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affects the way you move. It happens when there is a problem with certain nerve
cells in the brain.
Normally, these nerve cells make an important
dopamine. Dopamine sends signals to the part of your
brain that controls movement. It lets your muscles move smoothly and do what
you want them to do. When you have Parkinson's, these nerve cells break down.
Then you no longer have enough dopamine, and you have trouble moving the way
you want to.
Parkinson's is progressive, which means it gets
worse over time. But usually this happens slowly, over many years.
And there are good treatments that can help you live a full life.
No one knows for
sure what makes these nerve cells break down. But scientists are doing a lot of
research to look for the answer. They are studying many possible causes,
including aging and poisons in the environment.
genes seem to lead to Parkinson's disease in some
people. But so far, there is not enough proof to show that it is always
The four main symptoms of
Tremor may be the first symptom you notice. It's one of
the most common signs of the disease, although not everyone has it.
importantly, not everyone with a tremor has Parkinson's disease.
starts in just one arm or leg or on only one side of the body. It may be worse
when you are awake but not moving the affected arm or leg. It may get better
when you move the limb or you are asleep.
In time, Parkinson's
affects muscles all through your body, so it can lead to problems like trouble
swallowing or constipation.
In the later stages of the disease, a person with
Parkinson's may have a fixed or blank expression, trouble speaking, and other
problems. Some people also lose mental skills (dementia).
People usually start to have
symptoms between the ages of 50 and 60. But sometimes symptoms start
will ask questions about your symptoms and your past health and will do a
neurological exam. This exam includes questions and tests that show
how well your nerves are working. For example, your doctor will watch how you
move, check your muscle strength and reflexes, and check your vision.
Your doctor will also ask
questions about your mood.
cases, your doctor may have you try a medicine. How this medicine works may
help your doctor know if you have Parkinson's disease.
There are no lab or blood tests that
can help your doctor know whether you have Parkinson's. But you may have tests
to help your doctor rule out other diseases that could be causing your
symptoms. For example, you might have an
MRI to look for signs of a
At this time, there is no cure
for Parkinson's disease. But there are several types of medicines that can
control the symptoms and make the disease easier to live with.
You may not even need treatment if your symptoms are mild. Your doctor
may wait to prescribe medicines until your symptoms start to get in the way of
your daily life. Your doctor will adjust your medicines as your symptoms get
worse. You may need to take several medicines to get the best results.
Levodopa (also called L-dopa) is the best drug for controlling symptoms
of Parkinson's. But it can cause problems if you use it for a long time
or at a high dose. So doctors sometimes use other medicines to treat people in the early stages of the disease.
The decision to start
taking medicine, and which medicine to take, will be different for each person. Your doctor will be able to help you make these
In some cases, a treatment called deep brain stimulation
may also be used. For this treatment, a surgeon places wires in your brain. The
wires carry tiny electrical signals to the parts of the brain that control
movement. These little signals can help those parts of the brain work
There are many things you can do at home that can help you
stay as independent and healthy as possible. Eat healthy foods. Get the rest
you need. Make wise use of your energy. Get some exercise every day. Physical
therapy and occupational therapy can also help.
Finding out that you have a long-term, progressive disease can lead to a wide range of feelings. You may feel angry,
afraid, sad, or worried about what lies ahead. It may help to keep a few things
Learning about Parkinson's disease:
Living with Parkinson's disease:
Low levels of
dopamine, a brain chemical involved
in controlling movement, cause symptoms of Parkinson's disease. Low levels happen when nerve cells in a part of the brain that makes dopamine break down. The exact cause of this
breakdown isn't known.
Scientists are looking for links between
Parkinson's disease and genetics,
aging, toxins in the environment, and
free radicals. Although
these studies are beginning to provide some answers, experts don't know the
exact cause of the disease.
Only a small
percentage of people with Parkinson's have a parent, brother, or sister
who has the disease. But abnormal
genes do seem to be a factor in a few families where
early-onset Parkinson's is common.
