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Parkinson's Disease

About Parkinson's Disease

In this section, you or a loved one can find out more about medical treatments, research studies and practical information about Parkinson's disease. Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step towards becoming an active decision-maker in your care plan. 

What Is Parkinson's Disease?

Our ability to move is controlled by nerve cells in the brain. The nerve cells communicate with each other and to the rest of the body using chemicals called neurotransmitters. In healthy people, these messages are transmitted well but, in people with Parkinson’s, the messages are disrupted.

One of the neurotransmitters involved in the control of movement is called dopamine. In people with Parkinson’s disease, the brain cells that make dopamine are damaged and dopamine production is reduced. As the level of dopamine decreases, slowness of movement and stiffness appear. Tremor is associated with the disease in 7 out of 10 cases and can also occur early in the disease course.

Parkinson’s symptoms usually begin on one side of the body but eventually affect the whole body as the disease progresses. Abnormal changes in neurotransmitters other than dopamine are seen in Parkinson’s disease and may be responsible for some of the non-motor symptoms that are linked to the disease.

What Causes Parkinson's Disease?

The cause of Parkinson’s disease is unknown; however, both genetic and environmental factors may play a role. Some people are more likely to develop Parkinson’s disease than others. Factors that may increase risk include:

  • Being aged 60 or older
  • Having a close relative with the disease
  • Male sex - men are more likely than women to develop Parkinson's disease
  • Exposure to toxins such as pesticides
  • Rural living
  • Drinking well water
What Are the Effects of Parkinson's Disease?

Specific signs: Motor and non-motor

Initially, the signs and symptoms of Parkinson’s disease may be mild and even go unnoticed.

Motor symptoms and the rate they progress can vary substantially from person to person. Certain motor symptoms are often seen in patients with Parkinson’s disease and are referred to as “cardinal symptoms”. These include tremor when at rest, rigidity, gait and posture problems, and slow movement.

Non-motor symptoms can affect people with Parkinson's at any stage of the disease. Different patients may experience different symptoms; examples of non-motor symptoms include pain and depression (see below).

Parkinson's disease is chronic and progressive, but is not considered to be life threatening. The way that it progresses varies between patients.

How Is the Body Affected?

The following are motor and non-motor symptoms that may be experienced by people with Parkinson's disease.

Motor symptoms:

  • Resting tremor – shaking of a hand, arm or leg while at rest. Tremor is the first symptom to appear in 70% of people with Parkinson’s disease. About 30% never have a tremor.
  • Stiffness in muscles and joints (rigidity) – can limit movement and cause pain
  • Slowness of movement (called “bradykinesia”) – with time, simple tasks can become difficult and time-consuming, your steps shorten and you may drag your feet
  • Problems with posture – you may become stooped
  • Problems with balance – you may have trouble standing up, maintaining your balance and walking
  • Small handwriting
  • Reduced facial expressions
  • Reduced eye blink
  • Softening of the voice
  • Difficulty swallowing
  • Freezing – temporary and involuntary inability to move

Non-motor symptoms:

  • Problems related to the sense of smell
  • Pain
  • Mood problems – such as depression
  • Sleep problems
  • Gastrointestinal troubles such as constipation
  • Fatigue
  • Decrease in blood pressure when standing – also called orthostatic hypotension
  • Sexual and urinary problems
  • Changes in the ability to think – such as dementia
Are there other complications?

People with Parkinson’s disease may also experience other symptoms such as pain (in specific areas of the body or all over the body), sexual dysfunction (decrease in sexual desire or performance), bladder problems (for example, being unable to control urine), smell dysfunction (for example, difficulty identifying certain odours) and difficulties in thinking (this usually happens in the later stages of Parkinson’s).

Lifestyle Options

For most people, regardless of having a chronic disease or not, exercise, healthy eating and good sleeping habits are recommended. A healthy lifestyle can lead to an enhanced quality of life for most people. Talk to your doctor before making any lifestyle changes.

People with Parkinson's disease who exercise tend to do better than those who don't exercise. Exercise can improve your quality of life by increasing your level of fitness, strength, flexibility and balance. It may also reduce depression and stress.

Make sure that you discuss any plans for new activities with your doctor. If you experience shortness of breath of severe pain while exercising, make sure that you seek medical attention.

Fun factor

Choose exercises and physical activities that you enjoy. This will help you to stay with your programme and experience positive feelings.

Elements of exercise

A good exercise programme includes different types of exercise such as:

  • Aerobic fitness (working your heart and lungs) – can have a positive effect on stiffness, slowness, mood and quality of life
  • Strength training such as lifting free weights - this can improve your strength so that you can perform everyday activities such as getting up from a chair
  • Flexibility – stretching exercises to help you keep a good range of movement
  • Balance exercises – improving your balance can help decrease your risk of falling
  • Think about your posture – sit and stand tall with your head aligned above your shoulders

Here are some activities you may want to consider; however, this is not a complete list. Most activities that keep you moving are options. Make sure that you discuss any plans for new activities with your doctor.

