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There is a lot of to know about Parkinson's disease. You may be wondering what it is, how it is diagnosed, and what treatment options are available. The National Parkinson Foundation is here to help you navigate through all of your questions and concerns. Get started now. 


What is Parkinsonís disease?


Parkinsonís disease (PD) is a neurodegenerative brain disorder that progresses slowly in most people. What this means is that individuals with PD will be living with PD for twenty years or more from the time of diagnosis. While Parkinsonís disease itself is not fatal, the Center for Disease Control rated complications from the disease as the 14th top cause of death in the United States. There is currently no cure for Parkinsonís; however, your doctors will be focused and dedicated to finding treatments that help control the symptoms of PD and have a good quality of life. 

Normally, there are brain cells (neurons) in the human brain that produce dopamine. These neurons concentrate in a particular area of the brain, called the substantia nigra. Dopamine is a chemical that relays messages between the substantia nigra and other parts of the brain to control movements of the human body. Dopamine helps humans to have smooth coordinated muscle movements. When approximately 60 to 80% of the dopamine-producing cells are damaged, and do not produce enough dopamine, the motor symptoms of Parkinsonís disease appear. This process of impairment of brain cells is called neurodegeneration. 

The current theory (so-called Braakís hypothesis) is that the earliest signs of Parkinsonís are found in the enteric nervous system, the medulla and in particular, the olfactory bulb, which controls your sense of smell. Under this theory, Parkinsonís only progresses to the substantia nigra and cortex over the years. This theory is increasingly borne out by evidence that non-motor symptoms, such as a loss of sense of smell, hyposmia, sleep disorders and constipation may precede the motor features of the disease by several years. For this reason, researchers are increasingly focused on these ďnon-motorĒ symptoms to both detect PD as early as possible and to look for ways to stop its progression.




What are the symptoms of Parkinson's





Four Main Motor Symptoms of PD:

  • Shaking or tremor at rest.
  • Slowness of movement, called bradykinesia.
  • Stiffness or rigidity of the arms, legs or trunk.
  • Trouble with balance and falls, also called postural instability. Postural instability usually appears later with disease progression and may not be present with initial diagnosis.

Secondary Symptoms of PD May Include:

  • Small, cramped handwriting, called micrographia.
  • Reduced arm swing on the affected side.
  • Slight foot drag on affected side creating a shuffled walk.
  • ďFreezingĒóa term used to describe the phenomenon of being ďstuck in placeĒ when attempting to walk.
  • Loss of facial expression due to rigidity of facial muscles, called hypomimia.
  • Low voice volume or muffled speech, called hypophonia.
  • Tendency to fall backwards, called retropulsion.
  • Decrease ability in automatic reflexes such as blinking and swallowing.

Other Symptoms of PD

  • Depression
  • Anxiety- beyond the normal response to stress
  • Hallucinations, psychosis
  • Sleep disturbances (vivid dreams, talking and moving during night sleep)
  • Constipation
  • Pain
  • Increase in dandruff (seaborrhea dermatitis) or oily skin

Table 1. Symptoms in Parkinsonís disease

Bradykinesia (slowness of movement)
Rigidity (stiffness of movement)
Tremor (involuntary shaking of the hands, feet, arms, legs, jaw, or tongue, usually more prominent at rest)
Postural Instability (tendency to fall without explanation, usually when pivoting)
Mood (depression, anxiety, irritability)
Cognitive changes (attention, visuo-spatial problems, memory problems, personality changes, psychosis/hallucinations)
Orthostatic hypotension (lightheaded and low blood pressure upon standing)
Constipation and early satiety (a feeling of fullness after eating small amounts)
Hyperhidrosis (excessive sweating), especially of hands and feet
Seborrhea dermatitis (dry skin) dandruff
Urinary urgency, frequency and incontinence
Loss of sense of smell (Anosmia)
Sleep disorders
Insomnia, Excessive Daytime Sleepiness (EDS), Rapid Eye Movement Behavioral Disorder (RBD) or active dreaming, dream enactment, involuntary movements and vocalizations during sleep, Restless Legs Syndrome (RLS)/Periodic Leg Movements Disorder (PLMD)
Sensory (pain, tightness, tingling, burning)
Drooling due to slowed swallowing (Sialorrhea)
Speech and swallowing problem





Putting Your Comprehensive Care Team




Patients suffering from complex, chronic illnesses, such as PD, benefit most from an interdisciplinary team of professionals collaborating to provide individualized treatment and a care plan designed to enhance the quality of life. The National Parkinson Foundation (NPF) promotes this approach in our Centers of Excellence and Care Consortium networks.


