What is Parkinson’s disease?
Parkinson’s disease is a slowly progressive neurological condition in which the dopamine-producing nerve cells in the part of the brain that regulates movement are gradually lost. It presents with tremor, slowness of movement and muscle stiffness.
Parkinson’s is one of the most common disorders of the nervous system, particularly in older people; in most cases it begins around the age of 60, but it can also start earlier. It is slightly more common in men.
What are the causes and risk factors of Parkinson’s?
Cells in an area of the brain called the substantia nigra release a chemical called dopamine, which is involved in regulating movement. In Parkinson’s disease these cells are gradually lost, and the shortage of dopamine causes the motor symptoms. Why the cells die is not fully understood.
- Age — the main risk factor.
- Genetic factors — a small proportion of cases are inherited; most patients have no family history of Parkinson’s.
- Environmental factors — exposure to certain chemicals (for example, pesticides) may increase the risk.
It should be noted that certain medicines, repeated damage to the brain’s blood vessels and other conditions can cause a Parkinson-like state (parkinsonism). Distinguishing them is important for treatment.
What are the symptoms of Parkinson’s?
At first the symptoms are mild and often begin on one side of the body: a slight tremor, stiffness or a feeling of tension in one arm or leg. Observant patients notice that the arm on the affected side moves less and that the foot drags on the floor when walking. Over time posture changes, the back becomes stooped and steps get shorter.
Main motor symptoms
- Hypokinesia (slowness of movement) — reduced facial expression, less frequent blinking, quiet speech, smaller handwriting, shorter steps, arms not swinging when walking.
- Rigidity — increased muscle tone and high resistance to passive movement; resistance that rises intermittently is called the “cogwheel” phenomenon.
- Resting tremor — shaking at a frequency of 4–6 Hz in the hands, sometimes the legs and jaw, at rest. The degree of tremor varies: it increases with stress and disappears during sleep.
- Balance problems — in the later stages of the disease the risk of falls increases.
Non-motor symptoms
Sometimes the disease starts years before the motor symptoms with non-specific complaints: a reduced sense of smell, constipation, moving while “acting out” dreams in sleep, depression, anxiety, fatigue. Later, orthostatic hypotension (a drop in blood pressure on standing), bladder problems, seborrhoeic dermatitis, pain in the limbs and lower back, and impaired memory and attention may develop.
When is emergency help needed?
Parkinson’s develops slowly and does not usually cause emergencies. However, call 103 in the following situations: sudden weakness on one side or speech problems (possible stroke), serious injury after a fall, sudden severe difficulty swallowing and choking, sudden confusion together with a high temperature, or sudden severe freezing of movement. Stopping medication suddenly can also lead to a serious condition — only do this after consulting your doctor.
How is Parkinson’s diagnosed?
There is no single test or investigation that confirms Parkinson’s disease. The diagnosis is based on the symptoms and the signs found during a detailed neurological examination. To rule out similar conditions, the doctor may order an MRI scan, blood tests and other investigations. The response to medication also helps confirm the diagnosis. On how it differs from other types of tremor: Tremor (shaking).
How is Parkinson’s treated?
There is currently no treatment that cures Parkinson’s disease, but modern treatment allows good control of symptoms and an active life for many years. The main principle of treatment is to relieve motor symptoms, as well as psychological, autonomic and sleep problems.
- Medication — medicines that compensate for the shortage of dopamine in the brain. The choice of medicine, dose and schedule are set individually by the doctor according to the stage of the disease and are adjusted periodically.
- Physical rehabilitation — physiotherapy, regular movement, balance exercises, speech and swallowing therapy.
- Surgical treatment — in selected patients whose symptoms are not adequately controlled with medication or whose medication side effects become severe, deep brain stimulation (DBS) is an evidence-based, modern surgical treatment. Suitability for this treatment is assessed jointly by a neurologist and a neurosurgeon.
Everyday life with Parkinson’s
- Be physically active every day — walking, swimming, stretching and balance exercises.
- Take your medication at the times prescribed by your doctor.
- Reduce the risk of falls at home: remove slippery rugs, improve lighting, install grab rails.
- Drink enough water and eat a fibre-rich diet to prevent constipation.
- Do not hide changes in mood — depression can be treated too.
Frequently asked questions
Does every tremor mean Parkinson’s?
No. The most common tremor is essential tremor, which gets worse with movement. Tremor at rest is more typical of Parkinson’s, but only a doctor can make the diagnosis.
Is Parkinson’s hereditary?
In most cases the disease does not run in families. Genetic forms account for a small proportion of cases.
Is exercise beneficial in Parkinson’s?
Yes. Regular physical activity improves mobility, balance and mood, and is an important part of treatment.
Does Parkinson’s disease shorten life expectancy?
Thanks to modern treatment, most people with Parkinson’s disease lead an active life for many years and have a life expectancy close to normal. The course of the disease varies from person to person; regular medical follow-up, physical activity and preventing falls are important in this respect.