  • Brisk walking
  • Golf
  • Racquet sports
  • Gardening
  • Dancing
  • Swimming
  • Cycling
  • Yoga or chair yoga
  • Tai chi
  • Pilates
For most people, healthy eating means having a balanced diet that includes lots of fruit,  vegetables and whole grains, plus drinking water and other fluids. For people with Parkinson's disease, good nutrition can help you attain and maintain a healthy weight and energy level.

Anyone can fall; however, people with Parkinson's disease are at a higher risk of falling due to some of the symptoms of the disease. Falls can lead to accidents and hospitalisation. Knowing what you can do to prevent falls can help to reduce your risk of falling and build your confidence. Here are some things you can do to help prevent falls:

  • Make repairs to any unsafe areas of your home, for example: broken handrails on a staircase, worn or broken steps on walkways
  • When you walk, don't let your centre of gravity shift forward over your feet
Complementary therapy options

“Complementary therapies are non-conventional health treatments, often based on ancient systems, which many people use alongside standard Western medicine. The range of such therapies is wide, with the majority taking a Holistic approach: that is, treating the patient as a whole, rather than just addressing the symptoms. It is this approach which makes complementary therapies so appealing, particularly to people with Parkinson’s.” - European Parkinson’s Disease Association

  • Massage
  • Acupuncture
  • Tai chi - an ancient form of Chinese exercise which can improve flexibility, balance and muscle strength
  • Yoga
  • Music or art therapy
  • Pet therapy – having a dog or a cat can help your physical and emotional health
  • Alexander technique – by focusing on muscle posture, balance and thinking, it is reported to help reduce muscle tension and pain
Medical Treatments

Effectiveness of certain medications for Parkinson’s disease can be reduced when combined with drugs for other health conditions. It is therefore important to seek advice from your doctor or pharmacist regarding the use of any new drug.

The main goal of medical treatment for Parkinson’s disease is to reduce the effect of symptoms on your daily life. Medication can have a positive effect on the disease, but it may also have side effects. It is important to balance the therapeutic effect of a medication with its side effects. Timing of when medications are taken can be a key element in maintaining this balance.

Many types of medications are used to treat Parkinson’s disease. All of these treatment options must be validated and discussed with your doctor.

Levodopa is a natural chemical that is converted to dopamine in the brain. It is always given with carbidopa or benserazide, a drug that prevents the degradation of levodopa in the blood allowing the conversion to happen only in the brain. The motor symptoms of people with Parkinson’s disease can improve with levodopa treatment. It is considered to be the most common and efficacious therapy for motor symptoms.

Side effects of levodopa include nausea, vomiting, light-headedness, sleepiness, hallucinations and involuntary movement.

Dopamine agonists stimulate the parts of the brain influenced by dopamine and are used to treat motor symptoms. These drugs mimic the effects of dopamine.

Side effects include nausea, vomiting, light-headedness, sleepiness, hallucinations, leg swelling, weight gain, involuntary movements and impulsive behaviours such as uncontrollable gambling and compulsive shopping.

COMT inhibitors prolong the effect of levodopa by blocking an enzyme that is responsible for breaking down levodopa before transforming it into dopamine. COMT inhibitors may improve response to levodopa, i.e. reduces “off” time.

Side effects include: involuntary movements (mainly resulting from an enhanced levodopa effect), diarrhoea, light-headedness, nausea, vomiting, hallucinations and reduced impulse control.

These medications act by preventing the breakdown of dopamine in the brain. The MOA-B inhibitors can be used for the treatment of early Parkinson’s disease.

Side effects of MAO-B inhibitors include hallucinations, headache, weight loss, nausea and involuntary movement.

Amantadine may provide short-term relief of mild early-stage disease. It may also be used in later stage disease with carbidopa-levodopa therapy to control involuntary movements.

Side effects may include weight gain, thinking problems, dry mouth, nausea, dizziness, insomnia, purple mottling of the skin, ankle swelling or hallucinations.

Anticholinergic medications act by correcting an imbalance between two chemicals in the brain. These medications are used to treat the early symptoms of Parkinson’s and may primarily help reduce tremors.

Side effects include: impaired memory, confusion, hallucinations, constipation, dry mouth and problems urinating.

Disclaimer

Please note that the information on this website is intended for informational purposes only and should not be used as a substitute for seeking medical advice or treatment from a healthcare professional. You should not use this information to diagnose or treat a medical condition or health problem. Speak to a healthcare professional if you have any questions about your health, medical condition, symptoms or treatment options.

References

https://www.parkinsons.org.uk

UK Parkinson’s charity

parkinson.org

National Parkinson’s Foundation

The National Parkinson Foundation (NPF) (USA) has focused on meeting the needs in the care and treatment of people with Parkinson’s disease for over half a century. To date NPF has funded more than

$180 million in care, research and support services.

pdf.org

Parkinson’s Disease Foundation

The Parkinson’s Disease Foundation (PDF) (USA) is an American leader in Parkinson’s disease research, education and public advocacy. The PDF works for the nearly one million people in the US who live with Parkinson’s by funding research and educational programmes and services.

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