Health A to Z
Parkinson's disease is a condition in which parts of the brain become progressively damaged over many years.
The three main symptoms of Parkinson's disease are:
A person with Parkinson's disease can also experience a wide range of other physical and psychological symptoms, including:
Read more about the symptoms of Parkinson's disease.
See your GP if you're concerned that you may have symptoms of Parkinson's disease.
Your GP will ask about the problems you're experiencing and may refer you to a specialist for further tests.
Read more about diagnosing Parkinson's disease.
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.
Read more about the causes of Parkinson's disease.
It's thought around 1 in 500 people are affected by Parkinson's disease, which means there are an estimated 127,000 people in the UK with the condition.
Most people with Parkinson's start to develop symptoms when they're over 50, although around 1 in 20 people with the condition first experience symptoms when they're under 40.
Men are slightly more likely to get Parkinson's disease than women.
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.
You may not need any treatment during the early stages of Parkinson's disease, as symptoms are usually mild. However, you may need regular appointments with your specialist so your condition can be monitored.
Read more about treating Parkinson's disease.
As the condition progresses, the symptoms of Parkinson's disease can get worse and it can become increasingly difficult to carry out everyday activities without assistance.
Many people respond well to treatment and only experience mild to moderate disability, whereas the minority may not respond as well and can, in time, become more severely disabled.
Parkinson's disease doesn't directly cause people to die, but the condition can place great strain on the body, and can make some people more vulnerable to serious and life-threatening infections.
However, with advances in treatment, most people with Parkinson's disease now have a normal or near-normal life expectancy.
Read more about living with Parkinson's disease.
It may also be useful to read your guide to care and support – written for people with care and support needs, as well as their carers and relatives.
It includes information and advice on:
The symptoms of Parkinson's disease usually develop gradually and are mild at first.
There are many different symptoms associated with Parkinson's disease. Some of the more common symptoms are described below.
However, 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.
The three main symptoms of Parkinson's disease affect physical movement:
These main symptoms are sometimes referred to by doctors as parkinsonism as there can be causes other than Parkinson's disease.
Parkinson's disease can also cause a range of other physical and mental symptoms.
See your GP if you're concerned you may have symptoms of Parkinson's disease.
Your GP will ask about your symptoms and your medical history to help them decide whether it's necessary to refer you to a specialist for further tests.
Read more about diagnosing Parkinson's disease.
Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.
Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements.
If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement can't work as well as normal, causing movements to become slow and abnormal.
The loss of nerve cells is a slow process. The symptoms of Parkinson's disease usually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost.
It's not known why the loss of nerve cells associated with Parkinson's disease occurs, although research is ongoing to identify potential causes.
Currently, it's believed a combination of genetic changes and environmental factors may be responsible for the condition.
A number of genetic factors have been shown to increase a person's risk of developing Parkinson's disease, although exactly how these make some people more susceptible to the condition is unclear.
Parkinson's disease can run in families as a result of faulty genes being passed to a child by their parents. However, it's rare for the disease to be inherited this way.
Some researchers also feel environmental factors may increase a person's risk of developing Parkinson's disease.
It's been suggested that pesticides and herbicides used in farming and traffic or industrial pollution may contribute to the condition.
However, the evidence linking environmental factors to Parkinson's disease is inconclusive.
"Parkinsonism" is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.
Parkinson's disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.
These include parkinsonism caused by:
You can read more about parkinsonism on the Parkinson's UK website.
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.
If your GP suspects Parkinson's disease, you'll be referred to a specialist. This will usually be:
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.
A diagnosis of Parkinson's disease is likely if you have at least two of the three following symptoms:
If your symptoms improve after taking a medication called levodopa, it's more likely you have Parkinson's disease.
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.
Being told you have Parkinson's disease can be emotionally distressing, and the news can often be difficult to take in.
This means it's important that you have the support of your family and a care team who will be able to help you come to terms with the diagnosis.
You may find it useful to contact Parkinson's UK, the Parkinson's support and research charity.
They can be contacted by:
Parkinson's UK brings people with Parkinson's, their carers and families together through a network of local groups, as well as online resources and a confidential helpline.
