How Does Parkinson's Start?

Parkinson's may cause muscle stiffness, tremors and slow movement.

Parkinson’s disease is a degenerative and chronic brain disorder that affects movement. It can affect other brain functions such as learning and memory. 

What Are Symptoms of Parkinson’s Disease?

Parkinson’s disease usually starts slowly and may only cause mild symptoms early on. As the condition progresses, symptoms may begin to affect a person's ability to do everyday activities, and as the disease becomes severe, people may need help with self-care. 

The three primary symptoms of Parkinson’s disease include: 

• Shaking (tremors), which often start in the fingers or hands
• Slow movement (bradykinesia)
• Muscle stiffness or rigidity

Other symptoms of Parkinson’s disease may include: 

• Loss of balance 
• Difficulty walking
• Loss of ability to think clearly
• Losing touch with reality or seeing things that aren't there (hallucinations)
• Depression
• Anxiety 
• Sleep problems such as insomnia and daytime sleepiness
• Tiredness
• Loss of ability to smell
• Constipation
• Sweating
• Difficulty urinating
• Trouble swallowing
• Sexual problems
• Sudden drop in blood pressure on standing that causes dizziness, lightheadedness, or fainting (orthostatic hypotension)

The cause of Parkinson’s disease is unknown. It is believed it may be due to a combination of genetics and environmental causes. 

The condition is the result of the loss of the brain chemical (neurotransmitter) dopamine. In Parkinson’s disease, nerve cells in the brain (neurons) slowly degenerate and lose their ability to produce dopamine, though the reason this occurs is not understood. This loss of dopamine causes the symptoms of Parkinson’s disease to develop gradually and become more severe over time. 

In a small number of cases, the condition may be passed from family members; about 10 to 15 percent of patients have at least one first-degree relative (parent or sibling) with the disease. In patients diagnosed before age 50, genetic mutations may play a role.

There are no blood tests or imaging tests used to diagnose Parkinson’s disease. Diagnosis is based upon a person's signs and symptoms, medical history, and physical and neurologic examination.

Two of the three primary symptoms (tremor, slow movement [bradykinesia], and rigidity) must be present to make the diagnosis, with one of the symptoms being slow movement.

Other characteristics of symptoms that support the diagnosis of Parkinson’s disease include:

• Symptoms began on one side of the body
• Tremors occur when the person's limb (arm) is resting
• Symptoms can be controlled with Parkinson’s disease medications
  • If the diagnosis of Parkinson’s disease is uncertain, a medication challenge test may be recommended
  • A medication commonly used to treat Parkinson’s symptoms (either levodopa or a dopamine agonist) is given for at least two months
  • If the person's symptoms improve, a diagnosis of Parkinson’s disease is likely
  • People with Parkinson’s disease-like symptoms caused by other diseases usually do not improve with medication

Imaging tests such as magnetic resonance imaging (MRI) may be used to rule out other possible diagnoses.

Dopamine transporter single-photon emission computed tomography (SPECT) imaging (also called DaTscan) is a brain imaging test that can diagnose a condition called essential tremor that may cause similar symptoms to Parkinson’s disease. 

There is no cure for Parkinson’s disease, but several medications can improve symptoms. 

The main medicines used to treat Parkinson’s disease are levodopa and dopamine agonists.

• Levodopa (L-dopa) comes in different forms
  • Carbidopa-levodopa (Sinemet, Parcopa) 
  • Levodopa-benserazide (Madopar, Prolopa)
• Dopamine agonists 
  • Pramipexole (Mirapex)
  • Ropinirole (Requip)
  • Rotigotine (Neupro)
  • Bromocriptine (Parlodel, Cycloset)
  • Apomorphine (Apokyn)
• Other medicines for Parkinson disease include: 
  • MAO B inhibitors 
    • Selegiline (Eldepryl, Emsam)
    • Rasagiline (Azilect)
    • Safinamide (Xadago)
  • Anticholinergics 
    • Trihexyphenidyl (Artane, Trihexy)
    • Benztropine (Cogentin)
    • Orphenadrine (Norflex)
  • Amantadine (Symmetrel) 
  • COMT inhibitors 
    • Tolcapone (Tasmar) 
    • Entacapone (Comtan)
  • Istradefylline (Nourianz) 

Patients can also:

• Exercise or do physical therapy
• Join a social support group
• Get rid of loose rugs and clutter, and make sure all electrical cords are tucked away to reduce the risk of falls
• For those who still drive, get tested to make sure it is safe to keep driving
• Learn about Parkinson’s disease and its treatment to actively involved in your own care