​Parkinson disease and Movement disorders

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Parkinson’s Disease

​Written by Caitlin Goodwin on Jan 21, 2021

​Last reviewed and updated by Caitlin Goodwin on Oct 18, 2022

Caitlin Goodwin, DNP, RN, CNM, is a Board Certified Nurse-Midwife, Registered Nurse, and freelance writer. She has over twelve years of experience in nursing practice.

Parkinson’s disease is a progressive nervous system disorder that affects movement. This neurodegenerative condition impacts cells in a specific area of the brain. According to the Centers for Disease Control and Prevention (CDC), the associated symptoms make Parkinson’s disease the 14th leading cause of death in the United States.


Parkinson’s disease causes stiffness and slowing of movement. It often begins gradually and can be missed in the early stages. Empowering you and your family with information can help support earlier recognition and diagnosis. This article covers what to expect regarding Parkinson’s disease, including its causes, symptoms, stages, diagnosis, and treatments.


Causes

The cause of Parkinson’s disease is mostly unknown. People with Parkinson’s have low dopamine levels in the brain, but several factors may increase the risk.


Experts believe that a combination of factors—such as genetic mutations, lifestyle influences, and environmental exposures—contribute to the development of this disorder. It is more common in men over the age of 60. Exposure to certain chemicals, such as Trichloroethylene (TCEs) and Polychlorinated Biphenyls (PCBs), may also increase the risk.


Symptoms

The symptoms of Parkinson’s disease vary depending on how far the disease has progressed. Signs and symptoms develop gradually and often begin with a slight hand tremor. As the disease progresses, symptoms typically worsen over time.


Parkinson’s signs and symptoms include:

  • Tremor: Shaking often begins in your hand or fingers. Some rub their thumb and forefinger (pill-rolling tremor), while others experience hand shaking while at rest.
  • Bradykinesia: As it progresses, Parkinson’s disease slows movement. This can mean taking shorter steps, dragging your feet while walking, or struggling to stand from a seated position. For some, routine tasks may seem complicated and time-consuming.
  • Muscle stiffness: Any muscle in your body can become stiff, painful, and limit your range of motion.
  • Impaired balance: Parkinson’s disease may initially affect posture. However, over time, balance problems can follow.
  • Loss of unconscious movements: Automatic actions you perform each day, like blinking, smiling, or swinging your arms while walking, may decrease. Some people with Parkinson’s experience a reduced ability to perform these movements.
  • Speech: Your speech may become monotone or soft-spoken. Some people hesitate before talking, or speak more quickly, slowly, or with slurring.
  • Writing changes: Handwriting may become more difficult, and often appears smaller than it used to.

As the disease progresses, the following may occur as a result of the above symptoms:

  • Loss of bladder control
  • Constipation
  • Dementia
  • Swallowing problems
  • Depression
  • Trouble sleeping
  • Cognitive problems
  • Fatigue
  • Pain


Stages of Parkinson’s Disease

There are five stages of Parkinson’s disease:

  • Stage 1: In this stage, the symptoms of Parkinson’s disease are mild, and diagnosis is unlikely.
  • Stage 2: The symptoms are more pronounced, but balance is not impaired.
  • Stage 3: While Parkinson’s disease is progressing, patients remain independent in this stage.
  • Stage 4: Performing daily tasks becomes difficult during this stage. Patients can still stand unassisted but often struggle to walk.
  • Stage 5: This stage is the most advanced and requires around-the-clock care.

Diagnosis

Diagnosing Parkinson’s disease may be challenging, as the symptoms are mild at first. There is no specific test that diagnoses the illness. A neurologist, a doctor specializing in nervous system conditions, will evaluate your case. If it is early in the process, a follow-up appointment may confirm worsening symptoms.


The neurologist will ask questions like:

  • How long ago did you first experience symptoms?
  • Are there any associated symptoms?
  • Are these symptoms constant, or do they come and go?
  • Where do you experience the symptoms?
  • What makes the symptoms better?
  • What makes your symptoms worse?