The Parkinson's UK website provides information and support on every aspect of living with Parkinson's.
There are several therapies that can make living with Parkinson's disease easier and help you deal with your symptoms on a day-to-day basis.
There are efforts underway to try to increase the availability of these supportive therapies for Parkinson's patients on the NHS.
Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment.
A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise.
The physiotherapist aims to make moving easier, and improve your walking and flexibility. They also try to improve your fitness levels and ability to manage things for yourself.
Read more about physiotherapy.
An occupational therapist can identify areas of difficulty in your everyday life – for example, dressing yourself or getting to the local shops.
They can help you work out practical solutions, and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible.
Read more about occupational therapy.
Many people with Parkinson's disease have swallowing difficulties (dysphagia) and problems with their speech.
A speech and language therapist can often help you improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology.
For some people with Parkinson's disease, making dietary changes can help improve some symptoms.
These changes can include:
You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks you may benefit from changing your diet.
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Medication can be used to improve the main symptoms of Parkinson's disease, such as shaking (tremors) and movement problems.
However, not all the medications available are useful for everyone, and the short- and long-term effects of each are different.
Three main types of medication are commonly used:
Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you. Regular reviews will be required as the condition progresses and your needs change.
Read on to learn about the treatments you may be offered. You can also see a summary of the pros and cons of treatments for Parkinson's disease, where you can compare your options.
Most people with Parkinson's disease eventually need a medication called levodopa.
Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement.
Increasing the levels of dopamine using levodopa usually improves movement problems.
It is usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa.
These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain.
They also reduce the side effects of levodopa, which include:
If you're prescribed levodopa, the initial dose is usually very small and will be gradually increased until it takes effect.
At first, levodopa can cause a dramatic improvement in the symptoms.
However, its effects can be less long-lasting over the following years – as more nerve cells in the brain are lost, there are fewer of them to absorb the medicine. This means the dose may need to be increased from time to time.
Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and "on-off" effects, where the person rapidly switches between being able to move (on) and being immobile (off).
Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect compared with levodopa. They can often be given less frequently than levodopa.
They are often taken as a tablet, but are also available as a skin patch (rotigotine).
Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used.
Possible side effects of dopamine agonists include:
Dopamine agonists can also cause hallucinations and increased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible.
For some people, dopamine agonists have been linked to the development of compulsive behaviours, especially at high doses, including addictive gambling and an excessively increased libido.
Talk to your healthcare specialist if you think you may be experiencing these problems.
As the person themselves may not realise the problem, it's key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity.
If you're prescribed a course of dopamine agonists, the initial dose is usually very small to prevent nausea and other side effects.
The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication.
A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep.
This generally happens as the dose is being increased and tends to settle once the dose is stable.
People are usually advised to avoid driving while the dose is being increased in case this complication occurs.
Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson's disease.
They block the effects of an enzyme or brain substance that breaks down dopamine (monoamine oxidase-B), increasing dopamine levels.
Both selegiline and rasagiline can improve the symptoms of Parkinson's disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists.
MAO-B inhibitors are generally very well tolerated, but can occasionally cause side effects, including:
Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson's disease. They prevent levodopa from being broken down by the enzyme COMT.
Side effects of COMT inhibitors include:
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When Parkinson's symptoms become difficult to control with tablets alone, a number of other treatments can be considered.
A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) either by:
If you have severe on-off fluctuations, a type of levodopa called duodopa may be used.
This medication comes as a gel that's continuously pumped into your gut through a tube inserted through your abdominal wall.
There's an external pump attached to the end of the tube, which you carry around with you.
About 25 specialist neuroscience centres in the UK offer this treatment. This treatment is only available if you have very severe on-off fluctuations or involuntary movements.
Most people with Parkinson's disease are treated with medication, although a type of surgery called deep brain stimulation is used in some cases.
This surgery is also available in specialist neuroscience centres around the UK, but it's not suitable for everyone.
If surgery is being considered, your specialist will discuss the possible risks and benefits with you.
Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall.
This is connected to one or two fine wires placed under the skin, and is inserted precisely into specific areas in your brain.
A tiny electric current is produced by the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinson's disease.
