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Parkinson's disease

Published by Bupa's health information team, April 2009.

This factsheet is for people who have Parkinson's disease, or who would like information about it.

Parkinson's disease is a movement disorder caused by a shortage of a chemical (dopamine) in the brain. People with Parkinson's disease develop stiffness, tremors and slow movement that can become worse over time.

About Parkinson's disease
Symptoms of Parkinson's disease
Causes of Parkinson's disease
Diagnosis of Parkinson's disease
Treatment of Parkinson's disease
Living with Parkinson's disease
Further information
Questions and answers
Sources

About Parkinson's disease

Parkinson's disease is caused by the loss of brain cells that produce a chemical called dopamine, resulting in low levels of the chemical in your brain. Dopamine is a chemical messenger, or neurotransmitter, which makes other parts of your brain that coordinate movement work properly.

The level of dopamine in your brain is linked with the levels of other chemicals, including one called acetylcholine. Low levels of dopamine and changes in other chemicals, including acetylcholine, cause the symptoms of Parkinson's disease.

Parkinson's disease affects around one to two out of 100 people over 65. It's slightly more common in men than in women. Most people develop the condition at around the age of 65, but around one in 12 people with Parkinson's disease start having symptoms before the age of 40 (known as early-onset Parkinson's disease).

Symptoms of Parkinson's disease

The symptoms of Parkinson's disease often start on one side of your body first and then affect both sides. The main symptoms are listed below.

Shaking (muscle tremor) is usually one of the first symptoms and affects most people with Parkinson's disease. It often starts in the hand with circular movements - as if rolling a marble or pill between your thumb and forefinger. It usually affects your arms and legs, but sometimes also your head and jaw (although this may mean you have another kind of tremor). The tremor is most obvious when you're at rest, and is reduced when you're moving or sleeping.
Stiffness (rigidity), which makes your limbs feel difficult to move.
Slow movement or an inability to move are common in people with Parkinson's disease. People with Parkinson's disease often walk with a slow shuffle.

As different muscles become affected you may develop:

problems with posture and balance - you may have falls and have difficulty turning in bed or getting out of a chair
speech changes - your speech may become quiet or rapid, making it hard for others to understand you
loss of facial expression - you may smile less, frown more and blink slowly
small handwriting

Other symptoms that you can have aren't related to movement. These can include:

mental health problems - including depression, loss of memory, difficulty reasoning, increased anxiety and changes in behaviour
bowel and bladder problems such as constipation and the need to urinate often
problems with swallowing
weight loss
impotence
low blood pressure when you stand up
increased saliva and sweating
sleep problems and tiredness

These symptoms aren't always due to Parkinson's disease but if you have them, you should visit your GP.

Causes of Parkinson's disease

The exact reasons why people develop Parkinson's disease aren't fully understood at present, but inherited factors seem to have a role. A family history is more common in early-onset Parkinson's disease.

Certain chemicals in the environment that might be harmful to the brain, called neurotoxins, have been linked to Parkinson's disease. It's possible that people who are exposed to more of these neurotoxins are more likely to develop the condition. Doctors need to do more research on possible environmental risk factors for Parkinson's disease.

Diagnosis of Parkinson's disease

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. If there is a chance you have Parkinson's disease, your GP will refer you to a neurologist (a doctor who specialises in conditions of the nervous system) or a geriatrician (a doctor who specialises in treating older people).

There is no single test for Parkinson's disease. Diagnosis is based on you having Parkinson's disease symptoms and by ruling out other conditions that cause similar symptoms. You may need to have a blood test or an MRI scan (this uses magnets and radiowaves to produce images of the inside of your body). You may need a further test called a SPECT (single photon emission computed tomography) scan to help your doctor distinguish between Parkinson's disease and another condition called essential tremor.

Symptoms similar to Parkinson's disease - known as parkinsonism - can be a side-effect of some medications, including those used to treat mental illness. If this is the case, changing your medication may reduce your symptoms.

If you have been diagnosed with Parkinson's disease, you should see your specialist doctor every six to 12 months for a review.

Treatment of Parkinson's disease

Treatment is aimed at restoring the levels of dopamine in your brain and controlling symptoms. The symptoms and progression of Parkinson's disease are different for each person. Your doctor will help you to decide which treatment is best for you depending on your symptoms and your individual needs.

Medicines

Several types of medicine are available. The main types are listed below.

Medicines that replace dopamine are the most effective treatment. These medicines are combinations of levodopa, which breaks down in the body to form dopamine, and another chemical that ensures that the levodopa reaches your brain. Dopamine replacement medicines can provide long-term improvement, although there are some side-effects such as feeling sick, vomiting and sudden sleepiness. They can also cause long-term problems such as unwanted movements of the face and limbs (dyskinesia) and may become less reliable over time, with symptoms fluctuating suddenly - often called the "on-off syndrome". Examples include co-benedopa (Madopar) and co-careldopa (eg Sinemet).
Medicines that mimic the action of dopamine (dopamine agonists) are commonly taken together with levodopa or alone before using levodopa. Side-effects of dopamine agonists can include feeling sick, constipation, headache and sudden sleepiness. Examples include pramipexole (Mirapexin), ropinirole (eg Adartrel, Requip) and rotigotine (Neupro).
MAOIs (monoamine oxidase B inhibitors), also known as MAOI-Bs, prevent the breakdown of dopamine. These can be used alone to delay the need for levodopa or in combination with levodopa to reduce the on-off syndrome. Low blood pressure is a potential side-effect. Examples include selegiline (eg Eldepryl) and rasagiline (Azilect).
COMT (catechol O-methyl transferase) inhibitors are a new type of medicines that stop the breakdown of dopamine. These are used with levodopa and are usually given when you have had Parkinson's disease for some time and when dopamine replacement medicines start to lose their effectiveness. They can affect your liver and so you will need regular blood tests to check its function. Examples include entacapone (Comtess) and tolcapone (Tasmar).
Amantadine acts like a dopamine replacement medicine but works on different sites in the brain. It has few side-effects, but is only used in the early stages of the disease.
Anticholinergic medicines block the action of the brain chemical acetylcholine. They help to correct the balance between dopamine and acetylcholine. Side-effects can include dry mouth, constipation and blurred vision. These medicines only help with tremor and are less effective than the medicines that replace dopamine, so doctors don't use them very often.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Surgery

Sometimes, if medicines are no longer helping, your doctor may recommend a surgical procedure known as deep brain stimulation. Electrodes are placed in your brain in the areas important in controlling movement. They are connected to a pulse generator, which is placed under the skin of your chest. Tiny electrical currents sent from the pulse generator to your brain may reduce symptoms of Parkinson's disease.

Other therapies

Other therapies that are important for managing and coping with Parkinson's disease include physiotherapy, speech therapy and occupational therapy. If you have Parkinson's disease, you will be cared for by health professionals with a range of different skills. They will make sure you have access to therapies that are right for your stage of disease.

Future treatments

Gene therapy involves delivering normal genes directly to the brain to help prevent the death of brain cells. However, this type of therapy is still at a very experimental stage and may not be available for some time.

Living with Parkinson's disease

A diagnosis of Parkinson's disease can be very upsetting. Most people stay reasonably active and symptoms may progress no further than a slight tremor. However, some people do become debilitated and may need help with washing, eating and dressing. With proper treatment, people with Parkinson's disease can have a usual life expectancy.

Further information

Parkinson's Disease Society
0808 800 0303
www.parkinsons.org.uk