Everything You Want to Know About Parkinson’s Disease | Neurology

Parkinson's Disease

Overview of Parkinson’s disease

Parkinson’s disease is a progressive neurological disorder. The first signs are movement problems. The smooth muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is a part of the brain called the “black substance.”

In Parkinson’s, the cells of the substantia nigra die. When this happens, dopamine levels drop. When they decrease by 60 to 80 per cent, Parkinson’s symptoms begin to appear.

There is currently no treatment for Parkinson’s disease, which is chronic and gets worse over time. More than 50,000 new cases are reported each year in the United States. Parkinson’s is often misdiagnosed and it can be even more so.

Symptoms of Parkinson’s disease

Some of the first symptoms of Parkinson’s disease can appear years before motor problems. These first signs are:

  • Decreased sense of smell (anosmia).
  • Constipation
  • Small, narrow print
  • Voice changes

Four main motor problems are observed:

  • Tremor (tremor at rest)
  • Slow movements.
  • Arm, leg, and trunk stiffness.
  • Balance problems and tendency to fall.

Secondary functions:

  • Empty facial expressions.
  • The tendency to get stuck when running.
  • Muffled and low-volume speech.
  • Decreased brightness and swallowing.
  • The tendency to fall back.
  • Decrease in build while running.

Other more serious symptoms can include:

  • Layers of white or yellow scales on the fatty parts of the skin called seborrheic dermatitis.
  • Risk of skin cancer acute melanoma.
  • Sleep disturbances including nightmares, talking, and movements during sleep.
  • Disappointment
  • Anxiety
  • Hallucinations
  • Psychosis
  • Attention and memory problems.
  • Problems with visual-spatial relationships.

The first signs of Parkinson’s disease are unnoticed. With these warning signs, your body may try to alert you to a movement disorder.

Causes of Parkinson’s disease

The exact cause of Parkinson’s is unknown. May contain genetic and environmental components. Some scientists believe that viruses can also trigger Parkinson’s.

Dopamine regulatory substances are associated with low levels of Parkinson’s dopamine and norepinephrine.

Abnormal proteins called tax bodies have also been found in the brains of people with Parkinson’s. Scientists do not know what role tax agencies play in the development of Parkinson’s disease.

Although there are no known causes, research has identified groups of people who develop this condition. In addition to:

Sex: Men are one and a half times more likely to develop Parkinson’s than men.

Race: Whites are more likely to get Parkinson’s than African Americans or Asians.

Age: Parkinson’s usually appears between 50 and 60 years. It occurs before age 40 in 5-10 per cent of cases.

Family history: People who are in close contact with family members with Parkinson’s disease are also more likely to develop Parkinson’s disease.

Toxins: Exposure to certain toxins increases the risk of Parkinson’s disease.

Head injury: People with head injuries are more likely to develop Parkinson’s disease.


Parkinson’s disease is progressive. That is, symptoms of the condition can get worse over time.

The Hohn & Yahr scale to classify its stages. This scale divides symptoms into five stages, and health care providers know how much the signs and symptoms of the disease have improved.

Stage 1

Stage 1 is a short form of Parkinson’s. It is very mild, and in fact, you may not experience any noticeable symptoms. They may not yet interfere with your daily life and work. If you have symptoms, they are isolated to one side of your body.

Stage 2

Progress from Phase 1 to Phase 2 can take months or years. Each person’s experience is different.

In this moderate stage, you may experience symptoms similar to:

  • Muscular strength
  • Vibrations
  • Changes in facial expressions
  • Shake

Muscle strength complicates daily tasks and the time it takes you to complete them. However, at this stage, you are not likely to face balance problems. Symptoms appear on both sides of the body. Changes in posture, gait, and facial expressions are more noticeable.

Stage 3

In this intermediate stage, the symptoms change. While you may not experience the new features, they are more recognizable. They can interfere with all your daily activities.

The movements are noticeably slower, which slows down the activity. Balance problems are more important, which is why waterfalls are very common. People with stage 3 Parkinson’s can generally maintain their independence and full function without much help.

Stage 4

Progress from stage 3 to stage 4 brings significant changes. During this time, it will be very difficult for you to stand without a walker or assistive device.

Reactions and muscle movements are also significantly slowed down. Living alone is not safe, perhaps dangerous.

Stage 5

At this more advanced stage, the extreme characteristics make watch attendance mandatory. If not, it will be difficult to stop. Wheelchairs may be required. People with Parkinson’s may experience confusion, hallucinations, and hallucinations. These complications of the disease begin in later stages.

It is the most common staging system for Parkinson’s disease, but alternative staging systems are sometimes used for Parkinson’s disease.


