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Parkinson's Disease

(PD; Paralysis Agitans; Shaking Palsy)

Definition

Parkinson's disease (PD) is a progressive movement disorder. PD is characterized by:
  • Slowing down of movements (bradykinesia)
  • Tremor at rest
  • Muscle rigidity
  • Loss of reflexes that maintain posture and equilibrium
Part of the Brain Affected by PD—Yellow Section
Substansia Nigra
Copyright © Nucleus Medical Media, Inc.

Causes

PD is caused by a loss of certain nerve cells in the brain. The loss of these cells causes a decrease in the amount of a brain chemical called dopamine. Low dopamine levels cause PD symptoms.
The brain cells may be lost because of genetic defects, the environment, or some combination of the two. A small amount of people with PD have an early-onset form. This type is caused by an inherited gene defect.

Risk Factors

PD is more common in men and in people aged 50 years and older. Other factors that increase your chance of PD include:

Symptoms

Symptoms of PD begin mildly. They will worsen over time.
PD may cause:
  • Problems with dexterity
  • Difficulty with activities of daily living
  • Fatigue
  • Stiffness and rigidity of muscles, usually beginning on one side of the body
  • Tremors are present at rest, improve with movement, and are absent during sleep
  • Slowness of purposeful movements
  • Neuropsychiatric symptoms, such as:
  • Difficulty and shuffling when walking
  • Poor balance
  • Tendency to fall
  • Loss of smell
  • Sleep problems
  • Flat, monotonous voice
  • Stuttering
  • Trouble speaking (often speaking with a low volume)
  • Increasingly mask-like face, with little variation in expression
  • Drooling and excessive salivation
  • Shaky, spidery, or small handwriting
  • Seborrhea (a skin problem that causes a red rash and white scales)
  • Trouble chewing and swallowing
  • Urinary symptoms (frequency and urgency)
  • Bowel movement symptoms (straining, constipation)

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no tests to definitively diagnose PD. The doctor will ask many questions. This will help to rule out other causes of your symptoms.
Tests to rule out other conditions may include:
  • Blood tests
  • Urine tests
Imaging tests take pictures of internal bodily structures. This can be done with:
  • CT scan
  • MRI
  • PET scan
  • A special kind of PET scan called a DAT scan may be used in the evaluation of PD

Treatment

Currently, there are no treatments to cure PD. There are also no proven treatments to slow or stop its progression. Some medications may help to improve symptoms. Over time, the side effects of the medication may become troublesome. The medications may also lose their effectiveness.

Medications

Medications that may be used to treat PD include:
  • Levodopa-carbidopa
  • Dopamine agonists
  • Monoamine oxidase inhibitors
  • Anticholinergics
  • COMT inhibitors
  • Antivirals
Depression or hallucinations may also occur with PD and its treatment. Medications may be prescribed to attempt to treat these conditions. The drugs may include:
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Tricyclic antidepressants
  • Antipsychotics
Hip fractures are common in those with PD. Bisphosphonates are medications that may help reduce this risk.
Constipation , drooling, and lightheadedness when standing are common and may improve with medications or other treatments.

Surgery

Different brain operations are available, and many more are being researched including:
  • Deep brain stimulation (DBS)—implanting a device to stimulate certain parts of the brain; can decrease tremor and rigidity
  • Thalamotomy and pallidotomy—destroying certain areas of the brain to improve tremor when medication does not work (not as common as deep brain stimulation)
  • Nerve-cell transplants (research only)—to increase amount of dopamine made in the brain

Physical Therapy

Therapy can improve muscle tone, strength, and balance. It includes exercises and stretches. There is also evidence that tai chi may be beneficial.

Psychological Support

Consider joining a support group with other people with PD. It will help to learn how others are learning to live with the challenges of PD.
If you are diagnosed with PD, follow your doctor's instructions .

Prevention

There are no current guidelines to prevent PD.

RESOURCES

National Parkinson Foundation http://www.parkinson.org

Parkinson's Disease Foundation http://www.pdf.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Parkinson Society Canada http://www.parkinson.ca

References

Alvarez MVG, Evidente VGH. Understanding drug induced parkinsonism: separating pearls from oysters. Neurology. 2008;70:e32-34.

Li F, et al. Tai chi and postural instability in patients with Parkinson’s Disease. N Engl J Med. 2012;366(6):511-5199.

Liu R, Gao X, et al. Meta-analysis of the relationship between Parkinson disease and melanoma. Neurology. 2011;76:2002-2009.

Managing your PD. Parkinson’s Disease Foundation website. Available at: http://www.pdf.org/en/managing%5Fpd. Accessed September 5, 2013.

Nielsen NM, Rostgaard K, et al. Poliomyelitis and Parkinson disease. JAMA. 2002;287:1650-1651.

NINDS Parkinson's disease information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/parkinsons%5Fdisease/parkinsons%5Fdisease.htm. Updated September 3, 2013. Accessed September 5, 2013.

Obeso JA, et al. Missing pieces in the Parkinson’s disease puzzle. Nature Medicine. 2010;16(6):653-661.

Parkinson disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 27, 2013. Accessed September 5, 2013.

Parkinson's disease. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Parkinsons%20Disease.aspx. Accessed September 5, 2013.

Perlmutter JS, Eidelberg D. To scan or not to scan: DaT is the question. Neurology. 2012;78:688-689.

Ristić AJ, Vojvodić N, et al. The frequency of reversible parkinsonism and cognitive decline associated with valproate treatment: a study of 364 patients with different types of epilepsy. Epilepsia. 2006:47(12):2183-2185.

Samii A, et al. Parkinson's disease. Lancet. 2004;363:1783-1793.

Schenkman N, et al. Exercise for people in early- or mid-stage Parkinson disease: a 16-month randomized controlled trial. Phys Ther. 2012.

Siderowf A, et al. Update on Parkinson's disease. Ann Intern Med. 2003;138:651-658.

Wider C, Wszolek CK. Movement disorders: insights into mechanisms and hopes for treatments. Lancet Neurology. 2009;8(1):8-10.

1/4/2011 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Spinks A, Wasiak J, Bernath V, Villaneuva E. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev. 2009;(4):CD002851.

4/7/2014 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Marras C, Hincapié CA, et al. Systematic review of the risk of Parkinson's disease after mild traumatic brain injury: results of the international collaboration on mild traumatic brain injury prognosis. Arch Phys Med Rehabil. 2014 Mar;95(3S):S238-244.

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