There are many other causes
of parkinsonism, which is a group of symptoms that includes tremor, muscle
stiffness, slow movement, and unsteady walking. Parkinsonism mimics Parkinson's
disease, but in fact is not Parkinson's disease.
Symptoms of Parkinson's disease differ from person to person. They also change as the disease progresses. Symptoms that one person gets in
the early stages of the disease, another person may not get until later—or
not at all.
Symptoms typically begin
appearing between the ages of 50 and 60. They develop slowly and often go
unnoticed by family, friends, and even the person who has them.
The disease causes motor symptoms and non-motor symptoms. Motor symptoms are those that have to do with how you move. The most common one is tremor.
Tremor, or shaking, often in a hand,
arm, or leg, occurs when you're
awake and sitting or standing still (resting tremor), and it gets better when you move that body part.
Tremor is often the first symptom that people with
Parkinson's disease or their family members notice.
At first the tremor may
appear in just one arm or leg or only on one side of the body. The tremor also
may affect the chin, lips, and tongue.
As the disease progresses, the tremor
may spread to both sides of the body. But in some cases the tremor remains
on just one side.
Emotional and physical stress tends to make the
tremor more noticeable. Sleep, complete relaxation, and intentional movement or
action usually reduce or stop the tremor.
Although tremor is one
of the most common signs of Parkinson's, not everyone with tremor has
Parkinson's. Unlike tremor caused by Parkinson's, tremor caused
by other conditions gets better when your arm or hand is not moving and gets
worse when you try to move it.
The most common cause of non-Parkinson's tremor
is essential tremor. It's a treatable condition that is often
wrongly diagnosed as Parkinson's.
Besides tremor, the most common symptoms
small number of people have symptoms on only one side of the body that never
move to the other side.
Parkinson's disease can cause many other symptoms that aren't related to how you move. These can be disabling and may include things like constipation, sleep problems, and depression.
There are many
other conditions with symptoms similar to Parkinson's disease. Some of these
may be reversible.
Treatment may help control
symptoms during the early
stages of Parkinson's disease. It is usually started
as soon as symptoms begin to affect your ability to work or do daily
activities. As the
disease progresses, drugs may become less effective.
usually the first symptom, appearing in just one arm
or leg or on only one side of the body. With time, the tremor usually—but not always—spreads
to both sides of the body. Joint pain, weakness, and fatigue may occur.
As the disease gets worse, the person may have slow
movement, stiff muscles, and poor coordination. He or she may have problems with tasks such as writing,
shaving, or brushing teeth. Changes in handwriting are common.
with posture and balance develop. A person with Parkinson's tends to
walk in a stooped manner with quick, shuffling steps.
several years, as muscle stiffness and tremor increase, the person may become
unable to care for himself or herself. He or she may
be confined to a wheelchair or bed.
People who have taken medicine for several years
may not only notice their symptoms getting worse but also may start to have other movement problems. These
motor fluctuations can be reduced somewhat by making changes in the person's
medicine, but they can be difficult to control and may further complicate
Dementia may develop in up to one-third
of people who have late-stage Parkinson's disease.1
Dementia symptoms may include disorientation at night, confusion, and memory
loss. Treatment for Parkinson's disease can also
contribute to this problem.
A risk factor is anything that increases your chances of getting sick or having a problem. Risk factors for
Parkinson's disease are hard to identify, because
the cause of the disease is unknown.
Advancing age is the only known risk
factor for typical Parkinson's disease (not including early-onset Parkinson's).
Most instances of Parkinson's occur after age 50. But the illness
does occur in people between the ages of 30 and 50 or, in rare cases, at a
A very small number of people with Parkinson's have a
close relative who also has the disease. But it doesn't appear that a family
history of typical Parkinson's significantly increases your risk for the disease.
Having a family history of the disease is a more
significant risk factor in cases of early-onset Parkinson's, but this
form of the disease is not common.
Some research suggests that
long-term exposure to certain environmental risk factors such as pesticides,
chemicals, or well water may increase a person's risk of developing Parkinson's
care isn't needed if you have had a tremor—shaking or trembling—for some time. But you should
discuss the tremor at your next doctor's appointment.
