Parkinson's disease is a progressive neurological condition affecting movements such as walking, talking, and writing.   It is named after Dr. James Parkinson (1755-1824), the London doctor who first identified Parkinson's as a specific condition.

Parkinson's has three main symptoms:

Tremor usually begins in one hand or arm and is more likely to occur when the part of the body affected is at rest.   Tremor will usually decrease or disappear when the affected part is being used and often becomes more noticeable when a person with Parkinson's is anxious or excited.   About 70% of people with Parkinson's have a tremor and it is slightly less common in younger people with Parkinson's.

Muscular rigidity or stiffness is a common early sign in untreated people with Parkinson's.   People may experience problems turning round, getting out of a chair, turning over in bed, or making fine finger movements, such as fastening a button, because of rigidity.  Some people find that their posture becomes stooped, or their face becomes stiff, making facial expressions more difficult.   Stiffness can affect many everyday tasks and can sometimes be quite painful.

Bradykinesia means slowness of movement.   People with Parkinson's often find that initiating movements becomes more difficult or that it takes them longer to perform movements. Lack of co-ordination when making movements can also be a problem.

As well as these three main symptoms, people with Parkinson's may experience other symptoms, such as tiredness, depression, difficulties with balance, handwriting and other forms of communication such as speech and facial expression.

What does the term "parkinsonism" mean?

The main symptoms of Parkinson's, tremor, rigidity and bradykinesia, can also be symptoms of other disorders.   Conditions that produce these symptoms are known collectively as parkinsonism.   Parkinson's is the most common form of parkinsonism and is often referred to as "idiopathic Parkinson's disease" (this means of unknown cause).

Other, less common, forms of parkinsonism include multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and drug-induced parkinsonism.   If you have one of these rarer conditions, the Parkinson's Disease Society (PDS) can provide you with support and may be able to put you in touch with specific organisations that support people with these conditions.

Who gets Parkinson's?

In the UK, one in 500 people, around 120,000 individuals have Parkinson's.   Usually symptoms appear after the age of 50 and the risk of getting Parkinson's increases with age. However, in some cases it starts before the age of 40. (This is known as young-onset Parkinson's disease).  About 10,000 people in the UK are diagnosed each year and 1 in 20 of these will be aged under 40 years. 

Although both men and women can get Parkinson's, the condition is somewhat more common in men than women.

Parkinson's is found all over the world.  Exact global figures are not always available, as good statistical research is not available from every country.  However it is estimated that 4 million people worldwide have Parkinson's.

What causes Parkinson's?

In the brain, two chemical messengers, dopamine and acetylcholine work in balance to transmit messages between nerve cells and muscles.  These messages enable us to perform a range of co-ordinated movements.  In people with Parkinson's this balance is upset, because some of the dopamine-producing cells are lost.   When about 80% of the dopamine has been lost, the symptoms of Parkinson's appear and the level of dopamine will continue to fall slowly over many years.

The reason why the loss of dopamine occurs in the brains of people with Parkinson's is currently unknown.  Most researchers believe the cause is likely to be multi- factorial - i.e. many factors may play a role in causing Parkinson's.  Areas of research into the cause include genetics, environmental factors and viruses.   See also the question - Is Parkinson's inherited?

How does Parkinson's progress?

The symptoms of Parkinson's usually begin slowly, develop gradually and in no particular order.  It is important to remember that everyone with Parkinson's is very different and may have a different collection of symptoms and response to treatment from another person with Parkinson's.  The nature and severity of symptoms and the rate at which the condition progresses will also be individual.   The symptoms may take years to progress to a point where they cause major problems and when they do, many of these symptoms can be treated.

Many people ask "how will I be in five or ten years"?   It is not possible to give any concrete answers to this question because of the individuality of the condition.   There have also been so many advances in treatments for Parkinson's that can offer a much better quality of life to people with Parkinson's than was possible a few years ago.   This trend is likely to continue.
 

Will I die from Parkinson's?

Parkinson's by itself does not directly cause people to die.  With the treatment that is now available to treat Parkinson's, life expectancy for someone with Parkinson's is fairly normal and none of the drugs that are used for Parkinson's have any serious side effects that could cause death.

However, occasionally in people who are seriously disabled (usually those who have had Parkinson's for many years), their general physical and mental condition can either cause or exacerbate other illnesses and so contribute to the final cause of death.

Is Parkinson's inherited?

There is no conclusive evidence that Parkinson's is a hereditary condition which can be passed on within families.  It is rare to find more than one person in a family who has Parkinson's, although occasionally it does seem to run in particular families.    In most cases, the development is sporadic.  What some researchers think is that although Parkinson's is not directly inherited, some people may inherit a genetic susceptibility to develop Parkinson's.  

By itself, this would not necessarily cause Parkinson's, but if combined with other factors such as environmental toxins or viruses, it may make people with this susceptibility more likely to develop Parkinson's.  The role genetics may play in the development of Parkinson's disease is currently the subject of much research. 