They will base their diagnosis on your medical history, signs, symptoms, and a neurological and physical exam. The neuro exam will cover mental status, balance, motor function, and a sensory exam. This will cover items like:

  • Pushing and pulling against the provider’s hands with arms and legs
  • Moving from a seated position to standing and walking
  • Standing with closed eyes and being pushed to one side or the other
  • Passive and active range of motion (ROM)
  • Discussing person, place, and time (who you are, where you are, and when it is)
  • Observation for speech and clarity
  • Assessing sensation with dull needles, tuning forks, alcohol swab, and cotton balls


Your healthcare provider may order other tests, such as blood work or imaging like an MRI. However, instead of diagnosing Parkinson’s, these tests rule out other conditions that may be causing these symptoms. In rare cases, you may receive a dopamine transporter scan (DaTscan) to support the suspicion of Parkinson’s.


Treatments

There are many medical and surgical options for treatments for Parkinson’s, but no cure. Some medications will manage problems with walking, tremors, and movement by increasing dopamine. Dopamine cannot directly enter your brain.


People with Parkinson’s disease have medication options:

  • Carbidopa-levodopa is the most effective Parkinson’s disease medication. In fact, it is usually so effective that it is used as a diagnostic tool. If the symptoms improve significantly with the administration of this medication, it can help confirm the diagnosis.
  • Levodopa is a natural chemical that your body converts to dopamine once it passes into your brain.
  • Carbidopa protects the levodopa from converting to dopamine before it passes into your brain and lessens side effects.
  • It can be taken orally, inhaled, or as a continuous gel through a feeding tube.
  • Dopamine agonists are not as effective as levodopa but last longer.
  • MAO B inhibitors prevent the breakdown of dopamine in the brain.
  • Catechol O-methyltransferase (COMT) inhibitors slightly prolong the effect of levodopa by blocking dopamine breakdown.
  • Anticholinergics were used for many years to control tremors associated with Parkinson’s disease. However, the risks often outweigh the benefits, with side effects like memory impairment, confusion, impaired urination, or constipation.
  • Amantadine alone provides short-term relief of mild, early-stage Parkinson’s symptoms. It can also be given during more advanced stages to control involuntary movements caused by carbidopa-levodopa.
  • A2A receptor antagonists are adenosine receptor antagonists that target areas in the brain that regulate the dopamine response to allow more dopamine to be released.
  • Pimavanserin is a drug that treats delusions and hallucinations associated with Parkinson’s disease.


There is also a surgical procedure called deep brain stimulation, in which the surgeon implants electrodes into your brain that connect to a generator in your chest. The generator near your collarbone sends impulses to your brain to reduce symptoms. There are risks like infection, stroke, or bleeding.


Deep brain stimulation (DBS) is best for those with advanced Parkinson’s disease who have unstable responses to their drug regimen. However, it will not cure Parkinson’s nor stop it from advancing.


Questions to Ask Healthcare Providers about Parkinson’s Disease

Getting a diagnosis of Parkinson’s disease can seem overwhelming. For others, it may be helpful to finally understand the changes you’re experiencing. However, having a support network and working with your medical team is important. You should ask questions after the diagnosis, such as:

  • What are my options for treatment?
  • Are there side effects to these treatments?
  • Are there any clinical trials or brand-new treatments?
  • What other specialists should I see?
  • What are the symptoms as Parkinson’s disease progresses?





Bottom Line

While the cornerstone of Parkinson’s disease is worsening symptoms, there are ways to reduce them as the disease advances. The most crucial part of the treatment plan is a supportive network, coping tools, and safety measures. Coping tools include meditation, tai chi, yoga, or seeing a trusted therapist.


If balance becomes a problem, it is important to prepare the bathroom with grab bars and remove rugs. An occupational therapist can help with other strategies to promote safety.


Unfortunately, treatment cannot cure Parkinson’s disease, but you can manage the symptoms. Contact your healthcare provider or neurologist to start the conversation if you suspect that you or a loved one is experiencing symptoms of Parkinson’s disease.


If you have questions about performing CPR for those with dementia, Pacific ACLS provides courses and a guide to first aid for people with dementia to give you a more in-depth look.


  1. Works CitedCenters for Disease Control. LCWK5: Deaths, Percent of Total Deaths, and Death Rates for the 15 Leading Causes of Death: United States and Each State, 2017. Updated December 31, 2018. Accessed October 17, 2022.
  2. Parkinson’s Foundation. Environmental factors. Accessed October 17, 2022.
  3. Mayo Clinic. Parkinson’s disease. Updated July 8, 2022. Accessed October 17, 2022.
  4. Bastiaan RB, Okun MS, Klein C. Parkinson’s Disease. Lancet. 2021;397(10291):2284-2303.