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Parkinson's Disease

 A close up of a person's hand – it is shaking, as it would with a hand tremor. The words – Parkinson's disease – can be seen

Please note that all content on this website (including, but not limited to, copy, images, commentary, advice, tips, hints, guides, observations) is provided as an informational resource only. It is not a substitute for correct and accurate diagnosis, or recommendation, or treatment by a medical professional. Please ensure that you obtain proper guidance from your GP, or another medical professional. The information provided on this website does not create any patient-medical expert relationship and must not be used in any way as a substitute for such. 

 

 

Parkinson’s disease is a degenerative neurological condition – a condition that affects the brain, or nerves, and gets worse over time. The most common and visible features of Parkinson’s disease are tremors, slow movements and 'shuffling' when walking.

Who is More Likely to Get Parkinson’s Disease?

Parkinson’s disease is not usually genetic. Some people can inherit it from their parents, but this is relatively rare.

Around 1 in 500 people in the UK will develop Parkinson’s disease. However, we are still uncertain about whether there are any specific causes. There has been research into whether or not pesticides can cause Parkinson’s disease, but there just isn’t the evidence at the moment to say that they do.

Men are more likely to get Parkinson’s than women, and it is more common in people over the age of 50.

What Causes Parkinson’s Disease?

A small part of your brain is responsible for making the chemical dopamine. This chemical is used to transmit signals in your nerves around the body, and this helps with movement and co-ordination. In Parkinson’s disease, the part of the brain that makes this chemical starts to slowly die, causing a lack of dopamine. This lack of dopamine leads to slow, jerky movements and other symptoms associated with Parkinson’s disease.

Most of the time, we don’t know why these brain cells stop working. Sometimes, it can be caused by poor blood supply to a specific part of the brain, or a stroke. This is known as vascular parkinsonism. For more information on what causes Parkinson’s disease, visit Parkinson UK’s website.

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The symptoms of Parkinson’s disease vary from person-to-person. There are three main symptoms which are common to most people who have the disease. These are:

  • A 'resting' tremor. This is a tremor which is worse when someone is resting. It is one of the symptoms people most commonly present with. When moving, or doing purposeful actions, the tremor may disappear. It is also known as a 'pill rolling tremor'. This is because it can look like someone is rolling their thumb over their hand, almost as though they have a pill which they are rolling around.
  • Even when resting, people with Parkinson’s often have very stiff muscles. This can sometimes be painful and can cause cramping.
  • Slow movements. People with Parkinson’s disease often move very slowly. When they walk, it might take them some time to speed up to a normal pace, and they may take short shuffling steps.

Beyond these three main symptoms, there are many others that people with Parkinson’s disease may suffer from. It is unlikely that people will suffer from all of these symptoms, but there will probably be a few. Some of these include:

  • Frequent falls, or a feeling of unsteadiness
  • Difficulty walking across lines, or through doors. People with Parkinson’s may have to stop before walking through doors, or around obstacles
  • Dizziness when standing up quickly, or orthostatic hypotension
  • Drooling
  • Problems with sleep
  • Constipation
  • Incontinence of urine
  • Loss of sense of smell
  • Sweating a lot
  • Depression
  • Memory problems

I Have Some of These Symptoms, do I Have Parkinson’s Disease?

To get a diagnosis of Parkinson’s disease, you will usually need to have two of the three main symptoms listed above. There are other conditions which can cause some of these symptoms:

Drug-induced Parkinson’s

There are some medications which can cause symptoms of Parkinson’s disease. When you see your GP with symptoms of Parkinson’s, one of the first things they will do is check your medications to see if they could be causing the problem.

If you are on a medication which could be causing your symptoms, it may be stopped, or changed. Typically, people who have symptoms of Parkinson’s disease caused by medication will get better within a few months of stopping that medication. Some people even improve after a few days.

Normal Pressure Hydrocephalus

This is where there is too much fluid in the space around your brain. People who get this may just suffer with headaches, or get no symptoms at all. Most of the time, it does not need any treatment however, in rare circumstances, it can cause difficulties with walking, loss of continence and poor memory. In these cases, some of the fluid may be drained from around the brain by a procedure called a lumbar puncture. This is where a small needle is put into the lower back with some local anaesthetic. The needle goes into the spine and drains some of the fluid. If this improves the symptoms, then it may be that a drain needs to be put in so that the fluid around the brain can escape, and the problem doesn’t come back.

Other Causes of Symptoms

Other conditions can cause symptoms which are very similar to Parkinson’s disease. They are rarer, and if they are suspected, they will be looked for by a neurologist (a doctor who specialises in the nerves and the brain). Some of these include progressive supranuclear palsy (PSP) and multiple system atrophy (MSA).

How is Parkinson’s Disease Diagnosed?

There is no specific test for Parkinson’s disease. If your GP thinks you may be suffering with Parkinson’s, then they will refer you to a specialist. This may be a neurologist, or a geriatrician who specialises in Parkinson’s in older people.

The specialist will do an examination, and if Parkinson’s disease is likely, they will prescribe medications to increase the levels of dopamine in the brain. If the symptoms improve, then this confirms the diagnosis.

If investigations are done, they will be done to rule out other conditions which may be causing the symptoms. For example, a brain scan to rule out a tumour, or blood tests to rule out vitamin deficiencies.

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What is the Treatment for Parkinson’s Disease?

There is no cure for Parkinson’s disease. Medications which are given to you will be aimed at increasing the levels of dopamine in your brain, which helps to reduce tremor and jerky, slow movements.

There are three main types of drug categories which can be used to achieve this, and some people will find certain drugs more useful than others.

It may take a while to achieve a medication regime which works. Medications are started on low doses and increased over time to try to reduce side effects.