How is Parkinson's diagnosed?

It is not easy to diagnose Parkinson's as there are no special tests that can prove whether or not someone has the condition.  Parkinson's tends to develop gradually and it can be some time before the symptoms become obvious enough for the person to consult a doctor.  Diagnosis is usually based on medical history and a clinical examination of the person.   The symptoms of Parkinson's can have other causes and laboratory tests and scans may be carried out to rule these out.

How is Parkinson's treated?

At present there is no cure for Parkinson's, but there are a range of treatments available to help control the symptoms and maintain quality of life.   Drugs are the main treatment, which are prescribed to help control the symptoms of Parkinson's.   More detailed information on these is available in the PDS publication, The Drug Treatment of Parkinson's Disease.  Surgery is also sometimes used in the later stages of Parkinson's disease, for people with severe symptoms which are not responding to the drug treatment.

See the PDS information sheet (FS17) Surgery for Parkinson's for further information.  Therapies such as physiotherapy, speech and language therapy and occupational therapy can also play an important role in the management of Parkinson's.   See the PDS information sheets on Speech and Language Therapy (FS7), Physiotherapy (FS42), and Occupational Therapy (B47).

Self-help strategies are also important. These include:

• Keeping yourself as healthy and active as you can, with plenty of fresh air, exercise and a sensible diet.  This will make coping with Parkinson's easier.
• Try not to be discouraged or depressed if Parkinson's slows you down or makes certain routine activities more difficult.  Keep active and work at your own pace.  Planning your activities in advance may help as then there is no pressure to hurry.
• Retain as many of your leisure activities as possible.  If you are finding certain activities that you used enjoy difficult, seek advice from an occupational therapist who may be able suggest way of making things easier.   There are also many sport and leisure organisations for disabled people who can offer information and support.
• Some people give up their social contacts when they have Parkinson's.  It is important to keep these up to avoid becoming isolated and lonely.
• Acknowledge and accept your feelings.  Don't be afraid to talk to someone if you think it might help you.   The PAI has a confidential Helpline staffed by nurses who can offer you information and support Mondays to Fridays 9.30 am -5.30 pm on 1800 359 359.

Can complementary therapies help Parkinson's?

The PAI receives many enquiries about the role of complementary therapies in the management of Parkinson's. There is very little scientific evidence about their benefits in relation to Parkinson's.  However, many people with Parkinson's find these approaches  beneficial for postural control, fitness, relaxation, social intervention, and personal development.  

Those used for relaxation have been found to be particularly helpful as stress makes the symptoms of Parkinson's worse.   Techniques used include acupuncture, the Alexander technique, aromatherapy, art therapy, hydrotherapy, massage, music therapy, reflexology, tai chi and yoga.

Guidelines for research into complementary therapy and Parkinson's have been developed by the PDS Complementary Therapies Working Party and the PDS is currently funding research into some complementary therapies.   The Society recommends that people interested in trying complementary therapies should consult their doctor to ensure that the complementary approach in question is not contraindicated for people with Parkinson's. 

This is particularly true of any herbal medicines or any therapy involving the taking of vitamins as some substances may be interfere with or be contraindicated with Parkinson's drugs.   It is also important that people find a qualified complementary therapist.  GP surgeries can often provide lists of local practitioners. 

Further information on complementary therapies and Parkinson's is available from the PDS.

What is new in Parkinson's research?

As well as ongoing development of new drugs for Parkinson's, there are two other techniques that are the subject of much research interest:

Gene therapy - a new approach to treating medical conditions, which can be described as the use of genes as drugs.   Gene therapy works by introducing normal genes into people with certain disorders to overcome the effects of defective genes that may cause or have a part to play in the development of the condition.   Gene therapy can also be used to treat disorders where the genetic cause is not known, or may not be caused exclusively by genetic defects, such as Parkinson's.

Gene therapy offers the possibility of changing the natural progression of Parkinson's.  So far all other treatments have aimed at modifying the symptoms.   With gene therapy it is hoped the progression of Parkinson's will eventually be halted and a cure found.

Stem cell research - uses the inner cell mass from an embryo, implanting it in the brain to replace those dopamine producing cells that have died, and thereby reversing the progress of Parkinson's.  Despite major setbacks in recent surgical trials, it is still one of the approaches that continue to offer early evidence and real hope of a breakthrough in treatment for Parkinson's in the longer term.

I live alone and have Parkinson's.    Will I be able to cope on my own?

Many people with Parkinson's live on their own and cope very well. If you live alone, remember that help is available to overcome specific problems you may encounter, which make living alone more difficult.  If you feel isolated, local PDS Branches and YAPP&Rs groups (for younger people with Parkinson's) can also offer friendship and support. Do not be afraid to ask for help - the PDS can offer information, publications, and support.

Medpages Medical Reference from: www.surgerydoor.co.uk

Last Updated: 28/1/2009
This information is not intended to replace the advice of a doctor. Disclaimer