Parkinson's disease is a progressive neurological condition that affects movement, and often much more. It usually begins gradually, so early signs are easy to miss or blame on aging. Recognizing the symptoms early and getting an accurate diagnosis allows treatment to start when it can make a real difference in daily life. Although there is not yet a cure, most people with Parkinson's live active, meaningful lives for many years with good care.
What Is Parkinson's Disease?
Deep in the brain, a group of cells in an area called the substantia nigra produce dopamine, a chemical messenger that helps the brain plan and coordinate smooth movement. In Parkinson's disease, these cells gradually stop working and die. By the time movement symptoms appear, a large share of the dopamine-producing cells have already been lost. The disease also affects other parts of the nervous system, which explains its many non-movement symptoms.
The exact cause is not fully understood. Age is the biggest risk factor, and most people are diagnosed after age 60, although some develop symptoms earlier. A combination of genetic and environmental factors probably contributes.
Early Motor Symptoms
The movement symptoms usually start on one side of the body and spread to the other side over time.
- Tremor at rest: a rhythmic shaking of a hand, thumb or fingers when the hand is relaxed, sometimes described as "pill rolling." It often lessens when the hand is used.
- Slowness of movement (bradykinesia): everyday tasks like buttoning a shirt or getting out of a chair take longer, and movements become smaller.
- Stiffness (rigidity): tight muscles in the arms, legs or neck, sometimes mistaken for arthritis or a frozen shoulder.
- Smaller handwriting (micrographia) that gets more cramped across the page.
- Reduced arm swing on one side when walking, or shuffling, shorter steps.
- A softer voice or speech that trails off.
- Less facial expression, so others may think you look serious or sad.
Balance problems and falls are usually a later feature. Early, prominent falls can point to a different diagnosis.
Non-Motor Symptoms You Might Not Expect
Some non-motor symptoms can appear years before the tremor or slowness:
- Loss of the sense of smell.
- Acting out dreams during sleep, such as shouting, punching or kicking (REM sleep behavior disorder).
- Constipation.
- Depression and anxiety.
- Lightheadedness on standing, due to blood pressure changes.
- Fatigue and, later, changes in thinking or memory.
Having one of these symptoms alone does not mean you have Parkinson's, but mentioning them to your doctor helps complete the picture.
How Parkinson's Is Diagnosed
There is no single blood test or routine scan that confirms Parkinson's disease. The diagnosis is clinical, based on a careful history and neurological examination by an experienced physician. The neurologist looks for slowness of movement together with rest tremor and/or rigidity, and checks for features that suggest another condition.
Additional tests may be used in specific situations:
- Brain MRI to look for strokes, fluid build-up or other structural causes.
- Dopamine transporter imaging (DaTscan) when the diagnosis is uncertain, especially to distinguish Parkinson's from essential tremor.
- A trial of medication; a clear improvement with levodopa supports the diagnosis.
Conditions That Can Look Like Parkinson's
- Essential tremor, which mainly causes shaking during use of the hands, such as holding a cup or writing, rather than at rest.
- Drug-induced parkinsonism, caused by some medications used for psychiatric symptoms or nausea. It may improve when the medication is changed.
- Vascular parkinsonism, related to small strokes, often affecting walking more than the hands.
- Atypical parkinsonian disorders, such as multiple system atrophy or progressive supranuclear palsy, which tend to progress faster and respond less to medication.
- Normal pressure hydrocephalus, which affects walking, thinking and bladder control.
Treatment Options
Medications
Medications are aimed at restoring dopamine signaling and can improve symptoms considerably, especially in the early and middle stages.
- Carbidopa-levodopa is the most effective medication for movement symptoms. The brain converts levodopa into dopamine.
- Dopamine agonists mimic dopamine's effect.
- MAO-B inhibitors and COMT inhibitors help dopamine last longer.
- Amantadine can help tremor and reduce involuntary movements that may develop later.
Treatment is individualized, and doses are adjusted over time as symptoms change. Non-motor symptoms such as sleep problems, constipation, mood changes and low blood pressure are treated as well.
Exercise and therapy
Regular exercise is one of the most powerful tools in Parkinson's care. Activities that challenge balance, strength and aerobic fitness, such as brisk walking, cycling, dancing, tai chi and boxing-based programs, help maintain mobility. Physical, occupational and speech therapy, including programs designed specifically for Parkinson's, improve walking, daily function and voice volume.
Advanced therapies
When medication effects begin to wear off between doses or cause involuntary movements, options such as deep brain stimulation or continuous medication delivery systems may be considered at specialized centers.
How Parkinson's Changes Over Time
Parkinson's disease usually progresses slowly, and the pace differs widely from person to person. In the early years, symptoms are often mild and respond well to medication. Over time, symptoms may involve both sides of the body, and some people develop fluctuations in which medication benefit wears off before the next dose, or involuntary movements called dyskinesias. Later stages can bring balance problems, freezing of gait, swallowing difficulty and changes in thinking. Regular follow-up allows the treatment plan to be adjusted as needs change, and planning ahead helps patients and families stay in control.
What to Bring to Your First Visit
- A list of current medications, including any recently started or stopped.
- A short video of the tremor or walking difficulty if symptoms come and go.
- Notes on non-motor symptoms such as sleep, smell, mood and constipation.
- A family member who has noticed the changes.
Living Well With Parkinson's
- Stay active every day and keep up social connections.
- Make the home safer with good lighting, grab bars and removal of loose rugs.
- Take medications on schedule; timing matters with levodopa.
- Report hallucinations, confusion, falls or mood changes promptly.
- Involve family members and consider joining a support group.
Parkinson's Disease Care in Westwood, NJ
Parkinson's disease is a clinical interest of Dr. David D. Van Slooten. Our neurologists can evaluate tremor, slowness and walking changes, distinguish Parkinson's from conditions that mimic it, and provide ongoing care. Related services include computerized cognitive testing and Botox for movement disorders such as dystonia.
Explore our neurology services or find directions on our contact page.
Have questions about your symptoms? Our neurologists in Westwood, NJ can help. Download our new-patient forms and get directions to the office.
This article is for general education and does not replace advice from your own physician. If you think you are having a medical emergency, call 911.
