Parkinson’s Disease In Older Adults

Reviewed by: HU Medical Review Board

Parkinson’s disease (PD) is a neurological disorder that gets worse over time. It affects movement, balance, and mood.1

PD is usually thought of as a disease that affects older adults. Nearly 1 million people in the United States are currently living with PD. Most cases are seen in people who are 60 years old or older. Roughly 5 to 10 percent of all PD cases are diagnosed in people younger than 50.2,3

What are the symptoms?

PD symptoms do not predictably differ according to age. However, everyone experiences PD slightly differently. Different people develop different symptoms at different times.3

The most common motor symptoms of PD include:3

  • Tremor at rest, such as a tremor in a finger, hand, or foot
  • Rigidity (stiffness) of limbs, neck, or shoulder
  • Impaired balance when standing up (postural instability), which can lead to falls
  • Slowness of movement or gradual loss of movement (bradykinesia), such as slower walking, decreased blinking, or slower facial expressions

Common non-motor symptoms include:3

  • Depression
  • Memory loss
  • Difficulty swallowing (dysphagia)
  • Speech issues, such as slurred speech, abnormally long pauses, or hoarseness
  • Sleep issues, such as difficulty falling or staying asleep (insomnia), restless legs syndrome, or acting out dreams (REM sleep behavior disorder)

What is the cause?

Researchers are working hard to understand why some people develop PD. Some studies suggest that the risk of PD may be increased by environmental factors, specifically exposure to certain chemicals. They also believe there may be a genetic risk factors for PD. Distinct environmental and genetic risks factors may play different roles in different people with PD.1

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PD affects the brain. There is an area of the brain called the substantia nigra. It holds brain cells (neurons) that create a messenger chemical called dopamine. This dopamine is used to send messages to the basal ganglia, an area of the brain that helps fine-tune movement.1

The basal ganglia sends messages to other areas of the brain that control movement by sending signals to the rest of the body, telling it how and when to move. The basal ganglia is important in helping regulate the movement control centers of the brain.1

In PD, the neurons in the substantia nigra are damaged or die. They are not able to produce as much dopamine as they should. Without dopamine, the substantia nigra cannot send messages to the basal ganglia. In turn, the basal ganglia cannot send messages to the movement centers of the brain. This is why people living with PD move slowly and experience tremors.1

Why is PD more common in the elderly?

As we age, damage to our body builds up very slowly. It can take a long time for us to notice. For example, people who live with osteoarthritis have had small amounts of damage to their joints over and over.

As a young adult, they may not notice any joint issues. However, at some point, the joints build up enough damage that they start to experience pain or stiffness. This can happen to individual cells too.

The biggest risk factor for PD is age. Dopamine-producing neurons can die slowly over time. This can build up for years before symptoms of PD are apparent.3

How is it treated?

There is currently no cure for PD. However, there are many treatments that can help manage both motor and non-motor symptoms.

Most treatments focus on increasing the amount of dopamine in the body. The most common and effective treatment for motor symptoms is carbidopa/levodopa. Levodopa is a chemical the body can directly turn into dopamine. Carbidopa is added so more levodopa can get into the brain.3

In some people, carbidopa/levodopa does not effectively control PD symptoms. Some other treatments for PD symptoms include:3

  • Dopamine agonists
  • MAO-B inhibitors
  • COMT inhibitors

Preventing falls

A key element of treating PD in older adults is preventing falls. PD can damage your balance and causes you to move slowly. This can make you more likely to fall. It is important to work with your doctor to find the best drug combination for you to reduce the risk of falls.1

Also, it is important to keep your home hazard-free. This includes keeping clutter and wires off of the floor and having good lighting. Handrails in the bathroom and stairs are also very helpful.1

If you are concerned about your balance, speak to your doctor. They may be able to prescribe physical therapy to help improve your balance. Reach out to your doctor if you have any questions about your PD symptoms or treatment.

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