Parkinson's Disease – Frequently Asked Questions
What is Parkinson’s disease?
Parkinson’s disease (PD) is a disorder that affects the nervous system. It is a chronic condition that slowly worsens over time, and there is no known cure. PD causes symptoms that impact a person’s ability to move (motor symptoms) such as tremor at rest, stiffness of the limbs, difficulty difficulty walking, and impaired impaired balance. Other motor symptoms can also include small handwriting, stooped posture, softness of voice, and problems swallowing. PD also affects other brain functions (non-motor symptoms) causing symptoms such as reduced ability to reduced ability to smell, sleep disturbances such as acting out dreams, constipation, and low blood pressure when standing up. The disease is unique to each individual, and not everyone has the same symptoms.
How is Parkinson’s disease treated? Is there a cure?
There is no known cure for Parkinson’s disease (PD). There are treatment options that are available - treatment for PD is focused on managing symptoms instead of slowing or reversing the progression of the disease.
Initial treatment for motor symptoms of PD is usually levodopa (administered in combination with carbidopa), dopamine agonists, and/or monoamine oxidase-B (MAO-B) inhibitors. The combination of levodopa and carbidopa is the most effective treatment available for the management of motor symptoms of PD. However, it can cause a side effect known as dyskinesia (abnormal involuntary movements). In addition, there are motor fluctuations with “on” periods when the patient receives positive effects of the drug and “off” periods when the motor symptoms return. Some of these symptoms are caused by the levodopa wearing off during the day.
I don’t have tremors—does that mean I don’t have Parkinson’s? What are the symptoms?
A tremor in one or both hands, arms, or legs is one of the most common symptom of Parkinson’s disease (PD), although not all people with PD experience tremor.
It is also important to note that PD affects each person differently. Different people with PD have different combinations of symptoms, and those symptoms can be at varying severity levels.
Symptoms of PD include:
- Rigidity, abnormal stiffness
- Postural instability, impaired balance
- Bradykinesia (gradual slowing down of spontaneous movement)
- Freezing of gait or shuffling gait
- Unwanted accelerated movements
- Speech difficulty or changes in speech
- Stooped posture
- Dystonia (muscle contractions that can cause twisting of body parts)
- Impaired fine motor dexterity – difficulty with precise hand and finger movement, such as in writing, sewing, or fastening buttons
- Poverty of movement (lack of natural, subtle movements)
- Akathisia (restless movement)
- Difficulty swallowing, drooling
- Micrographia (shrinking in handwriting)
- Cramped muscles
- Sexual dysfunction
- Digestive issues, constipation
- Sleep problems, REM sleep behavior disorder
- Orthostatic hypotension
- Increased sweating
- Depression and/or anxiety
- Cognitive changes, including memory difficulties, slowed thinking, confusion, impaired visual-spatial skills, and dementia
- Hallucinations, paranoia, and agitation
How is Parkinson’s disease different from parkinsonism or Lewy body dementia?
Parkinson’s disease (PD) is a chronic, neurodegenerative movement disorder. People with PD commonly experience muscle rigidity, changes in speech and walking, and tremors. Some studies suggest that having PD also increases your risk of developing LBD, but most patients have only one of these conditions.
Lewy body dementia (LBD) is a chronic, neurodegenerative cognitive disorder, and is the 3rd most common form of dementia. Unlike most other forms of dementia, people with LBD have Lewy bodies in the brain. Lewy bodies are abnormally-folded proteins found in the nerve cells of the brain. Patients with LBD may experience memory/cognitive problems, visual hallucinations, and Parkinsonism symptoms.
Parkinsonism refers to the motor symptoms that are typically associated with PD, such as tremors, stiffness, and walking/balance problems. Both PD and LBD are forms of Parkinsonism, meaning that PD patients and LBD patients may experience these motor symptoms. Because the Parkinsonism motor symptoms of PD and LBD can be very similar, it can be difficult to differentiate between the two conditions.
What causes Parkinson’s disease?
The exact cause of Parkinson’s disease (PD) is not known, although scientists believe it results from a combination of genetic and environmental factors. Although rare, sometimes PD runs in families, which suggests a hereditary factor; however, most cases of PD are sporadic, occurring in people without a family history of the disease.
PD develops when certain neurons in the brain communicate poorly with one another. Neurons in the substantia nigra pars compacta produce dopamine. When neurons in the substantia nigra pars compacta are damaged, the loss of dopamine prevents normal function in certain parts of the brain. This commonly results in the motor symptoms of PD: tremor, rigidity, impaired balance, and loss of spontaneous movement.
How is Parkinson’s disease diagnosed?
Unfortunately, there is no single test that can diagnose Parkinson's disease (PD). If PD is suspected, the person should be referred to a neurologist specially trained in movement disorders who can assess for signs and symptoms of the disease. The exam usually involves questions about the person’s history followed by a neurologic exam.
Diagnosis of PD is generally made using a medical history and a physical exam, or a neurological exam. Imaging tests, such as MRI (magnetic resonance imaging), PET (positron emission tomography) scans, or DaTscans are expensive and are not routinely used.
Am I a candidate for Deep Brain Stimulation (DBS)?
Deep brain stimulation (DBS) is a surgical procedure in which a device is implanted in the patient to deliver electrical pulses to the brain to decrease motor symptoms of Parkinson’s disease (PD). Generally, DBS improves symptoms that had previously responded to medication, like levodopa therapy.
DBS may be considered for people who have had Parkinson’s for four years or more and who have significant “off” periods, times when their medication isn’t working well, or those who have dyskinesias (uncontrolled, abnormal movements). It does not work well to treat balance impairments, freezing when walking, or non-motor symptoms of PD. Because DBS can worsen cognition or memory problems, it is not recommended for people with dementia.
Both a neurologist and a neurosurgeon evaluate people with PD who may be candidates for DBS. Evaluation includes reviewing medications and symptoms. Brain scans, using MRI (magnetic resonance imaging) or CT (computed tomography) scans, are performed, and a memory and thinking test may be used to evaluate cognitive function.
I’m a caregiver or care partner—and it’s hard. How do I cope?
There are a variety of challenges caregivers/care partners face, including financial, health, and emotional. The caregiver is often the health care advocate for their loved one, manages medications and scheduling, and assists with daily care, like hygiene and getting dressed. In addition, the caregiver provides emotional support for their loved one, as they deal with living with a chronic, progressive disease.
That’s a ton of work and a ton of added stress! It is vital that caregivers take time to care for themselves and set up support systems. Asking for help is a sign of strength—be open to accepting help from others! Also, finding ways to manage your stress is important. Some ways to reduce stress and recharge your batteries include:
- Abdominal breathing
- Prayer and/or meditation
- Leisurely walks
- Yoga or Tai chi
- Social support from friends and family
I’m struggling with my diagnosis, and I need support. Where do I go to find it?
You’ve come to the right place! Join the ParkinsonsDisease.net community to share your own experiences and learn from others. You can also check out our FB community: https://www.facebook.com/ParkinsonsDiseaseDotNet.
We also have a few articles related to being newly diagnosed with Parkinson’s that may be helpful:
Additionally, the Parkinson’s Foundation offers a hotline that you can call to find support groups in your area – (800) 457-6676.
Do you or a loved one experience micrographia (small handwriting)?