There is no specific test for the diagnosis of Parkinson’s. The diagnosis is based on medical history, a physical and neurological examination, as well as a review of the signs and symptoms.

Imaging tests such as a CT scan or MRI can be used to rule out other conditions. A dopamine transporter scan can also be used. Although these tests do not confirm Parkinson’s disease, they can rule out other conditions and support a doctor’s diagnosis.

Treatment for Parkinson’s disease

Parkinson’s disease can’t be cured, but medications can help control your symptoms, often dramatically. In some more advanced cases, surgery may be advised.

Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.

Medicines and drugs used to treat Parkinson’s disease

Medications may help you manage problems with walking, movement and tremor. These medications increase or substitute for dopamine.

People with Parkinson’s disease have low brain dopamine concentrations. However, dopamine can’t be given directly, as it can’t enter your brain.

You may have significant improvement in your symptoms after beginning Parkinson’s disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent. You can usually still control your symptoms fairly well.


Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into your brain and is converted to dopamine.

Levodopa is combined with carbidopa (Lodosyn), which protects levodopa from early conversion to dopamine outside your brain. This prevents or lessens side effects such as nausea.

Side effects may include nausea or lightheadedness (orthostatic hypotension).

After years, as your disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane (“wearing off”).

Also, you may experience involuntary movements (dyskinesia) after taking higher doses of levodopa. Your doctor may lessen your dose or adjust the times of your doses to control these effects.

Dopamine agonists

Unlike levodopa, dopamine agonists don’t change into dopamine. Instead, they mimic dopamine effects in your brain.

They aren’t as effective as levodopa in treating your symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

Dopamine agonists include pramipexole (Mirapex), ropinirole (Requip) and rotigotine (Neupro, given as a patch). Apomorphine (Apokyn) is a short-acting injectable dopamine agonist used for quick relief.

Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa. But they can also include hallucinations, sleepiness and compulsive behaviours such as hypersexuality, gambling and eating. If you’re taking these medications and you behave in a way that’s out of character for you, talk to your doctor.


These are used to block the parasympathetic nervous system. They can help with vision. Anticholinergics used to treat benztropine (cognition) and trihexyphenidyl Parkinson’s.

Amantadine (Symmetrel)

Amantadine (Symmetrel) can be used in addition to carbidopa-levodopa. It is a glutamate blocking drug (NMDA). Provides short-term relief from involuntary movements (dyskinesia) that are a side effect of levodopa.

MAO B inhibitors

These medications include selegiline (Zelapar), rasagiline (Azilect) and safinamide (Xadago). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme metabolizes brain dopamine. Selegiline given with levodopa may help prevent wearing-off.

Side effects of MAO B inhibitors may include headaches, nausea or insomnia. When added to carbidopa-levodopa, these medications increase the risk of hallucinations.

These medications are not often used in combination with most antidepressants or certain narcotics due to potentially serious but rare reactions. Check with your doctor before taking any additional medications with an MAO B inhibitor.

Parkinson’s surgery

Surgical intervention is specialized in people who do not respond to medications, treatment, and lifestyle changes.

Two basic types of surgery are used to treat Parkinson’s disease:

Deep brain stimulation

During deep brain stimulation surgeons implant electrodes in specific parts of the brain. A generator connected to the electrodes sends pulses to help reduce characteristics.

Pump delivery therapy

In January 2015, the US Food and Drug Administration (FDA) approved a pump delivery therapy called Duopa.

The pump provides a combination of levodopa & carbidopa. To use the pump, your doctor may need to perform a surgical procedure to place the pump close to the small intestine.

Parkinson’s prognosis

Complications from Parkinson’s can greatly reduce the quality of life and prognosis. For example, individuals with Parkinson’s can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal.

Proper treatment improves your prognosis, and it increases life expectancy.

It may not be possible to slow the progression of Parkinson’s, but you can work to overcome the obstacles and complications to have a better quality of life for as long as possible.

Parkinson’s dementia

Parkinson’s dementia is a complication of Parkinson’s disease. It causes people to develop difficulties with reasoning, thinking, and problem-solving. It’s quite common 50 to 80 per cent of people with Parkinson’s will experience some degree of dementia.

Symptoms of Parkinson’s disease dementia include:

  • Depression
  • Sleep disturbances
  • Delusions
  • Confusion
  • Hallucinations
  • Mood swings
  • Slurred speech
  • Changes in appetite
  • Changes in energy level

Parkinson’s disease destroys chemical-receiving cells in the brain. Over time, this can lead to dramatic changes, symptoms, and complications.

