Know the causes, symptoms and treatment of this nerve disorder.

Parkinson’s Disease, Explained

You can&#39;t cure PD, but you can get a handle on its symptoms.

7 Things a Neurosurgeon Wants You to Know About Parkinson's Treatment

You know about the tremors, but Parkinson's is connected to lung problems, depression and more.

5 Health Risks Linked to Parkinson’s Disease

An estimated one million Americans today are living with <a href="https://www.sharecare.com/health/parkinsons-disease/slideshow/parkinsons-disease-explained">Parkinson&rsquo;s disease (PD)</a>. According to the Parkinson&#39;s Foundation, it strikes more than 60,000 individuals annually, with men diagnosed 1.5 times more often than women. In the last several decades public awareness of PD has grown, as celebrities like boxing great Muhammad Ali and actor Michael J. Fox&mdash;who was diagnosed in 1991 at age 29&mdash;have chosen to address it publicly.

<a href="https://www.sharecare.com/health/parkinsons-disease/article/6-early-warning-signs-parkinsons">Early symptoms</a> may be barely noticeable, experts say. But, with time, this central nervous system disorder progresses, causing a range of disabilities from increasingly visible tremors and stiff limbs to shaky balance and even slow, low or repetitive speech.

Researchers know that Parkinson&#39;s develops due to the death of nerve cells that coordinate muscle movement, located primarily in the mid-brain. Once too many of these cells are gone, the remaining ones can no longer produce enough of a vital chemical messenger called dopamine, which brain cells use to communicate.

Unlike Fox, most people who develop PD do so after age 60. But besides age, risk factors that contribute to disease development have not been as clear.

What we know about risk factors 
Many studies have implicated environmental toxins, either alone or in interaction with our genes, but the results can be inconclusive, according to Jill Giordano Farmer, DO, MPH, director of the Parkinson&rsquo;s Disease and Movement Disorders program at Drexel Neurosciences Institute in Philadelphia. In studying twins, for example, she says researchers have found differences in the development of PD based on their exposure to industrial solvents over time&mdash;those with greater exposure had higher rates of Parkinson&#39;s&mdash;but the connection requires further confirmation.

Study results about genetic risk factors also have proven inconclusive so far. Only about 15 percent of people with PD have a family history of the disease. And while mutations or errors in several genes have been identified, genetic factors, when present, are considered rare, she says. They carry a low risk of penetrance, or being passed from one generation to another.

&ldquo;So, there really are no risk factors that are modifiable,&rdquo; at least at this time, Dr. Farmer says. &ldquo;We do not tell patients to avoid certain foods or to be on certain diets or to take certain supplements. The data just isn&rsquo;t there.&rdquo;

Instead, doctors advise patients to follow general rules of good health, like eating a healthy diet high and fruits and <a href="https://www.sharecare.com/health/diet-nutrition/slideshow/easy-ways-to-add-greens-to-every-meal">vegetables</a>, as well as:

<ul>
	<li>Using barrier protection if working with chemicals. In her own practice, Farmer says, she always asks patients about exposure to Agent Orange, an herbicide widely used to defoliate trees during the Vietnam War; it&#39;s linked to some cancers and other diseases, including PD.</li>
	<li>Avoiding repetitive head trauma. A recent study involving military veterans found even a mild traumatic brain injury is associated with a higher risk of Parkinson&rsquo;s disease later in life. Individually, the risk was seen as low, but the authors called the association between traumatic brain injuries and PD the &quot;highest level of evidence&rdquo; yet. The results, published in Neurology in April 2018, compared 165,000 vets who experienced a head injury to veterans of a similar age who hadn&#39;t.</li>
</ul>

Diagnosing the disorder 
Early diagnosis of PD is still considered difficult, lacking blood or laboratory tests that are definitive. But based on medical history and a physical exam, Farmer says, doctors still can make fairly accurate diagnoses.