Although surgery doesn't cure Parkinson's disease, it can ease the symptoms for some people.
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As well as the main symptoms of movement problems, people with Parkinson's disease can experience a wide range of additional symptoms that may need to be treated separately.
Much progress has been made in the treatment of Parkinson's disease as the result of clinical trials, where new treatments and treatment combinations are compared with standard ones.
All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.
If you are asked if you want to take part in a trial, you will be given an information sheet about the trial.
If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.
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Some people with Parkinson's disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson's disease.
However, there's no clinical evidence they're effective in controlling the symptoms of Parkinson's disease.
Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn't be used instead of the medicines prescribed by your doctor.
Some types of herbal remedies, such as St John's wort, can interact unpredictably if taken with some types of medication used to treat Parkinson's disease.
If you're considering using an alternative treatment along with your prescribed medicines, check with your care team first.
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It's important to do what you can to stay physically and mentally healthy if you have Parkinson's disease.
Regular exercise is particularly important in helping relieve muscle stiffness, improving your mood, and relieving stress.
You should also try to eat a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy.
Everyone with a long-term condition is encouraged to get a yearly flu jab each autumn.
The pneumococcal vaccination is also usually recommended, which is a one-off injection that protects against a serious chest infection called pneumococcal pneumonia.
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Being diagnosed with a long-term condition like Parkinson's disease can put a strain on you, your family and friends. It can be difficult to talk to people about your condition, even if they're close to you.
Dealing with the deterioration of symptoms, such as increasing difficulty with movement, may make you feel frustrated and depressed. Spouses, partners or carers will inevitably feel anxious or frustrated as well.
Be open about how you feel, and let your family and friends know what they can do to help. Don't feel shy about telling them you need some time to yourself, if that's what you want.
If you have any questions about your condition, your GP or Parkinson's disease specialist nurse may be able to help.
You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have details of these.
Some people find it helpful to talk to others with Parkinson's disease, either at a local support group or in an internet chat room.
It's worth taking time to think about your specific needs and what would help you achieve the best quality of life.
For example, you may wish to consider equipment, help in your home, and home adaptations.
Read more about:
Parkinson's UK is the main Parkinson's support and research charity in the UK.
They can offer the support and advice you may need if you're living with Parkinson's disease, and can let you know about support groups in your local area.
They can be contacted by:
The Parkinson's UK website also features all the latest news, publications and research updates, as well as an online community where you can share your experiences of living with Parkinson's.
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Being diagnosed with Parkinson's doesn't mean you have to stop working. Many people with the condition keep working for years after their diagnosis.
You may find it hard to cope financially if you do have to stop work or work part-time because of your condition.
However, you may be entitled to one or more of the following types of financial support:
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If you've been diagnosed with Parkinson's disease, you must inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance company.
You won't necessarily have to stop driving. You'll be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists. The DVLA will use this to decide whether you're fit to drive.
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Complex Parkinson's disease is defined as the stage when treatment is unable to consistently control symptoms, or the person has developed uncontrollable jerky movements (disabling dyskinesia).
These problems can still be helped by adjustment or addition of some of the medications used to treat Parkinson's disease, under the supervision of a doctor with a specialist interest in Parkinson's disease.
As Parkinson's disease progresses, you'll be invited to discuss the care you want with your healthcare team as you near the end of your life. This is known as palliative care.
When there's no cure for an illness, palliative care tries to alleviate symptoms, and is also aimed at making the end of a person's life as comfortable as possible.
This is done by attempting to relieve pain and other distressing symptoms, while providing psychological, social and spiritual support for you and your family.
Palliative care can be provided at home or in a hospice, residential home or hospital. You may want to consider talking to your family and care team in advance about where you'd like to be treated and what care you wish to receive.
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Parkinson's disease is usually considered to be an older person's illness, but Karen Rose was diagnosed with it when she was just 34. She talks about the impact it's had on her life over the following 10 years.
"I was 34 when I first noticed the symptoms of Parkinson's. At the time, my dad noticed I wasn't walking properly and I wasn't swinging my right arm. And at work I was typing the wrong keys when I was using the computer.
"A year or so later I had a car accident and started to develop a tremor. Over the following year I realised this wasn't right. Every time I was anxious or upset, the tremor would start.