Members of a comprehensive care team

Neurologists are doctors who specialize in problems with the nervous system.  A movement disorders specialist is a neurologist who has completed an extra one-to-two years of training in movement disorders such as PD. The neurologist will monitor your case of PD, work with you to prescribe appropriate medications, monitor your response to therapies and make recommendations for care.

Primary Care Providers (PCP) are usually the first point of contact and are usually internists or family practice physicians who will manage your overall health. Donít be afraid to ask the family doctor for a referral to a specialist. Your PCP should receive periodic reports from your neurologist regarding the current management of your PD.

Physicianís Assistants (PA) have an advanced degree and work under the supervision of a physician.

Nurses are often your primary contact and the central coordinator of your care. Nurse Practitioners (NP) are Registered Nurses (RN) who have an advanced degree and who have passed special licensing requirements. Nurse Practitioners can perform physical exams and prescribe medications and other therapies. They often work with a physician, although they can function independently.

Social Workers provide non-medical assistance and work in a variety of hospital and community settings. Many provide individual, couple and family counseling to help persons cope with stressful life events. Social workers often lead support groups. They can also help you to connect with a variety of community resources and help you and your family plan for the future.

Physical Therapists (PT) are licensed professionals who evaluate and treat mobility problems such as flexibility, strength, balance, posture and walking. They design exercises or provide training to meet an individualís needs. A PT can also help family caregivers by teaching safe and effective ways to provide assistance.

Occupational Therapists (OT) help to modify or adapt activities of daily living which include dressing, feeding oneself, getting in and out of bed, writing, and performing in the workplace.  An OT can address issues of safety and independence in the home. 

Speech-Language Pathologists (S-LP) are health care professionals trained to assess, manage and treat speech, voice, memory and swallowing problems. Treatment with a therapist can improve problems you may experience with communication or eating.

Nutritionists/Dieticians can help you design an eating plan for overall health. A Nutritionist can be particularly helpful if you have trouble chewing or swallowing, difficulty preparing nutritious meals or problems with your weight.

Pharmacists provide valuable information about prescription medication and can provide counsel on possible drug interactions and side effects. Try to use the same pharmacy all the time so there is a record of all medications being taken.

Neuropsychologists are licensed psychologists with expertise in how behavior and cognitive (thinking) skills are related to brain structure and symptoms.

Psychiatrists are physicians who specialize in the diagnosis and treatment of mental, behavioral or emotional problems such a depression and anxiety. These symptoms may require specialized treatment.

Psychologists can work with individuals and family members by providing advice and counseling for coping with the disease.

Please also remember, that your caregivers and loved ones are often your best advocates and can help you communicate with your health care team.


Want to Learn More?
Print this checklist:
Building a Support Network

Print this checklist:
Making the Most of Your Medical Appointment

Read this "Parkinson Report" article:
Assembling a Comprehensive Care Team

Read this "Parkinson Report" article:
Social Workers in the Forefront

Watch this video:
What are some strategies to improve the quality of community care for PD patients?

Watch this video:
Why is comprehensive care or a team approach important?


Medical content reviewed by: Nina Browner, MDóMedical Director of the NPF Center of Excellence at the University of North Carolina at Chapel Hill in North Carolina and by Fernando Pagan, MDóMedical Director of the NPF Center of Excellence at Georgetown University Hospital in Washington, D.C.



10 Early Warning Signs of Parkinson's




Sometimes it is hard to tell that you might have Parkinson's disease. Parkinson's disease is when your brain stops making an important chemical called dopamine. This chemical helps your body to move, and helps your mood. If you do have Parkinson's, you can feel better by taking a pill that helps your body to replace that chemical. Parkinson's disease will get worse slowly over time, and your doctor can help you stay healthy longer. Some of the problems listed here could be signs of Parkinson's disease.