If a tremor is affecting
your daily activities or if it is a new symptom, see your doctor sooner.
description will help your doctor make a correct diagnosis. In writing your
description, consider the following questions:
If you have been diagnosed with Parkinson's, call your doctor if:
The following health professionals can help diagnose or
treat Parkinson's disease:
Other health professionals who may be involved in your
care include the following:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
A diagnosis of
Parkinson's disease is based on your
medical history and a thorough
Your doctor also may check your
sense of smell.
In some cases, your doctor will have you try a medicine for
Parkinson's disease. If that medicine helps your symptoms, it may help the
doctor find out if you have the disease.
There are no lab
tests that can diagnose Parkinson's.
But if your doctor isn't sure you have Parkinson's, he or she may do certain tests to see if you have another condition with similar symptoms.
blood tests may be done to check for abnormal thyroid hormone levels or liver
damage. An imaging test (such as a
CT scan or an
MRI) may be used to check for signs of a
stroke or brain tumor.
Another type of
imaging test, called
PET, sometimes may detect low levels of dopamine in
the brain, a key feature of Parkinson's. But PET scanning isn't
commonly used to evaluate Parkinson's because it's very expensive, not available in many hospitals, and only used experimentally.
No known treatment can stop or reverse the breakdown of nerve cells that causes Parkinson's disease. But there are many treatments that can help your symptoms and improve your quality of life.
Your age, work status, family, and living situation
can all affect decisions about when to begin treatment, what types of treatment
to use, and when to make changes in treatment. As your medical condition
changes, you may need regular changes in your treatment to balance
quality-of-life issues, side effects of treatment, and treatment costs.
You'll need to see members of your health care team regularly (every 3 to 6
months, or as directed) for adjustments in your treatment as your condition
Treatments for Parkinson's include:
Depression is common in people with
Recognizing and dealing with depression is important. There are medicines that can help the
symptoms of depression in people with Parkinson's.
Your doctor, other health
professionals, or Parkinson's support groups can help you get emotional
support and education about the illness. This is important both early and
throughout the course of the disease.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see
There is no known way to prevent
Research has shown
that people who eat more fruits and vegetables, high-fiber foods, fish, and
omega-3 rich oils (sometimes known as the Mediterranean diet) and who eat less
red meat and dairy may have some protection against Parkinson's. But
the reason for this is still being studied.2
Parkinson's disease may not greatly disrupt your life. But for most people, the
disease becomes more disabling over time. Home treatment can help you adjust as
time goes on and help you stay independent for as long as possible.
Medicines are the most common treatment
Parkinson's disease. The goal is to correct the
shortage of the brain chemical
dopamine, which causes the symptoms of Parkinson's.
The decision to start
taking medicine, and which medicine to take, will be different for each person. Medicine is usually started when your symptoms become disabling
or disrupt your daily activities.
Symptoms change as the
disease progresses. Because of this, your doctor will adjust your medicine to deal
with the symptoms as they appear.
Medicines often improve symptoms, but they also may cause side effects. It
may take some time to find the best combination of medicines for you.
Several medicines may be used at
different stages of the disease:
Levodopa is thought to be the most effective drug for controlling symptoms. But many doctors prescribe dopamine agonists in the beginning of the disease. This is because after a few years, levodopa can cause motor complications (times when the medicine suddenly stops working or when
you have uncontrollable jerking movements). Talk to your doctor about which medicines are best for you.
Although it's always important to follow your doctor's
instructions when you take medicines, it's especially vital when you have Parkinson's.
Increasing, decreasing, or stopping
the medicines you are taking may cause big changes in your symptoms and can be
dangerous. Even if a medicine doesn't seem to be working, when you stop taking
it, your symptoms of Parkinson's disease may be worse.
Early in the disease, it might be helpful to take pills with food to help
with nausea, which may be caused by some of the medicines for Parkinson's
Later in the disease, taking the medicines at least 1 hour before
meals (and at least 2 hours after meals) may help them work best.
medicines for Parkinson's disease don't work as well if you take them at the
same time you eat food with protein in it, such as meat or cheese. The protein
can block the medicine and keep it from working as well as it should.