"My GP didn't know what was wrong, so he sent me to a neurologist, who gave me a tablet to try. It worked and my symptoms improved, confirming I had Parkinson's.
"I went back to see the consultant, and he gave me the medication I have to take every day and for the rest of my life.
"People consider Parkinson's to be an older person's disease. Every time I mention I have it, people always say, 'You're not old enough, you look fine'.
"When my medication's working, I do look fine, but they don't see the times when the medication's worn off and I'm struggling to move and do everything that everybody takes for granted.
"I feel stiff and slow in the mornings, and am hardly able to move one foot in front of the other. The medication helps to get me going. I take it throughout the day to stop the symptoms. Stairs aren't a problem as I can run up those easily. It's walking I have the problem with.
"I become worse as the tablets wear off. The twitching I suffer from is a side effect of the medication, but I need to take it regularly. If I don't, I slow down, get stiff, and I'm unable to do what I want to.
"So it's essential to take your medication on time. I have a pill timer, which reminds me when I'm due to take a tablet.
"My family are really supportive. My husband and children have to do quite a lot of housework for me, but they don't mind at all.
"I was lucky at work. My boss is supportive and made sure I could do the jobs that suited me at the time. If I was having a bad day, my boss let me do a job I could manage and never put any pressure on.
"When I was first diagnosed I didn't know anybody my age who had Parkinson's, only very old people. Then a nurse specialist at my local hospital put me in touch with the Bristol branch of the Parkinson's Disease Society (PDS).
"The people at PDS supported me. I joined their committee so I could also help other people with young-onset Parkinson's.
"It's important to talk when you find out you have Parkinson's. Ask your GP if they know of a nearby support group, or contact the PDS. They have contact numbers of people you can talk to on their website.
"I don't think you ever accept that you have Parkinson's disease, but you do need to learn to live with it. Don't let it live your life for you. Do what you can, when you can, and stay positive because this will always help."
Ernie May was diagnosed with Parkinson's when he was 65. He tells us his story.
"Looking back, I was experiencing the symptoms of Parkinson's for at least two years before my diagnosis.
"I had 'frozen' a couple of times – literally stopped moving – while walking and I seemed to be having problems with my facial muscles, which were causing me to dribble badly.
"I had suffered for years with a painful right hip due to arthritis in my adolescence. This, I thought – now I know incorrectly – explained the 'freezing' incidents.
After carrying out a few basic tests, my GP concluded there was nothing wrong with my facial muscles and that the root cause of my dribbling could be excess saliva caused by the type of filling used by my dentist.
"Early in 2005 I had a full right hip replacement. Though initially I seemed to recover well, it soon became clear my progress was falling behind the group of patients I'd been admitted with. They soon went home, while my mobility wasn't improving.
"I was transferred to a rehabilitation centre, where one of the GPs suspected I had Parkinson's simply by looking at my expressionless face.
"I was referred to a consultant, who confirmed Parkinson's. He was accompanied by a Parkinson's disease nurse specialist (PDNS), who gave me some information from Parkinson's UK about what the condition is.
"At the moment I'm in relatively good health. My joints, particularly my ankles, tend to be very stiff in the mornings and my movement is slow.
"I try to exercise as much as I can, which seems to help with my mobility. I believe it's very important to stay as active as possible when you have Parkinson's, so I try to go to the gym three times a week.
"Fortunately I have only a very slight tremor in my left hand, which in itself is not a problem. Currently, the biggest problem I have is getting up from a chair.
"Also, my handwriting is so small that even I can't read it, so I just tell people I can no longer write! Recently I've been experiencing problems with my speech, which is very frustrating as often people can't hear me very well.
"I see my consultant every three months and the PDNS is usually there, too. She gives me the information I need to manage my symptoms effectively so I can do as much as I can and live life to the full, albeit in the slow lane.
"I'm also secretary of my local Parkinson's UK support group, which was set up eight months after my diagnosis. Being part of the group is extremely helpful, as there are people I can talk to who are going through the same things.
"Living with this condition can be incredibly difficult, but life doesn't end with a Parkinson's diagnosis. For me, everything just takes a bit longer."