute for dopamine. These medicines may not work as well as levodopa, but they’re less likely to wear off over time, or to cause involuntary movements. They do have other side-effects, like making you feel sleepy or causing impulsive behaviour. Your doctor may prescribe dopamine agonists on their own or with levodopa.

Monoamine oxidase B inhibitors

Monoamine oxidase B inhibitors (MAO-B inhibitors), such as rasagiline and selegiline, prevent dopamine from being broken down. They have a moderate effect on symptoms. The side-effects of MAO-B inhibitors aren’t usually as bad as other medicines. You might be prescribed MAO-B inhibitors on their own or together with levodopa.

Catechol O-methyl transferase inhibitors

Catechol O-methyl transferase inhibitors (COMT inhibitors), such as entacapone, block the breakdown of levodopa in your body. You have it alongside levodopa to make it more effective. Your doctor may suggest a COMT inhibitor if you’re currently taking levodopa and it’s started to lose its effectiveness.

Amantadine

Amantadine mimics the effect of dopamine in the body. It’s not used very often. But you might be offered this if you’ve been on other medication that is not controlling your symptoms or you’re getting involuntary movements.

Anticholinergic medicines

Anticholinergic medicines like procyclidine block the action of a chemical in the brain called acetylcholine. They only help with certain symptoms (such as tremor) and can produce serious side-effects. They’re not used very often now for Parkinson’s disease, and only in the early stages of the condition.

Always ask your doctor if you need any advice on your medicine, and read the patient information leaflet that comes with it.

Other therapies

Medicines are just one part of treatment for Parkinson’s disease. There is a range of other therapies that can help improve your quality of life and manage your symptoms over the long term. The healthcare team looking after you will make sure you have access to therapies that are right for your stage of the disease.

  • Physiotherapy may help with balance and movement problems. A physiotherapist can also give you advice about the types of physical activity you can do. If you’ve got Parkinson’s disease, it’s really important to keep as active as you can. For more information, see the section: Living with Parkinson’s disease.
  • Occupational therapy can help to support you on how to continue with your daily activities and maintain your independence.
  • Speech and language therapy can help if you’re having any speech problems or difficulties with swallowing and excess saliva.

Your doctor may suggest referring you to other types of health professional as necessary. For instance, they may recommend that you see a dietitian for advice on changes to your diet that may help your symptoms.

Treatments for advanced Parkinson’s disease

If you have advanced Parkinson’s disease and the medicines listed above are no longer helping to control your symptoms, your doctor may recommend one of the following treatments.

  • Apomorphine. This is a strong dopamine agonist (a substitute for the dopamine that you’ve lost in your brain), which you take by injection. You can either administer the injections yourself as you need them or have a device that gives you a continuous dose under your skin.
  • Deep brain stimulation (DBS). In this procedure, electrodes are placed in areas of your brain that are important in controlling movement. A pulse generator under the skin in your chest stimulates the electrodes, which can help to reduce your symptoms. DBS does have possible side-effects and complications. Your doctor will discuss exactly what will happen and the risks and benefits of this procedure, before you decide whether to go ahead.

Future treatments

Research into potential new treatments for Parkinson’s disease is happening all the time. Scientists are looking at things like:
  • drugs that might have a protective effect on the nerve cells in your brain
  • stem cells that might be able to grow into new nerve cells
  • gene therapy, to improve the production of dopamine or help prevent the death of brain cells

Before new treatments can be made available, they have to go through a lot of testing to check how well they work and how safe they are.

Causes of Parkinson’s disease

Parkinson’s disease is caused by the death of nerve cells in your brain that produce the chemical messenger dopamine. This causes a fall in the level of dopamine in your brain. The disease develops gradually, often over many years.

At the moment, scientists don’t fully understand why the dopamine-producing nerve cells start to die. Although it’s thought that a combination of your genes and factors in your environment are involved.

A rare hereditary form of Parkinson’s disease has been identified in a small number of people. But most people who have Parkinson’s disease don’t have a family history of the condition. For more information on this, see the FAQ: Is Parkinson’s disease hereditary? Certain chemicals called neurotoxins are found in the environment and are harmful to your brain. They 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.

Living with Parkinson’s disease

Many people with Parkinson’s disease find that medical treatment can help to control their symptoms for many years. However, how quickly the disease progresses varies between people (for more information, see the FAQ: How quickly does Parkinson’s disease progress?). You may find that you eventually need help with everyday activities 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, you may find your ability to drive safely is affected. If you’ve been diagnosed with Parkinson’s disease, it’s important that you inform the Driver and Vehicle Licensing Agency (DVLA) and your car insurer.

