Understanding Parkinson’s disease

Understanding Parkinson’s disease begins by learning not only about the disease but knowing that thousands of people manage the condition and live a full life every day.

Parkinson’s disease is a movement disorder disease resulting in controllable tremors. Although no cure exists, ongoing research gives scientists and doctors more information about how to help patients.

Actor Michael J. Fox, diagnosed with Parkinson’s at age 29 in 1991, has raised awareness and education through the Michael J. Fox Foundation for Parkinson’s Research. His own story has been a shining light for those diagnosed with Parkinson’s.

The source is a problem in the brain in a region called the substantia nigra. This is a tiny part of the brain that makes a chemical messenger called dopamine. Dopamine is a neurotransmitter. It sends messages back and forth in the brain to help us make smooth, purposeful movements.

Cells in the substantia nigra start to die, and they continue to die over time. This means people with Parkinson's have less and less dopamine in their brain. As time goes on, the less dopamine you have, the more trouble you have moving.

This is why Parkinson's is called a progressive disease, and it explains the symptoms of Parkinson's uncontrolled movement, shaking, slowness of movement, balance issues and muscle stiffness.

By the time these symptoms appear, 60 to 80% of the substantia nigra could be damaged or destroyed.

• 1.2 million Americans will be living with Parkinson's by the year 2030. Nearly 90,000 Americans are diagnosed with Parkinson's each year and approximately 1.2 million will be living with the disease by the year 2030.

• Memory loss and trouble thinking are not early warning signs of Parkinson's. Memory loss and trouble thinking may be secondary symptoms of Parkinson's but not a primary indicator of the disease.

• There's currently no cure for Parkinson's disease. There are ways to help ease the symptoms, including medications, deep brain stimulation, and other therapies.

• Parkinson's is a movement disorder, and one of its main symptoms is a tremor.
  But just because somebody has a tremor doesn't mean they have Parkinson's.

No one understands the exact cause of the disease. Research shows that a combination of risk factors may lead to a greater chance of a Parkinson’s diagnosis. General risk factors include:

Age: Most cases appear over age 60. Five to 10% of Parkinson's patients may have early onset before 50.

Gender: Parkinson's tends to effect men nearly 50% more than women.

Genetics: Having one or more close relatives with Parkinson's is a risk factor. About 15 to 25% of those with Parkinson's have a close family member that also has Parkinson's.

Chemicals: Exposure to toxins such as pesticides or other farm chemicals.

Head injuries: In 2016, researchers found that people who reported head injuries were 3.5 times more likely to develop Parkinson’s.

Early in this disease process, it may be hard to know where whether somebody has Parkinson's or a syndrome that can mimic it. If you’re having symptoms, talk with your physician to rule out other possible conditions like:
 

• An essential tremor - It's a common neurologic symptom characterized by an involuntary rhythmic tremor of a body part, usually a hand or an arm, especially writing or eating.
• Parkinsonism. People with Parkinsonism have some of the symptoms of Parkinson's disease, such as a tremor, slow movement, and muscle stiffness. Parkinsonism can be caused by medications, including medicines, to treat psychosis or nausea or other nervous system disorders. It can also be caused by a brain injury or another illness.
• Super nuclear palsy, or PSP, and normal pressure hydrocephalus, or NPH. They may look like Parkinson's, but PSP is characterized by an early onset of imbalance, frequent falls, rigidity of the trunk, and eye movement problems. Symptoms tend to progress more quickly than they do with Parkinson's as well. NPH is characterized by gait problems, urinary incontinence, and dementia.

If you’re experiencing any of these symptoms for a time, keep a record or notes about how and when they occur. Then, schedule an appointment with your primary care physician to share your concerns.

1. A tremor or shaking in a hand or foot
2. Trouble sleeping, especially thrashing about or falling out of bed
3. Loss of the sense of smell, especially for foods like bananas, dill pickles and licorice.
4. Constipation that doesn’t go away or an urgent need to urinate
5. Muscle stiffness that doesn’t ease up through the day
6. Masking or an expression that appears serious or mad or just blank
7. Hypophonia, a low or hoarse voice
8. Micrographia, or small writing or a change in writing
9. Dizziness, especially when standing up from a chair or from a sitting position
10. Stooped posture, leaning or slouching even when trying to stand upright

Other symptoms may include depression, mood disorders, anxiety, apathy, irritability, difficulty swallowing and chewing especially in the later stages of the disease. 

Four common symptoms:

Of all the symptoms, four common symptoms are more prevalent and present with Parkinson’s.

