What Is Parkinson's Disease?


Quick summary

Parkinson's disease is a complex and progressive neurological disorder. Symptoms differ greatly from person to person, so much so that there's no predicting for sure which ones a patient will experience or how quickly. No cure exists yet. However, as neurological disorders go, this one is among the most treatable. Responses to treatment vary, but medications can give a patient substantial symptom relief and a good quality of life for many years, sometimes a decade or more. When drugs aren't enough, brain surgery may be an option. Here's a primer on the disease.


Parkinson's disease gradually impairs the ability to move, walk, talk, and swallow. It typically develops when patients are in their 50s or 60s, but in roughly 8 percent of cases it strikes before age 40.

For some people, the condition can be severely debilitating in the long term; others are able to function relatively well even after 25 years of living with Parkinson's disease.

The disease stems from gradual destruction of certain nerve cells -- in a part of the brain called the substantia nigra -- that make a key chemical known as dopamine. Dopamine helps relay messages within the brain centers that orchestrate muscles of the body to produce smooth, coordinated motions. Without that signal, muscles can't respond properly.

Parkinson's isn't a death sentence

With current treatments, average life expectancy with Parkinson's disease is nearly normal, and the disease process isn't itself fatal. But severely disabled patients can die from complications of the illness. For instance, problems with swallowing can cause patients to choke or aspirate food into their lungs, leading to infection and deadly pneumonia. Or a bad fall might cause a broken hip and contribute to a general decline from which the patient never recovers.

Diagnosis can be tricky in early stages

About 5 to 10 percent of Parkinson's disease patients are wrongly told at first that they have some other condition. And up to 20 percent of people given a Parkinson's diagnosis don't actually have the illness. To obtain an accurate assessment, it would be best for a patient to see a movement disorder specialist, a neurologist with one to two years of extra training in treating Parkinson's disease and similar illnesses.

Because there's no lab test to pinpoint Parkinson's disease, the doctor identifies it by examining and questioning the patient, looking for a certain constellation of clinical signs. Parkinson's disease belongs to a category of neurologic disorders that all cause similar symptoms, known as parkinsonism. So the physician must rule those out and other potential diagnoses such as small strokes, arthritis, head injury, and essential tremor.

What Parkinson's disease looks like

Motor symptoms


The first hints of the illness are usually mild, intermittent, and show up on just one side of the body. Three cardinal signs are:

  • Shakiness, from a tremor in a hand, arm, or leg or the jaw or face when the patient isn't actively moving.
  • Stiffness, or rigidity of the arms, legs, and torso.
  • Slowness of movements, also known as bradykinesia.

Other common signs and symptoms include:

  • Small, cramped handwriting.
  • A stooped posture.
  • Less arm-swinging than before while walking.
  • A blank, "masklike" facial expression.

As the disorder progresses, additional problems may grow more significant, including:

  • Problems with balance and falling.
  • Walking with small, shuffling steps.
  • Moments of "freezing" when the patient's feet suddenly can't move forward.
  • Difficulty swallowing.
  • A weak and muffled voice.

Nonmotor symptoms

A patient may not develop these difficulties, but over time, up to 60 percent of patients suffer from more than one nonmotor symptom. Many are treatable with standard therapies.

Cognitive and behavioral problems:

  • Depression
  • Apathy
  • Fatigue
  • Dementia
  • Anxiety
  • Sle ep disorders
  • Difficulty with impulse control
  • Sensory difficulties
  • Loss of sense of smell
  • Pain in a limb affected by muscle stiffness

Problems with bodily functions

  • Drooling
  • Fainting or dizziness after standing up, due to abnormalities in blood pressure regulation
  • Sexual dysfunction
  • Constipation
  • Frequent urination or incontinence
  • Skin problems, such as eczema or excessive sweating


Treatments That Ease Parkinson's Disease

No currently available treatments can stop or slow down Parkinson's disease. However, doctors now have more than a dozen drugs to control symptoms. The name of the game is to make up for the loss of dopamine in the brain, in a variety of ways. Again, it's crucial for patients to consult an expert. Most of Parkinson's disease treatment is a matter of juggling and tweaking medications, and a movement disorder specialist will have a lot more experience doing that than a general neurologist, says Martha Gardner, a Parkinson's patient and former nurse who is coordinator of the American Parkinson Disease Association (APDA) Information and Referral Center at Stanford University.