The DVLA’s decision won’t be based on your diagnosis of Parkinson’s disease but on your specific symptoms. You won’t need to stop driving as long as your symptoms aren’t affecting your ability to drive, and you can maintain safe control of the vehicle. The DVLA may issue you a new licence for a shorter period than usual (maybe one or two years). If your symptoms start to get worse, you may need to give up your license.

Eating and drinking

Depending on your specific symptoms and the stage of your disease, your doctor or dietitian may advise you to make changes to your diet. For instance, if you have constipation, they’ll 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’re losing weight due to swallowing problems, your dietitian may prescribe you supplements.

If you’re taking levodopa, protein-rich foods such as meat, fish, eggs, cheese, beans and pulses can start to affect its absorption in your body. It’s important not to cut down on protein because it’s an essential part of a balanced diet. You may find that it helps to take your levodopa about 30 to 60 minutes before meals. Or your doctor or dietitian may discuss following a diet where you eat most of your protein in the final meal of the day.

Exercise

Doing exercise and being as active as you can is helpful in many ways if you have Parkinson’s disease. Exercise can help to improve movement-related symptoms of Parkinson’s disease, as well as balance, co-ordination and posture. There’s even evidence that exercise may slow down the progression of the disease. Being more active is also good for your general health and wellbeing.

It’s worth trying to increase the amount of exercise you do as soon as you’ve been diagnosed. Aim to build up to doing 30-minute bouts of moderate-intensity exercise on at least five days of the week. You might want to try jogging, swimming, exercise classes or exercise DVDs at home. You should also try to incorporate some exercises that target your flexibility and posture; examples include Tai chi, dance, Pilates or yoga. As your disease progresses, you may need to adapt your exercise, for instance changing to chair-based exercises. Parkinson’s UK organise exercise classes and groups specifically for people with Parkinson’s disease.

It’s important to only carry out exercise that is safe for you to do. A physiotherapist will be able to advise you about the best types of exercise to do.

Frequently asked questions

  • Parkinson’s disease is progressive. This means that your symptoms will gradually get worse over time. In general, the disease progresses slowly but how quickly it actually gets worse varies from person to person. Some people show only little disability after 20 years, whereas others may be severely disabled after only 10.

    Symptoms of Parkinson’s disease tend to appear very gradually and slowly, so in the early stages of the disease, you may not even notice any problems. Most people find that for the first two or three years, their symptoms can be completely controlled with medicines. After a number of years, you might start to develop complications from treatment or find that the medicines become less effective. Your symptoms gradually become more severe, reaching a point where they restrict your activities more and more.

    For many people, it can take years until the disease starts to have a real impact on their daily life.

    There are some factors that can make it more likely that your disease will progress more rapidly. These include:

    • if you’re older when you’re diagnosed
    • if you have more problems with muscle stiffness and lack of movements than you do with tremor
    • if you have other health problems too
    • if you have a lower response to initial medication

    There are some conditions, known as atypical Parkinsonism or ‘Parkinson’s plus’ syndromes, which have very similar features to Parkinson’s disease. However, people with these conditions to get worse much more quickly and don’t respond so well to treatment. These include multiple system atrophy and progressive supranuclear palsy.

  • Parkinson’s disease isn’t normally hereditary (that is, it’s not a condition that’s passed to you from your parents, in your genes). Most people who get it don’t have a family history of the disease, and it’s rare for people to pass it onto their children. However, there are a small number of people who have been identified as having a rare hereditary form of Parkinson’s disease.

    Lots of research is being done into how your genes may affect your risk of Parkinson’s disease. It’s thought that the disease may be down to a complex interaction between a number of different genes and factors in your environment. The genes that have been identified may increase your risk of getting Parkinson’s disease. This doesn’t mean that you will definitely get it if you have these genes – it will depend on a number of other factors too.

    If you’re worried about your risk or your children’s risk of developing Parkinson’s disease, talk to your GP, specialist or Parkinson’s nurse. It’s sometimes possible to have a test to see if you carry a genetic risk factor for Parkinson’s disease.

  • Your symptoms may improve when you start taking medication. However, the symptoms of Parkinson’s disease do gradually get worse over time – there’s currently no cure for the disease and no treatment that can stop it or slow it down. However, how the disease affects you, and the symptoms you experience, can change from day to day. A particular symptom that is bothering you one day may not be noticeable the next.

    Many people learn the best way of managing their symptoms and adapting their lifestyle as necessary. Your healthcare team may offer you different treatments at different stages of the disease to help you to cope better with any symptoms. So although your symptoms may not improve, you may find better ways of managing them as you learn to live with your disease. Talking to support groups with other people in the same situation can help you to keep a positive outlook.


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Related information

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  • Reviewed by Pippa Coulter, Freelance Health Editor, November 2018
    Expert reviewer, Dr Jeremy Rees, Consultant Neurologist
    Next review due November 2021



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