Parkinson's disease

Symptoms

The symptoms of Parkinson's disease usually develop gradually and are mild at first.

There are many different symptoms associated with Parkinson's disease. But the order in which these develop and their severity is different for each individual.

It's unlikely that a person with Parkinson's disease would experience all or most of these.

Main symptoms

The main symptoms of Parkinson's disease affect physical movement:

• tremor – shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed and resting
• slowness of movement (bradykinesia) – physical movements are much slower than normal, which can make everyday tasks difficult and result in a distinctive slow, shuffling walk with very small steps
• muscle stiffness (rigidity) – stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions, and can result in painful muscle cramps (dystonia)

These main symptoms are sometimes referred to by doctors as parkinsonism.

Other symptoms

Parkinson's disease can also cause a range of other physical and mental symptoms.

Physical symptoms

• balance problems – these can make someone with the condition more likely to have a fall and injure themselves

• loss of sense of smell (anosmia) – sometimes occurs several years before other symptoms develop
• nerve pain – can cause unpleasant sensations, such as burning, coldness or numbness
• problems with peeing – such as having to get up frequently during the night to pee or unintentionally peeing (urinary incontinence)
• constipation
• an inability to obtain or sustain an erection (erectile dysfunction) in men
• difficulty becoming sexually aroused and achieving an orgasm (sexual dysfunction) in women
• dizziness, blurred vision or fainting when moving from a sitting or lying position to a standing one – caused by a sudden drop in blood pressure
• excessive sweating (hyperhidrosis)
• swallowing difficulties (dysphagia) – this can lead to malnutrition and dehydration
• excessive production of saliva (drooling)
• problems sleeping (insomnia) – this can result in excessive sleepiness during the day

Cognitive and psychiatric symptoms

• depression and anxiety

• mild cognitive impairment – slight memory problems and problems with activities that require planning and organisation
• dementia – a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there (visual hallucinations) and believing things that are not true (delusions)

Causes

Parkinson's disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson's disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.

Diagnosis

No tests can conclusively show that you have Parkinson's disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination.

Your GP will talk to you about the problems you're experiencing and may ask you to perform some simple mental or physical tasks, such as moving or walking around, to help with the diagnosis.

In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild.

Referral to a specialist

If your GP suspects Parkinson's disease, you'll be referred to a specialist.

This will usually be:

• a neurologist, a specialist in conditions affecting the brain and nervous system

• a geriatrician, a specialist in problems affecting elderly people

The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.

Special brain scans, such as a single photon emission computed tomography (SPECT) scan, may also be carried out in some cases to try to rule out other causes of your symptoms.

Treatment Options

Although there's currently no cure for Parkinson's disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible.

These include:

• supportive treatments, such as physiotherapy and occupational therapy
• medication

• in some cases, brain surgery

You may not need any treatment during the early stages of Parkinson's disease, as symptoms are usually mild.

But you may need regular appointments with your specialist so your condition can be monitored.

When To See A Doctor

See a GP if you're concerned that you may have symptoms of Parkinson's disease.