  • Drugs

The gold standard medicine is levodopa, sold as Sinemet, which is converted in the brain into dopamine. Other classes of drugs -- such as dopamine agonists, COMT inhibitors, and MAO-B inhibitors -- either mimic the actions of dopamine or counteract its breakdown in the brain.

If a patient has run-of-the-mill Parkinson's disease, Sinemet or dopamine agonists are likely to work well for several years after diagnosis. Over time, though, symptoms start to re-emerge. And side effects from the drugs themselves begin to become problematic. Most troublesome are the random wiggly, writhing movements called dyskinesias.

  • Surgery

If adjustments in a patient's medication regimen fail to adequately solve these challenges, surgical treatments may improve the situation. In particular, in some patients a method called deep brain stimulation can reduce the need for drugs: Electrodes are permanently placed in the brain and connected to a battery-operated pacemaker (implanted in the chest). The pacemaker sends electrical signals to the brain that block the abnormal nerve impulses causing motor symptoms.

  • Other strategies for improving and maintaining a patient's functioning

Regular stretching, strengthening, and aerobic exercises can help a person stay flexible, improve posture, and move more easily. As the disease advances, physical therapy and occupational therapy can offer advice and strategies for navigating difficulties with the daily activities of living. And speech therapy can train a patie nt to talk at a louder volume to be understood clearly.

Forecasting Parkinson's prognosis is difficult

In some Parkinson's disease patients, symptoms slowly worsen over 20 years or more, but in others the pace is faster. Which course any individual's illness will take is hard to say. However, according to the American Academy of Neurology, some evidence suggests that patients who are diagnosed at an older age, and whose initial symptoms do not include tremor, will see their Parkinson's disease advance more rapidly.

On the other hand, someone who comes in chiefly complaining of a tremor on one side of the upper body may feel miserable about it, but the shakiness can be a positive sign, says Susan Imke, a gerontological nurse practitioner in Fort Worth, Texas. "That's a good prediction of typical Parkinson's disease that responds well to medicine for many years," she says.

Another potential clue to a patient's long-term outlook is how the illness unfolds in the first few years, because in any given individual, the disease tends to progress at the same rate over time. "Parkinson's that creeps along in the early stages doesn't tend to just start to gallop at some point," says Imke.

about 3 years ago, said...

I didn't know that Emily M read and answered some of the comments..I hope she reads mine..and I would like to add that a detailed list of the stages of Parkinsons would be very helpful..also I really felt comforted by how many people are concerned enough to write here..

about 3 years ago, said...

yes it was very helpful. I am not only a published writer, I taught in a public school until I was eighty years old, and I only retired because of the effects of parkinsons.I would like to get in touch with Ms. Chen, as I got my start in getting things published in California. I was especially good at teaching reading, and writing skills to disadvantaged children, I hold teaching credentials in both California and Texas and I am writing a book about what methods I have invented and developed to help non readers to become readers who can go to college if they choose to.. I don't know when I got Parkinson's. I don't think it was in the last five years before I retired as I was working full time as a special education teacher in a title one school and attending the University of Texas at Arlington at the same time, UTA is where I earned my masters of Education. However, when the problem of keeping my balance became a nuisance and I went to the doctor and THEN..I was sent to a neurologist who tested me for everything..First they thought I had MS..then they tested me for MLS.and then Mystemia Gravis, and finally Parkiinsons and I don't think they knew anything for sure..First I was put on carbidopa/levodopa and then another doctor put me on Prednisone for something else..and I feel a little better but I still have the problem of not being able to keep my balance.. and if seems to me getting worse. I am not ready to face losing my independence. I need help.

over 3 years ago, said...

This is the best article I have found to explain the symptoms and progression of this disease.

over 3 years ago, said...

Page 4 information was totally new to me, and encouraging.

over 4 years ago, said...

Is parkinson disease generic? My father has Parkinson's at 102. I just retired at 65 & notice my hand tremors, two fainting spells after long walks & lifting 50 lbs packages. My doctors prescribed brain MRI scan. Does that help prognosis? Greatly appreciate your time & effort on informational materials for my own education. Thanks, Florence M Lee

over 4 years ago, said...

No comments, really. Just very useful at my husband´s a my age.

over 4 years ago, said...

very informative

over 4 years ago, said...

The article was clearly described and well organized.

almost 5 years ago, said...

gave me some answers about many of the things (symptoms) that I have been living with and wondering why? I feel alot better to know. I am now going to try and do some strenous exercises-- for two reasons: 1) to lose about 80 pounds and 2) (if I understand the article correctly) distribute more blood flow to the brain and most importantly to the cells that produce dophamine.

almost 5 years ago, said...