Over time, as the natural levels in the brain decrease, medications may need to be increased, changed, or new ones added. You will continue to be followed up by a specialist who will make these changes and discuss the options with you.

Levodopa

This is a medication which gets converted into dopamine when it reaches your brain. There are different brands and formulations of this medication which you may be started on, and it is the most commonly used type of medication for Parkinson’s disease. Side effects include nausea, a feeling of tiredness and dizziness.

Dopamine Agonists

These drugs increase the amounts of natural dopamine in your brain. They can be used alongside levodopa to decrease the doses needed. They have similar side effects, but just because someone gets side effects from levodopa, this does not mean you will get the same results with dopamine agonists. The side effects are similar, in that they include nausea, tiredness and dizziness, but they can also cause confusion and hallucinations. For this reason, they may not be the preferred choice in elderly patients.

When dopamine agonists are being started, or the dosage is increased, there is a risk that the patient can suddenly fall asleep without warning. For this reason, driving is best avoided when being started on these drugs, or having a dose increased.

Another side-effect people sometimes complain of with this type of medication is impulsiveness. This may be financially, with increased gambling, or sexually, with sometimes very forward, or inappropriate behaviour. People who get these symptoms are often unaware that they are experiencing them, and it is important for carers and loved ones around them to be aware that this is a possibility. If you think that someone is experiencing these symptoms, discuss it with the person, their GP, or a specialist doctor.

Mono-Amine-Oxidase B Inhibitors (MAO-B inhibitors)

These drugs also stop the breakdown of dopamine in the brain. Side effects include high blood pressure, tummy pain and nausea. They can also make some of the side effects of levodopa worse. It can be used on its own when you have just been diagnosed with Parkinson’s, or it can be used in the later stages alongside other drugs.

If you are on certain anti-depressants, you may not be able to use MAO-B inhibitors. They also interact badly with some over the counter medications, such as cold and flu remedies. If you are on a MAO-B inhibitor, make sure to speak to your pharmacist before buying any drugs over the counter.

Other Medications

The medications used for Parkinson’s disease are generally specialist, and there are many different combinations which can be used. If you have questions about your medications, their side effects and other options, make sure you ask your specialist about them at the time of prescribing. They will often have advice and information leaflets which they can give you.

How Important is it That I Take My Medication?

Parkinson’s medications aim to maintain the right level of dopamine in your brain at all times. This means that the dosing schedule of your medication is extremely important. If you miss tablets, or take them late, the symptoms of your Parkinson’s disease will come back. In advanced Parkinson’s, this can mean that people struggle to move at all, or even swallow.

You could try setting alarms on your phone, or even using a pillbox reminder. Use whatever works to help you with remembering to take your medications at the right times.

Do People With Parkinson’s Get Dementia?

Around half of people who are diagnosed with Parkinson’s disease will develop some form of dementia. Dementia in Parkinson’s disease is only diagnosed in people who have memory problems severe enough that it is impacting on their everyday life.

It is common for people with Parkinson’s to feel like they think more slowly, or are a little bit more forgetful. This is normal and does not mean that you are developing dementia. Some medications can also cause these symptoms.

If you are worried about your memory, make sure you see your GP. They can assess your memory and decide whether you need a referral to a specialist memory clinic.

What Does Parkinson’s Disease Mean for the Long-term?

Following a diagnosis with Parkinson’s, it is understandable that you might be worried about the future. Following a diagnosis, people can live for decades and have a very good quality of life. The charity Parkinson’s UK operates a helpline on 0808 800 0303. It is free to use and they can answer any specific questions you may have and offer you support.

Parkinson’s disease is currently incurable. There is ongoing research to look for a cure.

Can I Drive With Parkinson’s Disease?

If you are diagnosed with Parkinson’s, it is a legal requirement that you tell the DVLA. This does not necessarily mean that you will have to stop driving, but you may need a driving assessment.

As your disease progresses, it is important to keep people informed. If you feel that your reactions and movements are affected to the point that you may not be able to avoid a hazard on the road, then you must stop driving.

Some of the medications which you will take for Parkinson’s disease can make you drowsy. Again, if you feel that you are mentally affected by your medication in this way, then you should not be driving.

Will I Need Home Adaptations?

Eventually, to help you stay at home, you may need adaptations to your home to make things more accessible. These can be to reduce falls risk, or can be just small things to make day-to-day tasks easier.

Eventually, you may need to use walking aids. If you are struggling around the home, and feel that you need some help, you can see your GP for a social assessment. You may be entitled to a lot of home adaptations, or mobility aids for free, and your GP can set this in motion. Alternatively, you can apply for a social care assessment online.

A picture of four light bulbs with the filaments replaced by words – help, support, advice and guidance

Photo by EtiAmmos on iStock

The charity Parkinson’s UK is dedicated to helping people with Parkinson’s disease. They operate the helpline listed above – you can also contact them via their website, or by email. Parkinson's UK are there to support you, answer questions and can direct you to extra support in your local area. They can also advise on financial services which may be available to you.

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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.

Degenerative – a condition which worsens over time

Dopamine – this is a chemical in the brain which is used to transmit signals along nerves. It is known as a neurotransmitter. It is the chemical which becomes reduced in Parkinson’s disease, and this leads to the classic features of slow movements, tremor and stiffness

Genetic – a medical condition which is inherited through your parents

Hallucinations – when you are seeing, or hearing something, that isn’t there

Neurologist – a doctor who specialises in the nerves, or brain

Orthostatic Hypotension – also known as postural hypotension. This is a condition where, when you stand up, your blood pressure drops. This means that your brain doesn’t get as much blood as it would normally and you start to feel dizzy. Some people will pass out, but they will quickly regain consciousness and feel back to normal within a few minutes