No single one of these signs means that you should worry about Parkinson's disease. If you have more than one symptom, you should make an appointment to talk to your doctor. 

Early diagnosis of Parkinson's disease gives you the best chance of a longer, healthier life.

What you can do if you do have Parkinson's disease:

  • Work with your doctor to create a plan to stay healthy. This plan might include:
    • A referral to a neurologist, a doctor who specializes in the brain
    • Care from an occupational therapist, physical therapist or speech therapist
    • Meeting with a medical social worker to talk about how Parkinson's will affect your life
  • Start a regular exercise program to delay further symptoms.
  • Talk with family and friends who can provide you with the support you need.

Tremor or Shaking

Have you noticed a slight shaking or tremor in your finger, thumb, hand, chin or lip? Does your leg shake when you sit down or relax? Twitching or shaking of limbs is a common early sign of Parkinsonís disease.
What is normal? Shaking can be normal after lots of exercise, if you have been injured, or could be caused by a medicine you take.

Small Handwriting

Has your handwriting suddenly gotten much smaller than in it was in the past? You may notice the way you write words on a page has changed, such as letter sizes are smaller and the words are crowded together. A sudden change in handwriting is often a sign of Parkinsonís disease.
What is normal? Sometimes writing can change as you get older, if you have stiff hands or fingers or poor vision, but this happens over time and not suddenly.

Loss of Smell

Have you noticed you no longer smell certain foods very well? If  you seem to have more trouble smelling foods like bananas, dill pickles or licorice, you should ask your doctor about Parkinsonís disease.
What is normal? Your sense of smell can be changed by a cold, flu or a stuffy nose, but it should come back after you are better.

Trouble Sleeping

Do you thrash around in bed or kick and punch while you are deeply asleep? You might notice that you started falling out of bed while asleep. Sometimes, your spouse will notice, or will want to move to another bed. Sudden movements during sleep may be a sign of Parkinsonís disease.
What is normal? It is normal for everyone to have a night when they Ďtoss and turní instead of sleeping.

Trouble Moving or Walking

Do you feel stiff in your body, arms or legs? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinsonís disease. You might notice that your arms donít swing when you walk, or maybe other people have said you look stiff. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem Ďstuck to the floor.í
What is normal? If you have injured your arm or shoulder, you may not be able to use it as well until it is healed or another illness like arthritis might cause the same symptom.


Do you have trouble moving your bowels without straining every day? Straining to move your bowels can be an early sign of Parkinsonís disease and you should talk to your doctor.
What is normal? If you do not have enough water or fiber in your body, it can cause problems in the bathroom. Also some medicine will cause constipation too. If there is no other reason such as diet or medicine that would cause you to have trouble moving your bowels, you should speak with your doctor.

A Soft or Low Voice

Have other people told you that your voice is very soft when you speak in a normal tone, or that you sound hoarse? If there has been a change in your voice you should see your doctor about whether it could be Parkinsonís disease. Sometimes you might think other people are losing their hearing, when really you are speaking more softly.
What is normal? A chest cold or other virus can cause your voice to sound different but you should go back to sounding the same when you get over your cough or cold.

Masked Face

Have you been told that you have a serious, depressed or mad look on your face more often, even when you are not in a bad mood? This serious looking face is called masking. Also, if you or other people notice that you have a blank stare or do not blink your eyes very often, you should ask your doctor about Parkinsonís disease.
What is normal? Some medicines can cause you to have the same type of serious or staring look, but you would go back to the way you were after you stopped the medication.

Dizziness or Fainting

Do you notice that you often feel dizzy when you stand up out of a chair? Feeling dizzy or fainting can be signs of low blood pressure and can be linked to Parkinsonís disease.
What is normal? Everyone has had a time when they stood up and felt dizzy, but if it happens on a regular basis you should see your doctor.

Stooping or Hunching Over

Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinsonís disease.
What is normal? If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.

Made possible through the generous support of the Medtronic Foundation and thousands of people with Parkinson's and their families.










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