Thanks for the information. I suffer from PD, and the diagnosis three years ago was an earthshaking experience. I am on medication, as we as various forms of therapy. I function a little less well than before the onset of PD. It is very useful to know of so many smaller indicators that help to confirm my symptoms. There is so much to learn, but knowledge is power. I am determined to not let PD get the better of me. So far, all my family and friends have been helpful and understanding. It is hard for them to see the various symptoms affect me, but they recognize my resolve to remain independent and healthy for the remainder of my years.

almost 5 years ago, said...

It would be advantageous to point out the necessity of getting treatment from a physiotherapist straight after being diagnosed with PD and not waiting until abnormal walking patterns and difficulties with activities of daily living become fixed.

about 5 years ago, said...

Descriptions support our experience. We wish that a treatment will be found soon to overcome this disease.

about 5 years ago, said...

Family Grandpa had this progrewssed He was a painter . Does it run in families the symmptoms help.

about 5 years ago, said...

Generally, the explanation was helpful for me. My wife and two sons have been diagnosed with Parkinson's. My wife (age 85) has been told by the surgeon who repaired her him (broken in a fall) that she will in all probability never walk again. Crushing information!!!

over 5 years ago, said...

yes, it was very helpful.

over 5 years ago, said...

because of cancer (colon) symptoms are passed off as side effects of treatment. Grandparents &mother have parkinson's.I am 64 and a good chance I will get Parkinson's. This article points to80 percent of my symptoms now. Also to be careful self diagnose could cause more anxiety

over 5 years ago, said...

i want to use visualization, etc., along with denial (not always a bad thing) and defiance. this approach probably requires something like a road map for the terrain of the likely,in order to defy as much as possible.

over 5 years ago, said...

Hi AZ Phyllis and Anonymous, Thank you both very much for your comments. If you have questions, you can post them in our Ask & Answer section, here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager

over 5 years ago, said...

When visiting a chiropractor for the 3rd time in 8 yrs. (while on vacation out of state), that I exhibited some changes from my previous visit several yrs. prior. He detected very early signs of possible neurological disease - possibly Parkinson's (both parents have/had - which he didn't know). He detected some "rigidity" (which I still don't see). He strongly suggested I see a neurologist for a CT scan of my brain. He was very concerned that it be checked out EARLY on & that I start taking some natural substances to help ward it off. As he's in another state, his own financial gain is not a factor. He also referred me to a well-known Dr. of Naturopathy - (too far from me, & I've yet to see ANY). I fully believe he was genuinely concerned for me. Yet, I see none of the signs listed in your very detailed article. Should I cast aside his suggestion? With my family background, I remain concerned. I lost some sense of smell in the 1980s, following sinus surgery & a root canal that left a HORRID tase in my moth for over a year! I've NOT lost ANY sense of taste! Food is DELICIOUS! The 2 MDs I've seen & shared of my concerns, as well as my regular chiropractor (of 12 years) see no changes. So, I'm left with remaining questions.

over 5 years ago, said...

I would like to see an article on Parkinsons Plus, MSA. My 53 year old husband has developed so many symptoms so fast. He falls 4 or 5 times a day, even with a walker. What is next?

over 5 years ago, said...

Symptoms and surgical treatment information is helpful. Thank you so much for this site.

over 5 years ago, said...

Hi sassy's mom, I'm so sorry to hear about your husband's difficult situation. Unfortunately, we are unable to give direct medical advice for our site members. I suggest that you contact your husband's doctor regarding his medical issue, and find out what the best solution is. I hope our informational site will be of help for you in the future. Take care, Emily | Community Manager

over 5 years ago, said...

According to a neurologist, my husband has the beginning of Parkinson's. But, he also is on very strong does of medicine for being bi-polar. The neurologists says he should not be on medicine for Parkinson's because it would affect his other medicine. What is the answer.

over 5 years ago, said...

The list of symptoms and treatments.

over 5 years ago, said...

Checking on my symptoms. I am taking Sinomet and CarboDolopa and have bradydyskinesia and shuffling gait.

over 5 years ago, said...

great article ,because my sister in switzerland had pcabout for 20 years,and we pray for her ,and she is in a nursing home where there she have the best ,for me its very hard to call her .it is so hard to communicate on the phone.thats all we can do to pray for her,because it breaks my hearth that we are so far away and i cant go visit pray for all those people.god bless them all