Primary Motor Symptoms Of Parkinson’s
The primary motor symptoms of PD are the symptoms that are the key characteristics of the disease. They are:
- Tremor a shaking of the hands, arms, or legs, especially when the limb is at rest it often initially occurs only in one arm or leg, and it may even begin as a small tremor in one finger
- Rigidity an abnormal stiffness in a limb or part of the body
- Postural instability impaired balance or difficulty standing or walking
- Bradykinesia gradual loss and slowing down of spontaneous movement1,2
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
What Is Parkinson’s Disease
Parkinsons disease occurs when brain cells that make dopamine, a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a movement disorder. But constipation, depression, memory problems and other non-movement symptoms also can be part of Parkinsons. PD is a lifelong and progressive disease, which means that symptoms slowly worsen over time.
The experience of living with Parkinson’s over the course of a lifetime is unique to each person. As symptoms and progression vary from person to person, neither you nor your doctor can predict which symptoms you will get, when you will get them or how severe they will be. Even though broad paths of similarity are observed among individuals with PD as the disease progresses, there is no guarantee you will experience what you see in others.
Parkinsons affects nearly 1 million people in the United States and more than 6 million people worldwide.
For an in-depth guide to navigating Parkinsons disease and living well as the disease progresses, check out our Parkinsons 360 toolkit.
What Is Parkinson’s Disease?
Dr. Rachel Dolhun, a movement disorder specialist and vice president of medical communications at The Michael J. Fox Foundation, breaks down the basics of Parkinson’s.
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Maximizing Quality Of Life
The decision to shine a light on women living with PD came from informal conversations in 2014 with women noting the lack of information, resources, and connections available to them.
Women living with Parkinson’s disease lead a panel session at the National Forum in Houston, Texas, in October 2018. From left: Yvonne Hylton, Kelly Weinschreider, Lisa Cone, and Ann Boylan.
Answering the call to action, Veronica Todaro, MPH, Feeney, and others launched a Women and PD Initiative, focusing on education and information. They organized a conference in 2015, selecting 25 women to attend.
Krischer was one. There, she learned about the limited information on women and PD, including knowledge on mental health and intimacy.
Attendees applied the knowledge, engaging their communities. For example, Krischer started a support group for women with PD, hosting activities including boxing classes and even a sex therapists talk.
We now had the educational and community pieces, but still needed to understand where the gaps in patient-reported outcomes were, said Todaro, executive vice president and chief operating officer, Parkinsons Foundation.
The project, Women and PD Teams to Advance Learning and Knowledge , allowed for a structured way to bring the voices of women with Parkinsons into discussions around better outcomes related to decision making with providers and researchers to maximize womens quality of life, Todaro said.
How Is Parkinson’s Disease Treated
If a doctor thinks a person has Parkinson’s disease, there’s reason for hope. Medicine can be used to eliminate or improve the symptoms, like the body tremors. And some experts think that a cure may be found soon.
For now, a medicine called levodopa is often given to people who have Parkinson’s disease. Called “L-dopa,” this medicine increases the amount of dopamine in the body and has been shown to improve a person’s ability to walk and move around. Other drugs also help decrease and manage the symptoms by affecting dopamine levels. In some cases, surgery may be needed to treat it. The person would get anesthesia, a special kind of medicine to prevent pain during the operation.
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Medicines For Parkinson’s Disease
Medicines prescribed for Parkinson’s include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.
People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinsons symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
Managing Depression In Parkinsons Disease
People with Parkinsons, family members and caregivers may not always recognize the signs of depression and anxiety. If you are experiencing depression as a symptom of Parkinsons, it is important to know it can be treated.
Here are some suggestions:
- For information and support on living well with Parkinsons disease, contact our Information and Referral line.
- As much as possible, remain socially engaged and physically active. Resist the urge to isolate yourself.
- You may want to consult a psychologist and there are medications that help relieve depression in people with Parkinsons, including nortriptyline and citalopram .
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Why The Lower Risk
Studies conducted around the world, and across race, ethnic and age groups, support the finding that women overall have a lower risk of developing PD than men, but we still dont know why. Environmental factors could explain this lower risk. It may be that women are less likely than men to be exposed to pesticides or heavy metals, or to sustain a head injuryall of which may increase a persons PD risk.
Biological differences between women and men may also play a role. Estrogen, the female sex hormone, may protect the brain against PD, but little is known about its influence. If estrogen is preventative, it may only be helpful at certain levels or for a specific time.
How Might Parkinsons Affect Women
Although almost 50% of people with Parkinsons are women , there has been very little research into the additional challenges that women may encounter. In fact, most information is anecdotal rather than based on clinical research and tends to emerge as a result of the sharing of problems. However, not everyone is forthcoming with their difficulties so the overall picture is perhaps not truly representative of the broad range of experiences of Parkinson’s in women.
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Research And Statistics: Who Has Parkinsons Disease
According to the Parkinsons Foundation, nearly 1 million people in the United States are living with the disease. More than 10 million people worldwide have Parkinsons.
About 4 percent of people with Parkinsons are diagnosed before age 50.
Men are 1.5 times more likely to develop the disease than women.
Expressing And Interpreting Emotion
PD rigidity can cause the muscles of the face to freeze. This leads to a mask-like expression. As a result, patients with PD have difficulty expressing emotion with their faces. They also can begin to have difficulty interpreting others facial expressions.
One study suggests that both men and women with PD can have difficulty interpreting anger and surprise, and that men are more likely to lose the ability to interpret fear.
However, women may be more upset by their inability to interpret emotions. All PD patients may benefit from speech and physical therapy to help with this symptom.
