Parkinson’s Disease: What to Know

Parkinson’s disease is a brain disorder that gets worse over time. It causes nerve cells in a part of the brain called the substantia nigra to die. This part of the brain is important for controlling movement. That’s why people with Parkinson’s often shake or show other abnormal movements. Treatments can help with symptoms, but there is no way to slow or reverse the condition.

No one knows exactly why a person gets Parkinson’s. It’s probably due to a mix of things, including genes and exposure to certain toxins. There’s usually no way to predict who will get it or why. It’s rare for Parkinson’s to run in families. Most of the time, it seems to happen randomly.

Both men and women get Parkinson’s disease. It’s 1.5 times more common in men. It’s also more common in older people. Only about 4 out of every 100 cases happen in people under age 50. Each year, about 60,000 people in the U.S. find out they have Parkinson’s. About 1 million people in the U.S. and 10 million around the world have this condition.

The four main symptoms of Parkinson’s are related to movement:

• Tremors or shaking of hands, arms, legs, jaw, or head
• Stiffness of arms, legs, and trunk
• Slowed movement
• Trouble with balance and coordination

People with Parkinson’s may also have:

• Depression or other emotional changes
• Trouble chewing, swallowing, or speaking
• Trouble sleeping
• Constipation

Parkinson’s is a progressive disease. That means that your symptoms usually get worse over time. The symptoms of Parkinson's also vary a lot from one person to the next. How quickly it worsens and how severe it gets can vary a lot, too. Early symptoms may be easy to ignore or dismiss. They might start on one side of your body, showing up on the other side only later. 

At first, it can be hard for doctors to tell if you have Parkinson’s. That’s in part because symptoms vary so much. Other disorders also can look similar. There’s no single test for it. Your doctor might order imaging tests to rule out other conditions. They’ll also ask questions about symptoms, medications, and any exposure to toxins.

Parkinson's affects nerve cells in your brain that make a chemical called dopamine. As a result, levels of the chemical fall. Doctors usually start treatment with levodopa (L-dopa). Your brain turns it into dopamine. But it can make you sick to your stomach, so you’ll probably take it with another medicine called carbidopa to control these side effects. The combination drug is called carbidopa-levodopa (Parcopa, Rytary, Sinemet).

Your doctor might give you one of these, alone or with another drug:

• Dopamine agonists: They act like dopamine but don’t raise levels of it in your brain. You can take them with any drug that has levodopa. You might try pramipexole (Mirapex) or ropinirole (Requip).
• COMT Inhibitors: They help levodopa last longer. You might get entacapone (Comtan) or tolcapone (Tasmar).
• MAO-B inhibitors: These stop your brain from breaking down levodopa. You could get selegiline (Eldepryl, Zelapar) or rasagiline (Azilect).

The doctor may also give you something to treat the tremors that come with Parkinson’s. These medications are called anticholinergics, and they put the brakes on a chemical in your brain that controls movement. You might take benztropine mesylate (Cogentin) or trihexyphenidyl (Artane).

If medicine doesn’t work well enough, your doctor may suggest deep brain stimulation (DBS). In DBS, your doctor implants electrodes deep in the brain. A device connected to them delivers electrical pulses. Those pulses can help control the tremors caused by Parkinson's.

In the past, doctors sometimes used other operations to damage the brain in ways to help with movement symptoms. But they rarely use those surgeries now.

Physical therapy can teach you exercises to improve strength and balance and help you stay independent. Occupational therapy shows you new ways to manage daily tasks. Speech therapy can help with slurred or unclear speech.

Eating healthy foods can help you feel better. It may also help with certain Parkinson’s symptoms, such as constipation. Getting regular exercise will also boost strength, flexibility, and balance. Ask your doctor to recommend a physical therapist or exercise program.

Along with your regular medical care, these approaches may help with mood, energy, and how you feel day to day:

• Massage
• Tai chi
• Yoga
• Meditation

It can help to talk with a counselor or support group. Your doctor may know of local resources. There are also many organizations dedicated to Parkinson’s, including the American Parkinson Disease Association, the Michael J. Fox Foundation for Parkinson’s Research, and the Parkinson’s Foundation.