Brain surgery may be considered when drugs
fail to control symptoms of
Parkinson's disease or cause severe or disabling side
Surgery isn't a cure. Drugs are usually still
needed after surgery. But you probably won't need as much medicine as before, which means you may have fewer side effects.
People who have
very advanced Parkinson's or who have other serious problems (such as
heart or lung disease, cancer, or kidney failure) usually aren't good
candidates for surgery. Surgery usually isn't considered for people who have
dementia or psychiatric disorders.
Neurotransplantation is an experimental procedure being studied for the treatment of
Parkinson's disease. It involves implanting cells that produce dopamine into
the brain. Information about how well neurotransplantation works is
limited. And it is not a proven treatment or a realistic option for most people
at this time.
A neurologist with special
training in Parkinson's disease is most often the best kind of doctor to make a
decision about surgery. If you might benefit from surgery or deep brain
stimulation, your neurologist can refer you to a brain surgeon with experience
doing these operations.
speech and language therapy, and
occupational therapy can all be helpful for people
therapies have been suggested as treatments for Parkinson's. None of
these have been proved effective. But it is important to maintain general
health and to eat a
Before trying a
complementary treatment, such as a special diet, talk with your doctor about
the safety and potential side effects of the treatment. Talking
with your doctor can help you both decide whether a treatment is safe and
effective. Complementary treatments should not replace the use of medicines to
treat Parkinson's if you are a candidate for treatment with these
Depression that does not respond to drugs may improve with
electroconvulsive therapy (ECT). ECT can also improve
movement for a short period of time, though the reason for this improvement isn't understood.
Buter TC, et al. (2008). Dementia and survival in
Parkinson disease: A 12-year population study. Neurology, 70(13): 1017–1022.
Sofi F, et al. (2008). Adherence to Mediterranean diet
and health status: Meta-analysis. BMJ. Published online
September 11, 2008 (doi:10.1136/bmj.a1344).
Other Works Consulted
Bronstein JM, et al. (2011). Deep brain stimulation for Parkinson disease. Archives of Neurology, 68(2): 165–171.
Deuschl G, et al. (2006). A randomized trial of
deep-brain stimulation for Parkinson's disease. New England Journal of Medicine, 355(9): 896–908.
Miyasaki JM, et al. (2002). Practice parameter: Initiation of treatment for Parkinson's disease (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 58(1): 11–17. Also available online: http://www.neurology.org/content/58/1/11.full.html.
Olanow CW, et al. (2009). A double-blind, delayed-start trial of rasagiline in Parkinson's disease. New England Journal of Medicine, 361(13): 1268–1278.
Stowe R, et al. (2010). Evaluation of the efficacy and safety of adjuvant treatment to levodopa therapy in Parkinson's disease patients with motor complications. Cochrane Database of Systematic Reviews (7).
Suchowersky O, et al. (2006). Practice parameter:
Diagnosis and prognosis of new onset Parkinson disease (an evidence-based
review). Report of the Quality Standards Subcommittee of the American Academy
of Neurology. Neurology, 66(7): 968–975. Also available online: http://www.neurology.org/content/66/7/968.full.
Suchowersky O, et al. (2006). Practice parameter:
Neuroprotective strategies and alternative therapies for Parkinson disease (an
evidence-based review). Report of the Quality Standards Subcommittee of the
American Academy of Neurology. Neurology, 66(7):
976–982. Also available online: http://www.neurology.org/content/66/7/976.full.
Weintraub D, et al. (2010). Impulse control disorders in Parkinson disease. Archives of Neurology, 67(5): 589–595.
Zesiewicz TA, et al. (2010). Practice parameter: Treatment of nonmotor symptoms of Parkinson's disease: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 74(11): 924–931. Also available online: http://www.neurology.org/content/74/11/924.full.
Current as of:
April 18, 2014
Kathleen Romito, MD - Family Medicine
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