If patients have three out of four features on exam, she says, there&rsquo;s a high probability of having the disease. The features are: slowness, rigidity, tremor and postural instability. Afterwards, doctors look to see how the patient responds to dopamine replacement, and &ldquo;If there&rsquo;s improvement in motor symptoms,&rdquo; she says, &ldquo;that gives us our answer.&rdquo;

Meanwhile, as Farmer and other neurologists seek to manage these illnesses, scientists continue to work towards identifying biomarkers&mdash;or signposts of disease&mdash;that would allow for earlier intervention. As with cancer, the hope is to tailor treatments to each individual, to somehow stay ahead of worsening disease.

The future of treatment 
Parkinson&rsquo;s disease is not yet curable, but medical treatments, and in some cases, surgery, can bring symptom relief to patients, sometimes for many years.

&ldquo;Symptomatically, anything that can best mimic continuous levels of dopamine,&rdquo; offers the greatest benefit right now, says Farmer. That can mean either electronically (through deep brain stimulation), she says, or through dopamine-modulating drugs taken orally or pumped through the intestine or under the skin.

What holds the greatest promise, she says, involves research efforts to identify disease-modifying therapies that can stop or reverse the degeneration that occurs once Parkinson&rsquo;s disease takes hold. &ldquo;We&rsquo;re not there yet,&rdquo; she says, &ldquo;but researchers are looking into these mechanisms.&rdquo;

Are You at Risk for Parkinson’s Disease?

Today, more than one million Americans live with <a href="https://www.sharecare.com/health/parkinsons-disease-causes-risk-factors/article/are-you-risk-parkinsons-disease">Parkinson&#39;s disease (PD)</a>, a progressive movement disorder. It develops as nerve cells that coordinate muscle movement in the mid-brain die off, depleting a vital chemical messenger called dopamine. Despite being one of the most common neurologic conditions physicians see, Parkinson&rsquo;s disease often comes with many &lsquo;myths&rsquo; or misconceptions.

For example, Although Parkinson&rsquo;s has no cure, physicians know that the disease can be successfully managed for a long time, and a PD diagnosis does not mean imminent death.

&ldquo;People can live for many years after a Parkinson&rsquo;s diagnosis,&rdquo; says <a href="https://www.sharecare.com/doctor/dr-jessica-hedeman">Jessica Hedeman, DO</a>, a neurologist at <a href="https://www.sharecare.com/group/mercy-health">Mercy Health Hauenstein Neurosciences Center</a>&nbsp;in Grand Rapids, Michigan. &ldquo;I&rsquo;ve had patients with PD for 20-plus years.&rdquo; Many options now exist for improving patients&rsquo; symptoms, she says, including better ways of delivering dopamine-restoring medications, as well as advances in deep brain stimulation that can ease some of PD&rsquo;s movement-related effects, such as tremors, imbalance and slow, shuffling gaits.

Medication misconceptions 
Perhaps, one of the most pervasive myths about Parkinson&rsquo;s, Dr. Hedeman suggests, concerns drug resistance, which she labels &ldquo;a huge misperception.&rdquo; Unlike cancer patients who develop resistance to chemotherapy over time, PD patients do not develop resistance to their medications, she says, but they may need higher doses of a drug to manage symptoms as the disease progresses.

Parkinson&#39;s drugs do cause known side effects, among them nausea and involuntary movements called dyskinesia. &ldquo;It has to do with how long you&rsquo;ve had PD, the dose of drugs you&rsquo;re on and susceptibility to dyskinesia,&rdquo; Hedeman says. In patients diagnosed with Parkinson&rsquo;s over 25 years ago, like actor Michael J. Fox, symptoms such as these may be severe, she adds. But in general, they&rsquo;re usually quite mild, setting in after 5 or 10 years of taking a drug.

Another medication myth: that you should wait to take yours until your last dose wears off. Doctors advise against waiting, as dopamine-restoring drugs are most effective when taken at the same time each day. A medication timer may be helpful and is often recommended.