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Treatment For Parkinsons Disease In The Elderly
Unfortunately, the disease is difficult to diagnose in many cases, and is incurable. The good news that older adults can live with Parkinsons disease comfortably with the proper types of treatment.
- Regular Medication. A treatment plan will most likely include at least one medicine for the patient. Fortunately, advances in medicine have given those with Parkinsons disease hope for a relatively normal life.
- Surgery. Treating Parkinsons disease in older adults with surgery is usually only an option when medication has become less effective and the symptoms have begun to get worse.
- Therapy. In addition to following a medication routine, several types of therapy may improve a patients overall health and help minimize Parkinsons toll on the persons lifestyle. Physical, occupational, and speech therapy have all been successful in helping Parkinsons disease patients maintain a high quality of life for longer. Psychological therapy is also helpful in working through the emotions that such a debilitating disease brings on.
- Exercise. By exercising several times a week, an older adult battling Parkinsons disease can help improve their balance, keep their muscles strong, and release some stress. Water exercises are good choices, along with simple walking. Pilates is another good option.
Is Parkinsons Disease Genetic
Researchers have identified gene mutations associated with Parkinsons disease.
Numerous other genetic mutations have also been identified in Parkinsons disease. Mutations in these genes result inabnormal cell function, weakening nerve cells, and eventually results in nerve cell death.
Researchers are still investigating further reasons for the link between Parkinsons disease and genes.
According to scientists, between 10% to 15% of people with Parkinsons disease may suffer from genetic mutation or other environmental factors.
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Pharmacological Therapy Of Motor Symptoms
In the absence of a disease-modifying therapy, PD treatment is currently based on the control of motor symptoms by levodopa supplementation. However, long-term therapy with levodopa is associated with the development of motor complications, such as levodopa-induced-dyskinesia, wearing off and on-off phenomena. It is generally assumed that dyskinesia is associated with sustained levodopa plasma levels . Commonly, women present greater levodopa bioavailability, which is further supported by lower levodopa clearance levels . Dopamine bioavailability in the central nervous system is dependent on the activity of two catabolic enzymes: catechol-O-methyltransferase and monoamine oxidase-B , whose encoding genes are located on the chromosome 22 and X chromosome, respectively . A study that explored the relationship between MAO-B or COMT functional SNPs and levodopa therapy reported that male PD patients carrying the MAO-B G allele had a 2.84-fold increased risk of developing motor complications when treated with high doses of levodopa .
Living With Parkinson’s Disease
As Parkinson’s develops, a person who has it may slow down and won’t be able to move or talk quickly. Sometimes, speech therapy and occupational therapy are needed. This may sound silly, but someone who has Parkinson’s disease may need to learn how to fall down safely.
If getting dressed is hard for a person with Parkinson’s, clothing with Velcro and elastic can be easier to use than buttons and zippers. The person also might need to have railings installed around the house to prevent falls.
If you know someone who has Parkinson’s disease, you can help by being a good friend.
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What Is Parkinson Disease
Parkinson disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinsons disease also have tremors and may develop cognitive problems, including memory loss and dementia.
Parkinson disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, it’s called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. It’s also much more common in men than in women.
Parkinson disease is a chronic and progressive disease. It doesn’t go away and continues to get worse over time.
Complementary And Alternative Therapies
Some people with Parkinson’s disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease.
However, there’s no clinical evidence they’re effective in controlling the symptoms of Parkinson’s disease.
Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn’t be used instead of the medicines prescribed by your doctor.
Some types of herbal remedies, such as St John’s wort, can interact unpredictably if taken with some types of medication used to treat Parkinson’s disease.
If you’re considering using an alternative treatment along with your prescribed medicines, check with your care team first.
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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
Disease Predictors And Risk Factors
The etiology of PD is not well understood. Despite the presence of familial cases, PD is substantially an idiopathic, multi-factorial disease caused by the interplay between genetic and environmental factors. Genetic studies have identified increasing numbers of risk polymorphisms, whereas little is still known about environmental risk factors and how these affect PD risk.
Heinzel and coll. recently highlighted the sex-related differences in prodromal PD. They concluded that women and men show distinctive prodromal markers of PD , suggesting that these differences should be taken into account to guarantee the diagnostic accuracy of prodromal PD .
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Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
Women And Parkinson’s Disease: What We Don’t Know
“It’s an unknown unknown,” Amie Hiller, M.D., says. She’s a neurologist at OHSU’s Parkinson Center and Movement Disorders Program, and she’s talking about how the impact of Parkinson’s disease on women might be different from the disease’s impact on men.
Parkinson’s disease is a neurological disorder that affects the nervous system. It’s a chronic disease that gets worse over time, and there is no cure. Parkinson’s disease can cause tremors, slowness, stiffness, and balance problems. In the advanced stages, it can impact cognitive function.
Most people diagnosed with Parkinson’s disease are over the age of 60, and as many as one million people in the United States have the disease. The disease is more common in men, but scientists don’t yet understand why.
As Dr. Hiller notes, this isn’t the only mystery about Parkinson’s disease, especially when it comes to women.
Outcomes may be worse for women
“Parkinson’s disease research has focused more on men, and we treat women the same way we treat men,” says Dr. Hiller. “We don’t know if the disease might behave differently in women.”
It’s possible that women are underdiagnosed due to symptoms presenting differently, or that the best treatment for women is different than the best treatment for men. Dr. Hiller is part of a team putting together a “Women and PD: TALK” forum at OHSU to tackle these questions.
Women and Parkinson’s disease forum
Research leads to better care
If your loved one has Parkinson’s
Evidence-based care
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How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.