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Parkinson's disease
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Overview
Parkinson's disease is a progressive disorder that affects the nervous system
and the parts of the body controlled by the nerves. Symptoms start slowly.
The first symptom may be a barely noticeable tremor in just one hand.
Tremors are common, but the disorder may also cause stiffness or slowing of
movement.

In the early stages of Parkinson's disease, your face may show little or no
expression. Your arms may not swing when you walk. Your speech may
become soft or slurred. Parkinson's disease symptoms worsen as your
condition progresses over time.

Although Parkinson's disease can't be cured, medications might significantly

improve your symptoms. Occasionally, your health care provider may suggest
surgery to regulate certain regions of your brain and improve your symptoms.

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Symptoms
Parkinson's disease symptoms can be different for everyone. Early symptoms
may be mild and go unnoticed. Symptoms often begin on one side of the
body and usually remain worse on that side, even after symptoms begin to
affect the limbs on both sides.

Parkinson's symptoms may include:

Tremor. Rhythmic shaking, called tremor, usually begins in a limb, often

your hand or fingers. You may rub your thumb and forefinger back and
forth. This is known as a pill-rolling tremor. Your hand may tremble when
it's at rest. The shaking may decrease when you are performing tasks.
Slowed movement, known as bradykinesia. Over time, Parkinson's
disease may slow your movement, making simple tasks difficult and time-
consuming. Your steps may become shorter when you walk. It may be
difficult to get out of a chair. You may drag or shuffle your feet as you try
to walk.
Rigid muscles. Muscle stiffness may occur in any part of your body. The
stiff muscles can be painful and limit your range of motion.
Impaired posture and balance. Your posture may become stooped. Or
you may fall or have balance problems as a result of Parkinson's disease.
Loss of automatic movements. You may have a decreased ability to
perform unconscious movements, including blinking, smiling or swinging
your arms when you walk.
Speech changes. You may speak softly or quickly, slur, or hesitate before
talking. Your speech may be more of a monotone rather than have the
usual speech patterns.
Writing changes. It may become hard to write, and your writing may
appear small.

When to see a doctor

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See a health care professional if you have any of the symptoms associated
with Parkinson's disease — not only to diagnose your condition but also to
rule out other causes for your symptoms.

Request an appointment

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Causes
In Parkinson's disease, certain nerve cells called neurons in the brain gradually
break down or die. Many of the symptoms of Parkinson's are due to a loss of
neurons that produce a chemical messenger in your brain called dopamine.
When dopamine levels decrease, it causes irregular brain activity, leading to
problems with movement and other symptoms of Parkinson's disease.

The cause of Parkinson's disease is unknown, but several factors appear to

play a role, including:

Genes. Researchers have identified specific genetic changes that can

cause Parkinson's disease. But these are uncommon except in rare cases
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 with many family members affected by Parkinson's disease.
However, certain gene variations appear to increase the risk of Parkinson's
disease but with a relatively small risk of Parkinson's disease for each of
these genetic markers.
Environmental triggers. Exposure to certain toxins or environmental
factors may increase the risk of later Parkinson's disease, but the risk is
small.

Researchers also have noted that many changes occur in the brains of people
with Parkinson's disease, although it's not clear why these changes occur.
These changes include:

The presence of Lewy bodies. Clumps of specific substances within brain

cells are microscopic markers of Parkinson's disease. These are called
Lewy bodies, and researchers believe these Lewy bodies hold an
important clue to the cause of Parkinson's disease.
Alpha-synuclein found within Lewy bodies. Although many substances
are found within Lewy bodies, scientists believe that an important one is
the natural and widespread protein called alpha-synuclein, also called a-
synuclein. It's found in all Lewy bodies in a clumped form that cells can't
break down. This is currently an important focus among Parkinson's
disease researchers. Researchers have found the clumped alpha-
synuclein protein in the spinal fluid of people who later develop
Parkinson's disease.

Risk factors
Risk factors for Parkinson's disease include:

Age. Young adults rarely experience Parkinson's disease. It ordinarily

begins in middle or late life, and the risk increases with age. People usually
develop the disease around age 60 or older. If a young person does have
Parkinson's disease, genetic counseling might be helpful in making family
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planning decisions. Work, social situations and medicine side effects are
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 also different from those of an older person with Parkinson's disease and
require special considerations.
Heredity. Having a close relative with Parkinson's disease increases the
chances that you'll develop the disease. However, your risks are still small
unless you have many relatives in your family with Parkinson's disease.
Sex. Men are more likely to develop Parkinson's disease than are women.
Exposure to toxins. Ongoing exposure to herbicides and pesticides may
slightly increase your risk of Parkinson's disease.

Complications
Parkinson's disease is often accompanied by these additional problems,
which may be treatable:

Thinking difficulties. You may experience cognitive problems, such as

dementia, and thinking difficulties. These usually occur in the later stages
of Parkinson's disease. Such cognitive problems aren't usually helped by
medicines.
Depression and emotional changes. You may experience depression,
sometimes in the very early stages. Receiving treatment for depression
can make it easier to handle the other challenges of Parkinson's disease.
You also may experience other emotional changes, such as fear, anxiety or
loss of motivation. Your health care team may give you medicine to treat
these symptoms.
Swallowing problems. You may develop difficulties with swallowing as
your condition progresses. Saliva may accumulate in your mouth due to
slowed swallowing, leading to drooling.
Chewing and eating problems. Late-stage Parkinson's disease affects the
muscles in the mouth, making chewing difficult. This can lead to choking
and poor nutrition.
Sleep problems and sleep disorders. People with Parkinson's disease
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often have sleep problems, including waking up frequently throughout the

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 night, waking up early or falling asleep during the day.
People also may experience rapid eye movement sleep behavior disorder,
which involves acting out dreams. Medicines may improve your sleep.
Bladder problems. Parkinson's disease may cause bladder problems,
including being unable to control urine or having difficulty in urinating.
Constipation. Many people with Parkinson's disease develop
constipation, mainly due to a slower digestive tract.

You may also experience:

Blood pressure changes. You may feel dizzy or lightheaded when you
stand due to a sudden drop in blood pressure (orthostatic hypotension).
Smell dysfunction. You may experience problems with your sense of
smell. You may have trouble identifying certain odors or the difference
between odors.
Fatigue. Many people with Parkinson's disease lose energy and
experience fatigue, especially later in the day. The cause isn't always
known.
Pain. Some people with Parkinson's disease experience pain, either in
specific areas of their bodies or throughout their bodies.
Sexual dysfunction. Some people with Parkinson's disease notice a
decrease in sexual desire or performance.

Prevention
Because the cause of Parkinson's is unknown, there are no proven ways to
prevent the disease.

Some research has shown that regular aerobic exercise might reduce the risk
of Parkinson's disease.
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Some other research has shown that people who consume caffeine — which
is found in coffee, tea and cola — get Parkinson's disease less often than
those who don't drink it. Green tea also is related to a reduced risk of
developing Parkinson's disease. However, it is still not known whether caffeine
protects against getting Parkinson's or is related in some other way. Currently
there is not enough evidence to suggest that drinking caffeinated beverages
protects against Parkinson's.

By Mayo Clinic Staff

Parkinson's disease care at Mayo Clinic

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Diagnosis & treatment

May 26, 2023

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