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Parkinson's disease

From MayoClinic.com

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Movement Disorders

Parkinson's disease is a disorder that affects nerve cells (neurons) in the part of the brain controlling muscle movement. People with Parkinson's often experience trembling, muscle rigidity, difficulty walking, and problems with balance and coordination. These symptoms generally develop after age 50, although the disease affects a small percentage of younger people as well.

Parkinson's disease is progressive, meaning the signs and symptoms become worse over time. But although Parkinson's may eventually be disabling, the disease often progresses gradually, and most people have many years of productive living after a diagnosis.

Furthermore, unlike other serious neurologic diseases, Parkinson's disease is treatable. For decades, the drug levodopa, commonly known as L-dopa, has been the mainstay of Parkinson's disease treatment. But L-dopa can cause side effects, and it may become less effective as the disease worsens, especially as new symptoms develop. In addition, responses to the drug may become more erratic over time. For that reason newer drugs are now also used, either alone or in combination with levodopa.

Another treatment that has had encouraging results is deep brain stimulation (DBS). DBS involves implanting a brain stimulator, similar to a heart pacemaker, in certain areas of the brain. For some people, DBS may control symptoms so well that medications can be greatly reduced. Meanwhile, research into other treatments continues.

Signs and symptoms

The earliest symptom of Parkinson's disease can be as subtle as an arm that doesn't swing when you walk, a mild tremor in the fingers of one hand or soft, mumbling speech that's difficult to understand. You also may lack energy, feel depressed or have trouble sleeping. Or you may notice that it takes you longer to shower, shave, eat or do other routine tasks.

Other signs and symptoms of Parkinson's disease may include:

  • Tremors. These often start with a slight shaking in one finger that later may spread to the whole arm. Sometimes hand tremors cause a back-and-forth rubbing of the thumb and forefinger known as pill rolling. Tremors also may develop in the head, lips or feet. These symptoms may occur on one or both sides of your body and may be more noticeable when you're under stress. Although tremors can be very distressing, they're usually not disabling and often disappear during sleep.

  • Slowed motion (bradykinesia). Over time, Parkinson's disease may cause a slow, shuffling walk with an unsteady gait and stooped posture. And certain muscles may freeze up, making it hard to resume normal movement. This is especially distressing because it can make performing the simplest tasks difficult and time-consuming. Even the functioning of the digestive tract may slow down, causing problems with swallowing, digestion and elimination. Constipation is often a major problem for people with Parkinson's disease.

  • Rigid muscles. Muscle stiffness (rigidity) often occurs in the limbs and neck. Sometimes the stiffness can be so severe that it limits the size of movements.

  • Loss of automatic movements. Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson's disease, these acts tend to be lost. Some people may develop a fixed staring expression and unblinking eyes. Others may no longer gesture or seem animated when they speak.

  • Impaired speech. Many people with Parkinson's disease have some trouble speaking, and their voices often become monotonous and very soft. This may be a special problem for older adults because the soft voice of a person with Parkinson's disease may not be audible to a spouse with poor hearing.

  • Difficulty swallowing. This is common in the later stages of the disease.

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