Certain people are more likely to develop Parkinson’s disease dementia. Risk factors for the condition include:

Sex: Men are more likely to develop it.
Age: The risk increases as you get older.
Existing cognitive impairment: If you had memory and mood issues before a Parkinson’s diagnosis, your risk may be higher for dementia.
Severe Parkinson’s symptoms: You may be more at risk for Parkinson’s disease dementia if you have a severe motor impairment, such as rigid muscles and difficulty walking.

Currently, there’s no treatment for Parkinson’s disease dementia. Instead, a doctor will focus on treating other symptoms.

Parkinson’s life expectancy

Parkinson’s disease is not fatal. However, Parkinson’s-related complications can shorten the lifespan of people diagnosed with the disease.

Having Parkinson’s increases a person’s risk for potentially life-threatening complications, like a fall, blood clots, lung infections, and blockages in the lungs. These complications can cause severe health issues. They can even be fatal.

It’s unclear how much Parkinson’s reduces a person’s life expectancy. One study looked at the 6-year survival rates of nearly 140,000 people who had been diagnosed with Parkinson’s. In that six-year span, 64 per cent of people with Parkinson’s died.

What’s more, the study found that 70 per cent of people in the study had been diagnosed with Parkinson’s disease dementia during the span of the study. Those who were diagnosed with memory disorder had lower survival rates.

Parkinson’s exercises

Parkinson’s often causes problems with daily activities. But very simple exercises and stretches can help you roll over and walk more safely.

Improve walking

  • Walk carefully.
  • Pace yourself try not to move too quickly.
  • Let your heel hit the floor first.
  • Check your posture and stand up straight. This will help you to shuffle less.

To avoid falling

  • Don’t walk backwards.
  • Try not to carry objects while running.
  • Try not to bend over and reach.
  • To turn around, make a U-turn. Don’t turn your feet.
  • Eliminate all tripping hazards like loose rugs in your home.

When you dress

  • Allow yourself plenty of time to get ready. Avoid rushing.
  • Select clothes that are easy to put on and take off.
  • Try using items with Velcro instead of buttons.
  • Try wearing pants and skirts with elastic waistbands. These may be easier than buttons and zippers. Yoga uses targeted muscle movement to build muscle, increase mobility, and improve flexibility. People with Parkinson’s may notice yoga even helps control tremors in some affected limbs.

The Parkinson’s diet

For people with Parkinson’s disease, diet plays an important role in daily life. While it doesn’t treat or prevent progression, a healthy diet can have some significant effects.

Parkinson’s is the result of decreased dopamine levels in the brain. Naturally, you can increase hormone levels with food.

Similarly, a healthy diet that focuses on specific nutrients can reduce some of the symptoms and prevent disease progression. These foods:


Foods high in these substances may help prevent oxidative stress and damage to the brain. Antioxidant-rich foods include nuts, berries, and nightshade vegetables.

Fava beans

These lime green beans contain levodopa, the same ingredient used in some Parkinson’s medications.


These hearts- and brain-healthy fats in salmon, oyster, flaxseed, and some beans may help protect your brain from damage.

In addition to eating more of these beneficial foods, you may want to avoid dairy and saturated fat. These food groups may increase your risk for Parkinson’s or speed up progression.

Parkinson’s and dopamine

Parkinson’s disease is a neurodegenerative disorder. It affects the dopamine-producing neurons (dopaminergic) in the brain. Dopamine is a brain chemical and neurotransmitter. It helps send electric signals around the brain and through the body.

The disease prevents these cells from making dopamine, and it may impair how well the brain can use dopamine. Over time, the cells will die entirely. The drop in dopamine is often gradual. That’s why symptoms progress or slowly get worse.

Many of the Parkinson’s medications are dopaminergic drugs. They aim to increase the level of dopamine or make it more effective on the brain.

Parkinson vs MS

At first glance, Parkinson’s disease and multiple sclerosis (MS) may seem very similar. They both affect the central nervous system, and they can produce many similar symptoms.

These include:

  • Tremors
  • Slurred speech
  • Poor balance and instability
  • Changes in movement and gait
  • Muscle weakness or loss of muscle coordination

The two conditions are very different, however. The key differences include:


MS is an autoimmune disorder. Parkinson’s is the result of decreased dopamine levels in the brain.


MS primarily affects younger individuals. The average age of diagnosis is between 20 and 50. Parkinson’s is more common in people over 60.


People with MS experience issues like headaches, hearing loss, pain, and double vision. Parkinson’s can ultimately cause muscle rigidity and difficulty walking, poor posture, loss of muscle control, hallucinations, and dementia.

If you’re showing unusual symptoms, your doctor may consider both of these conditions when making a diagnosis. Imaging tests and blood tests may be able to help distinguish between the two conditions.

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