A question of age 
When Fox was diagnosed in 1991, he was age 29, which highlights another common myth about Parkinson&rsquo;s. Although advancing age, especially after age 60, is the biggest single risk factor for developing the disease, PD also can strike the young. An estimated 10 percent of cases are diagnosed in patients before age 50. When this happens, Hedeman says, there&rsquo;s likely a genetic factor at play, one of several genes identified, so far, associated with increased vulnerability to the disease.

Tremor myths 
Many people believe all Parkinson&rsquo;s disease patients have tremors. While the large majority do, a sizable percentage of those who develop PD present with other symptoms, as well, according to Hedeman. &ldquo;Parkinson&rsquo;s is hugely individual in how it manifests,&rdquo; she says, with <a href="https://www.sharecare.com/health/parkinsons-disease/article/6-early-warning-signs-parkinsons">non-motor symptoms</a> often predating the onset of motor symptoms by many years. These include changes in sleep patterns, the sense of smell or even the voice, as well as dizziness, fainting and constipation. However, you must present with bradykinesia&mdash;a slowing of movement&mdash;plus tremor or rigidity for your doctor to consider a diagnosis of PD.

What&#39;s more, having tremors does not always mean you have PD. Essential tremor, a separate disorder that causes parts of your body to shake, is far more common than PD. It carries a strong family connection and may start in one hand and progress to the other, Hedeman says. When your doctor is determining whether you have Parkinson&#39;s, having essential tremor can make it more difficult. For specific cases where diagnosis is particularly tough, some physicians may turn to scanning technologies that allow them to measure dopamine uptake in the brain. Reduced dopamine levels mean a likely PD diagnosis.

What people don&#39;t know about PD 
Although not a myth or misperception, the pain Parkinson&rsquo;s disease can cause often comes as a surprise to many of her patients, Hedeman notes. &ldquo;There&rsquo;s a high association with pain&rdquo; in PD, she says. &ldquo;Parkinson&rsquo;s doesn&rsquo;t just mean you have tremors or a shuffling gait,&rdquo; but it also causes limb stiffness that can trigger painful episodes over time.

Fortunately, physicians can help manage that pain, she adds, much as they manage <a href="https://www.sharecare.com/health/parkinsons-disease/slideshow/health-risks-linked-parkinsons-disease">other symptoms</a> in this complex disease. And, while exhaustive research has not yet found a way to slow PD progression, she adds, investigators are still actively pursuing that goal.

Parkinson's Myths This Neurologist Wants You to Forget

Most diagnoses of&nbsp;<a href="https://www.sharecare.com/health/parkinsons-disease/slideshow/parkinsons-disease-explained">Parkinson&rsquo;s disease</a>&nbsp;come after age 60, but about 4 percent of diagnoses come before age 50. Regardless of the age of onset, the manifestations of the disease can be subtle. What changes might clue you in to possible Parkinson&rsquo;s?

Diagnosing Parkinson&rsquo;s&nbsp; 
Some  Parkinson&rsquo;s disease signs are well-known, like the tremors&nbsp;that&nbsp;boxing great Muhammad&nbsp;Ali&nbsp;experienced. But Parkinson&rsquo;s can start with very mild signs that appear years before a diagnosis. The disease is often difficult to diagnose in its early stages, and no blood or imaging test can confirm if someone has it.&nbsp;

So, how is Parkinson&rsquo;s diagnosed?

For starters, a healthcare provider (HCP) will take a medical history and do a physical exam. In addition to slow body movement (also known as bradykinesia), stiffness or tremors must also be present for a diagnosis to be made. The HCP may also use a brain imaging test called SPECT that tracks the chemical dopamine in the brain.

But in order to check for Parkinson&rsquo;s, your HCP needs to know to look for it. That&rsquo;s where you come in. Tell your HCP if you&rsquo;ve noticed any of these potential warning signs.

