Parkinson’s Disease

Parkinson's Disease (PD) is a long-term, and often progressive, degenerative disorder of the central nervous system that affects a person’s motor skills.

PD belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The primary symptoms of the disease are caused by the death of cells in a mid-region of the brain which results in not enough dopamine in these areas. When dopamine levels decrease, it causes abnormal brain activity, leading to signs of Parkinson's Disease.

The cause of Parkinson's Disease is generally unknown but believed to involve both genetic and environmental factors. There is also an increased risk in people with a family member affected, who were exposed to certain pesticides or have had head injuries.

Although Parkinson's Disease can't be cured at this time, medications may markedly improve symptoms. In some cases, physicians may suggest surgery to help improve symptoms.


The progression of symptoms in PD is different from one person to another.

Early signs may be mild and even go unnoticed. They generally develop slowly and then progress through the years. Also, symptoms may begin on one side of the body and usually remain worse on that side, even after symptoms begin to affect both sides.

While one symptom alone does not point to PD, a general rule for a neurologist to consider a PD diagnosis is that two of the four main motor or movement-related symptoms are present and pronounced over time.

No single one of these signs means that you should worry, but if you have more than one sign you should consider making an appointment to talk to your personal physician or one of the neurologists or movement disorder specialists at Semmes Murphey Clinic.

A slight shaking, usually beginning in a limb (often the hand, fingers or chin) and occurring when these muscles are at rest. You may notice a back-and-forth rubbing of the thumb and forefinger, known as a pill-rolling tremor

This slowness or inability to move may make simple tasks difficult and time-consuming. It may be difficult to get out of a chair, steps may become shorter, or feet may drag during walking.

Muscle stiffness may occur in any part of your body and can limit range of motion and cause pain. Some patients describe their feet feeling “stuck to the floor” when they try to move. Another sign of rigid muscles is the lack of arm swing when walking.

Stooped posture, balance problems or an uneven gait which could result in falls is another prominent sign of Parkinson’s.

A decreased ability to blink, smile or swing your arms when you walk

Noticeable voice and speech changes, such as too soft, too quick, monotone, hoarse, slurred or a hesitation before talking

Handwriting becomes hard or changes, may appear smaller than it has been

Inability to smell fragrant foods like bananas, dill pickles or licorice, which is not caused by a cold, flu or a stuffy nose

Sudden movements, thrashing around in bed or acting out dreams during sleep

Trouble moving bowels or straining every day to move bowels, which is not caused by medication side effects

A serious, depressed or mad look, even when you are not in a bad mood

Occurring on a regular basis, could be a sign of low blood pressure which is linked to PD

Pronounced stooping, leaning or slouching when you stand


Parkinson’s disease can be difficult to diagnose accurately because there currently are no blood or laboratory tests to determine the presence of Parkinson’s disease. Today, diagnosing PD is based on medical history, a review of signs and symptoms, and a neurological and physical examination.

This may include a variety of tests—MRI, ultrasound of the brain, and PET scans—to rule out other conditions that may be causing your symptoms and to more specifically determine a proper course of treatment.

Similarly, because each person with Parkinson's may have different symptoms, there is not a standard treatment for this disease. However, there are a variety of medications as well as surgical options that improve symptoms. Please note that these treatments do not slow or halt disease progression.

There are also important lifestyle modifications and activities that can help people with PD improve their quality of life.

Although there are general guidelines that doctors use to choose a treatment regimen, each person with Parkinson’s disease must be individually evaluated to determine which drug or combination of medications is best for them. It is common for people with PD to take a variety of medications — all at different doses and at different times of day — to help manage their specific symptoms.

Medications may help manage problems with walking, movement, and tremor.

While keeping track of medications can be challenging, it is important to understand your medications and stick to a schedule to receive the greatest benefit from the drugs and avoid unpleasant “off” periods due to missed doses.

Patients may have a significant improvement or decreased symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent.

Surgical treatment is reserved for PD patients who have exhausted medicinal treatments or who suffer profound motor fluctuations (wearing off and dyskinesias).

Currently, there are three surgical treatments available for people living with PD —

These treat a variety of disabling neurological symptoms — most commonly the debilitating symptoms, such as tremor, rigidity, stiffness, slowed movement and slowed walking.

The procedures block problematic electrical signals from targeted areas in the brain and do not damage healthy brain tissue or destroy nerve cells.

It is possible to have a good to great quality of life with PD.

The first step to living well with Parkinson’s disease is to understand the disease and its progression. Properly following your physician’s recommended therapies and medications is important to successfully treating symptoms.

Beyond that, there are recommended lifestyle changes that can help patients have a more positive quality of life.

  • A speech-language pathologist can help strengthen or improve speech muscles.
  • Ongoing aerobic exercise and stretching can help retain or improve balance.
  • Formal physical therapy can also be beneficial to some patients.

All of these, in combination with a healthy diet, can help patients have an improved quality of life.

For people with PD, exercise is a vital component to maintaining balance, mobility and activities of daily living. Exercise and physical activity have been researched and proven to help improve many PD symptoms.

The Parkinson’s Outcomes Project (conducted by the Parkinson’s Foundation) shows that people with PD who start exercising earlier and a minimum of 2.5 hours a week, experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is essential to overall disease management.

To help manage the symptoms of PD, be sure your exercise program includes a few key ingredients:

  • Flexibility or stretching exercises
  • Aerobic activity
  • Resistance training or strengthening exercises

Biking, running, Tai chi, yoga, Pilates, dance, weight training, non-contact boxing, qi gong and more — have all shown positive effect on PD symptoms.

There is no “exercise prescription” that is right for every person with PD. The type of exercise needed depends on the symptoms and challenges.

For sedentary people, just getting up and moving is beneficial. More active people can build up to regular, vigorous activity.

Many approaches work well to help maintain and improve mobility, flexibility, and balance to ease non-motor PD symptoms such as depression or constipation.

The most important thing is to exercise regularly. Simply find an exercise, or several, that you enjoy and stick with it.

While it’s generally accepted that vitamins are a good thing, it’s important to discuss herbs, vitamins and supplements with your physician before taking them to avoid potentially dangerous interactions.

Nutritional supplements, vitamins and herbs are not regulated with the same approval method as prescription drugs. If you are considering complementary medicine, we strongly urge you to investigate the credentials and experience of anyone offering advice or recommendations regarding such product.

Also discuss your eating habits with your physician. A healthy diet and nutritional plan is an important positive step people with PD can make to help improve their lifestyle.

Deep Brain Stimulation (DBS)

Deep Brain Stimulation (DBS) is most often offered to people with advanced Parkinson's disease who have unstable medication (levodopa) responses. DBS can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesias), reduce tremors, reduce rigidity, and improve slowing of movement.

DBS allows for electrodes to be implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed.

For more information about DBS, click here.

MR Guided Focused Ultrasound

MR-Guided Focused Ultrasound (MR, FUS) is offered to Parkinson's patients who are primarily debilitated by tremors. MR, FUS is an incision-less ultrasound technology that can target and destroy troublesome tremor cells.

Read about MR-Guided Focused Ultrasound

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.

The Semmes Murphey team members are nationally recognized leaders in this field. They have the experience along with a variety of treatment options available which can help effectively manage movement disorders.

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