1. A tremor or persistent shaking, especially uncontrolled movement of the limbs even at rest
2. Bradykinesia, or slowness of movement. People with Parkinson's may find it hard to move quickly, even to do normal tasks they've done thousands of times, like taking a shower or getting dressed
3. Rigidity or muscles that are very stiff
4. Postural instability or trouble standing upright

According to the Parkinson's Foundation, a diagnosis is first made by an internist or your family doctor, and many people see a movement disorder specialist who is a neurologist with experience and training in Parkinson's.

Your doctor may consider the following:

• Two of the 4 common symptoms mentioned above
• Your medical history
• Your leg or arm movement, balance or gait.

Your physician may order a PET scan or a DAT scan to rule out essential tremor. Or your physician may start medications to treat Parkinson's to see if symptoms approve.

Receiving a Parkinson's disease for yourself or a loved one can be scary. Understanding the most recent research and treatment options, however, can help you feel more in control of your health.

Medications

The Michael J Fox Foundation says medications typically work best to treat a tremor, and again, they can be used alone or in combination with other medications.

Levodopa

Levodopa works by replacing that dopamine that's lost in your brain. It’s often combined with another medication called carbidopa, which helps prevent the body from breaking down dopamine and limits the side effects such as nausea and vomiting.

Dopamine agonist

These mimic the effects of dopamine in the brain. Generally, they are thought to be less effective for motor symptoms than levodopa, but they do work well for many people.

MAOB inhibitor or monoamine oxidase B inhibitor

These decrease the normal activity of an enzyme called monoamine oxidase that breaks down dopamine.

Anticholinergic medications

These work by decreasing an enzyme in the brain called acetylcholine, or a chemical in the brain called acetylcholine. It helps restore balance between the levels of acetylcholine and dopamine.

Deep brain stimulation (DBS)

This is a surgical procedure where electrodes are implanted inside the brain and then they are connected to a device that's implanted in the chest. The goal is to override those confused signals that produce the symptoms of Parkinson's, including the tremor, the bradykinesia or slow movement and the rigidity.

Currently, deep brain stimulation is only used for those whose symptoms cannot be adequately controlled with medication, another treatment for Parkinson's disease.

Physical therapy

This can help a patient improve their movement and their muscle tone. Occupational therapists can teach patients new ways to get dressed, to feed themselves, to bathe themselves, and more. A speech therapist can help with speaking problems as well as swallowing problems.

Diet and exercise

This is particularly important for those with Parkinson's disease. According to the Parkinson's Foundation, eating a whole food plant-based diet rich in a variety of fresh fruits and vegetables and high in fiber, such as the Mediterranean diet, may help some Parkinson's symptoms. Eating a diet high in protein can interfere with the absorption of levodopa, so timing medications and meals is important.  One study showed that 2.5 hours of physical activity may slow the progression of the symptoms of Parkinson's. Any exercise that's beneficial, including aerobic activity, strength training, stretching, and balance exercises.

Alternative therapies

There are also alternative therapies for Parkinson's, such as massage therapy, yoga, Tai chi, hypnosis or acupuncture. Little evidence exists to prove that supplements help Parkinson's.

• In January 2023, the first Test was discovered to detect Parkinson's disease in living people. The test uses spinal fluid to find a key biomarker of the disease.
• Researchers at Duke University School Medicine found another test called Myo DNADX that can identify damage in someone's DNA that typically occurs when someone has Parkinson's.
• A new drug showed positive results from its phase three trial, a drug called ND 0612. It's a liquid form of levodopa and carbidopa.
• In 2021, researchers at Stanford Medicine began a clinical trial to test gloves to help ease Parkinson's symptoms like tremors and muscle stiffness. They've not yet been approved as a treatment, but it does give hope that technology can develop to help continue to improve Parkinson's symptoms.

Whether you’re facing a new diagnosis or have been living with Parkinson’s for years, it’s important to find the emotional and mental support to continue living your best.

• Learn all you can and stay informed about treatment options
• Talk about the future with your family and healthcare providers. As hard as it may feel, it’s important to plan as the disease progresses
• Recognize that depression is a symptom and seek help
• Create a safe home environment to safeguard against instability and imbalance
• Recognize stress and find ways to reduce it.
• Find support with a companion or support group

If you’re a caregiver, it’s important to take care of yourself as well. Ask for help. Let friends and family know you need help driving to doctor's appointments, doing grocery shopping, or sitting with your loved ones so you can take a break or do something for yourself. Look for respite care with nursing homes or hospitals.

For more inspiration and resources, visit The Michael J. Fox Foundation for Parkinson's Research

Content contained on this page is for informational purposes only and does not constitute medical advice. Consult your health care provider before beginning any new fitness or dietary plan. References provided are for informational purposes only and do not constitute endorsement of any websites or other sources. Should you have any health-related questions, you should contact your health care provider.

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