Parkinson’s Disease

For unclear reasons, there is a reduction in the normal functioning of cells in a part of the brain called the substantia nigra. This part of the brain is involved in sending messages about movement to the rest of the body, and helps to produce the chemical dopamine which is a type of neurotransmitter, vital in helping the brain work normally. Over time, this leads to a significant reduction in dopamine levels that then causes body movements to become un-coordinated and slowed down. 

The three main symptoms of Parkinson's disease are tremor, stiffness, and slowed movement. 

The symptoms start slowly usually with a tremor affecting one hand and begin to get progressively worse, although not everyone develops a tremor. The tremor (shaking) is usually worse at rest or if you are stressed, the stiffness can affect any muscle but often causes your arms to swing less when walking, and the slowed movement can lead to a shuffling type of walk over time.

Other symptoms include a change in posture, making you more prone to falls, and there may be a lack of facial expressions, such as smiling or frowning, with reduced blinking and softer, more slurred speech. Handwriting may become very small or ‘spidery’ and there may also be problems sleeping, nightmares, constipation, worsening memory and depression, and anxiety. In some people, impulsive behaviour can develop such as gambling or compulsive shopping.

It is also now known – for reasons that are not yet clear – that people with PD are more prone to developing skin cancer so skin protection should be used if the diagnosis is made.

There is no test that can diagnose Parkinson's disease and is usually diagnosed from the history and a medical examination. Your doctor will talk to you about your symptoms and how it affects your daily activity. They will ask you to complete a memory test to understand the severity of your symptoms and assess how you walk. If there is doubt about the diagnosis a brain scan may be done to see if other conditions are present.

In the early stages, Parkinson's can be quite difficult to diagnose. If your doctor thinks you may have Parkinson's, they will refer you to a specialist who will ask you to perform more detailed exercises and activities. At times to confirm whether you have Parkinson's, your doctor may try you on a medication - to see if your symptoms respond well. 

There is no cure for Parkinson's, but treatment has been very effective in reducing the progression of the disease and improving life expectancy.

If the symptoms are mild, medication may not be needed in terms of treatment initially and it can be managed by being kept under review on a regular basis. As well as medication, more severe symptoms may require occupational therapists, who can ensure your home is safe and correct provisions are made and physiotherapists - to support your posture, balance, and movement.

The medication levodopa can be tried in combination with other medications and almost all people will see a benefit from this initially although its effects gradually reduce and so the dose usually needs to be increased over time.

Other possible treatments include dopamine agonists, monoamine-oxidase-B inhibitors (MAOBs) such as selegiline and rasagiline that block some chemicals in the brain that break down dopamine, and so help make its effects last longer, and a new type of medicine called COMT inhibitors that also help to stop dopamine being broken down by the body.

In rare cases, brain surgery may be undertaken if medicines do not work well and these continue to be researched and developed. One method involves chronic deep brain stimulation which uses electrodes to stimulate part of the brain affected by PD. Your specialist doctor will also monitor you regularly and alter treatments as and when required.

In 2023 the National Institute for Health and Care Excellence (NICE) approved a number of devices that help monitor symptoms of PD in the UK. These are PKG, STAT-ON, KinesiaU, Kinesia 360 and PDMonitor. The Parkinson’s UK charity is a great resource for further information.