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- What is Parkinson's disease?
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- What are the symptoms of Parkinson's disease?
- What other conditions resemble Parkinson's disease?
- How is Parkinson's disease diagnosed?
- What is the treatment for Parkinson's disease?
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- What is the prognosis of Parkinson's disease?
Quick GuideParkinson's Disease: Symptoms, Causes, Stages, Treatment
What are the symptoms of Parkinson's disease?
The primary symptoms of Parkinson's disease are all related to voluntary and involuntary motor function and usually start on one side of the body. Symptoms are mild at first and will progress over time. Some individuals are more affected than others. Studies have shown that by the time that primary symptoms appear, individuals with Parkinson's disease will have lost 60% to 80% or more of the dopamine-producing cells in the brain. Characteristic motor symptoms include the following:
- Tremors: Trembling in fingers, hands, arms, feet, legs, jaw, or head.Tremors most often occur while the individual is resting, but not while involved in a task. Tremors may worsen when an individual is excited, tired, or stressed.
- Rigidity: Stiffness of the limbs and trunk, which may increase during movement. Rigidity may produce muscle aches and pain. Loss of fine hand movements can lead to cramped handwriting (micrographia) and may make eating difficult.
- Bradykinesia: Slowness of voluntary movement. Over time, it may become difficult to initiate movement and to complete movement. Bradykinesia together with stiffness can also affect the facial muscles and result in an expressionless, "mask-like" appearance.
- Postural instability: Impaired or lost reflexes can make it difficult to adjust posture to maintain balance. Postural instability may lead to falls.
- Parkinsonian gait: Individuals with more progressive Parkinson's disease develop a distinctive shuffling walk with a stooped position and a diminished or absent arm swing. It may become difficult to start walking and to make turns. Individuals may freeze in mid-stride and appear to fall forward while walking.
Secondary symptoms of Parkinson's disease
While the main symptoms of Parkinson's disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These vary in severity, and not every individual will experience all of them. Some of the secondary symptoms include:
- anxiety, insecurity, and stress
- confusion, memory loss, and dementia (more common in elderly individuals)
- difficulty swallowing and excessive salivation
- diminished sense of smell
- increased sweating
- male erectile dysfunction
- skin problems
- slowed, quieter speech, and monotone voice
- urinary frequency/urgency
What other conditions resemble Parkinson's disease?
In its early stages, Parkinson's disease can resemble a number of other conditions with Parkinson-like symptoms known as Parkinsonism. These conditions include multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, stroke, encephalitis (inflammation of the brain), and head trauma. Alzheimer's disease and primary lateral sclerosis can also be mistaken for Parkinson's disease. Other similar conditions include essential tremor, dystonic tremor, vascular Parkinsonism, and drug-induced Parkinsonism.
How is Parkinson's disease diagnosed?
An early and accurate diagnosis of Parkinson's disease is important in developing good treatment strategies to maintain a high quality of life for as long as possible. However, there is no test to diagnose Parkinson's disease with certainty (except after the individual has passed away). A diagnosis of Parkinson's disease - especially in the early phase - can be challenging due to similarities to related movement disorders and other conditions with Parkinson-like symptoms. Individuals may sometimes be misdiagnosed as having another disorder, and sometimes individuals with Parkinson-like symptoms may be inaccurately diagnosed as having Parkinson's disease. It is therefore important to re-evaluate individuals in the early phase on a regular basis to rule out other conditions that may be responsible for the symptoms.
A neurologist who specializes in movement disorders will be able to make the most accurate diagnosis. An initial assessment is made based on medical history, a neurological exam, and the symptoms present. For the medical history, it is important to know whether other family members have Parkinson's disease, what types of medication have been or are being taken, and whether there was exposure to toxins or repeated head trauma in the past. A neurological exam may include an evaluation of coordination, walking, and fine motor tasks involving the hands.
Several guidelines have been published to assist in the diagnosis of Parkinson's disease. These include the Hoehn and Yahr scale and the Unified Parkinson's Disease Rating Scale. Tests are used to measure mental capacity, behavior, mood, daily living activities, and motor function. They can be very helpful in the initial diagnosis, to rule out other disorders, as well as in monitoring the progression of the disease to make therapeutic adjustments. Brain scans and other laboratory tests are also sometimes carried out, mostly to detect other disorders resembling Parkinson's disease.
The diagnosis of Parkinson's disease is more likely if:
- at least two of the three major symptoms are present (tremor at rest, muscle rigidity, and slowness);
- the onset of symptoms started on one side of the body;
- symptoms are not due to secondary causes such as medication or strokes in the area controlling movement; and
- symptoms are significantly improved with levodopa (see below).