Possible warning signs&nbsp;of Parkinson&rsquo;s&nbsp;disease: 
Tremors: If one of your fingers, a hand, or your chin shakes while you&rsquo;re at rest, that can signal early Parkinson&rsquo;s. Tremors usually start on one side of the body.&nbsp;Other conditions, such as a nervous system disorder called essential tremor, can also cause shaking.

Changes in handwriting:  How can your handwriting reveal if you have a disease or not? With Parkinson&rsquo;s, a person&#39;s handwriting often changes, such as becoming smaller or more crowded. Just remember that stiff fingers or poor vision can also affect handwriting in people without Parkinson&rsquo;s.

Rigid limbs:  Stiffness in the body, arms, or legs that does not go away after you begin to move is another potential sign&nbsp;of Parkinson&#39;s. Take note if you&rsquo;re starting to shuffle, or if you&rsquo;re not swinging one of your arms as you walk.&nbsp;Stiffness could also occur if you have arthritis or another injury.

Loss of smell:  Maybe you don&rsquo;t notice the fragrance from a bouquet of flowers or you didn&rsquo;t detect that you kept last week&rsquo;s leftovers in the fridge a little too long. A weakened sense of smell may happen years before a Parkinson&rsquo;s diagnosis. Your sense of smell can also go away for other reasons, <a href="https://www.sharecare.com/coronavirus/loss-of-smell-taste-coronavirus">including a cold or COVID-19</a>, but in those cases it should return after you recover.

Changes in voice:  This change often takes the form of a softer or hoarser voice. It could also be that you speak less clearly or that you need to strain to speak.&nbsp;Like the loss of smell, however, bear in mind that vocal changes can also happen if you&rsquo;re having a respiratory infection. In that case the changes are temporary and should go back to normal once you get better.

Masking:  A person with Parkinson&#39;s may sometimes appear to have their &ldquo;game face&rdquo; on. In other words, they may look serious or depressed or have a blank stare, sometimes hardly blinking. This occurs because the muscles of the face become stiff, making it harder to be expressive.&nbsp;Some medicines can also have this effect.

Disturbed sleep: People with Parkinson&rsquo;s may talk or make jerky movements while sleeping, as if they are acting out their dreams. They may also have trouble turning over in bed, or have difficulty falling and staying asleep. These signs can develop before movement problems show up. Other factors besides Parkinson&rsquo;s can <a href="https://www.sharecare.com/sleep-disorders/insomnia/surprising-triggers-insomnia">cause sleep disturbances</a>, too. These include certain medications, mental health problems, or poor sleep habits.

Constipation: Having fewer than three bowel movements a week is sometimes related to Parkinson&rsquo;s disease, and as with some other signs, it can occur before movement problems develop. Remember that <a href="https://www.sharecare.com/digestive-health/constipation/signs-talk-doctor-constipation">constipation can also arise</a> from dietary problems, dehydration, and taking certain medications. If the issue doesn&rsquo;t go away, it deserves medical attention.

Slouching over: A change in posture (where you are leaning over, stooping, or hunched) could be due to Parkinson&rsquo;s. Injuries and bone diseases may also affect posture in the absence of Parkinson&rsquo;s.

Dizziness: Do you ever feel dizzy, lightheaded, weak, or as if you are about to black out after standing up? This is typically due to a drop in blood pressure, and it may be a warning sign of Parkinson&rsquo;s. Other conditions can also cause this issue, though, including heart disease, medications, or dehydration.

Don&rsquo;t panic&nbsp; 
If you&rsquo;ve noticed any of these signs in yourself or a loved one, don&#39;t be alarmed. Having just one of them doesn&#39;t necessarily mean&nbsp;it&rsquo;s&nbsp;Parkinson&#39;s. But if you have more than one&mdash;or if any of them is concerning you&mdash;talk with your HCP.&nbsp;Parkinson&rsquo;s is treatable.

Parkinson's Disease