Parkinson’s disease

What is Parkinson’s disease?

Parkinson’s disease is a movement and mood disorder. It is a condition that progresses with time and happens when the nerve cells in the brain can’t make enough of a body chemical called dopamine. Dopamine is a chemical that is naturally made in your brain, and is vital for the smooth control of your muscles and movement.

Most people with Parkinson’s disease are diagnosed around the age of 65 years, but 1 in 10 people diagnosed are younger than 45 years.

What are the symptoms of Parkinson’s disease?

Parkinson’s symptoms vary. The typical symptoms are a combination of:

• tremor or shaking at rest, usually one sided at first
• muscle stiffness (rigidity), which can cause pain and affect posture and movement
• slowing of movement, which can make daily activities such as getting dressed and cooking difficult
• changes to your posture

Early symptoms can be vague and non-specific, which makes it difficult to diagnose. These may include:

• fatigue
• mild depression
• restlessness
• localised muscle pain

Other symptoms that you may develop with Parkinson’s disease affect how you move, such as:

• balance problems
• slowed speech
• handwriting becoming very small and difficult to read
• swallowing changes
• low blood pressure, especially when going from lying to sitting, or sitting to standing

There are also non-movement symptoms, such as:

• sleep problems, including acting out your dreams and sleep talking
• constipation
• slowing of thoughts
• anxiety and depression
• decreased sense of smell
• fatigue not relieved by resting
• increased saliva production

Many of the symptoms of Parkinson’s disease could be caused by other conditions. If you are worried about your symptoms, it is a good idea to see your doctor.

What causes Parkinson’s disease?

Doctors do not yet know the cause of Parkinson’s disease. Some contributing factors include ageing, genetic changes, toxins, medicines and infection.

When should I see my doctor?

See your doctor if you notice shaking, stiff muscles, lack of balance or slowing down of your movement. Parkinson’s can be difficult to diagnose, so your doctor may refer you to a specialist, such as a neurologist or geriatrician, who can assess you and order tests.

How is Parkinson’s disease diagnosed?

Diagnosing Parkinson’s disease is difficult, especially early in the disease. No single test can provide a diagnosis. A diagnosis will involve your doctor speaking to you about your symptoms and doing a physical examination. Your doctor might also see if you respond to medicine that increases dopamine levels in your brain.

You may need brain scans to rule out other conditions that could cause your symptoms. These could include MRI and CT scans or others. Your doctor may also refer you for blood tests to check for other illnesses.

How is Parkinson’s disease managed?

Your doctors and other health professionals will make a treatment plan especially for you. You condition will be best managed if you have the support of a team. This team may include your general practitioner (GP), neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.

While there is no cure for Parkinson’s disease, symptoms can be treated with a combination of medicines, surgery and lifestyle changes.

Medicines

The medicines used to treat Parkinson’s disease are designed to increase the level of dopamine in the brain. They may be given in tablet (pill) form or via an injection or tube straight into the small intestine.

There are many different types of these medicines. The most commonly used are:

• levodopa, which is a dopamine precursor (building block) and acts to replace dopamine
• dopamine agonists, which copy the effects of dopamine
• COMT inhibitors, which increase the amount of levodopa that can work in the brain
• MAO-B inhibitors, which help stop the breakdown of dopamine in the brain
• amantadine, which is used by people who have developed abnormal movements (known as dyskinesia)
• anticholinergic medicines to help with the tremor, but cause side effects which limit their use

People respond to medicines in different ways. If your doctor prescribes medicine for Parkinson’s disease, it may take some time to find the one that suits you best.

To search medicines by active ingredient or brand name, use the healthdirect Medicines search feature.

Surgery

Deep brain stimulation (DBS) surgery can be used for some people to reduce the amount of medicine they need. It can reduce the tremor, or lessen wriggling movements in the body.

It involves placing electrodes into the part of the brain that controls movement. The electrodes are connected to a tiny generator, implanted in the chest, that you can switch on to send electrical impulses to the brain. It is then programmed and adjusted to give the best effect. In most cases you are awake during the surgery.

DBS is not suitable for everyone, so ask your doctor if it’s a good option for you.

Lifestyle changes

If you are living with Parkinson’s, making some changes to your lifestyle and physical environment may make it easier.

Healthy diet

Eating a high-fibre diet of fruit, vegetables and grains, and drinking plenty of water, can help prevent the constipation that often occurs in Parkinson’s disease.

You can usually still have some alcohol, but it may affect your medicines and you may be more sensitive to its effects on your balance, speech and thinking. You can get more personal advice from your doctor.

Exercise

Exercising may slow the progression of Parkinson’s disease and help you maintain your mobility, posture and quality of life. Exercise can also reduce depression and anxiety.

A team of allied health specialists including physiotherapist, occupational therapist, exercise physiologist and speech therapist can recommend an exercise program and other strategies to help issues such as freezing of movement and loss of balance.

Can I still work if I have Parkinson’s disease?

Your ability to continue working safely and productively may involve simple modifications to your workplace, flexible hours, and regular review and adjustment to your medicines.

It’s up to you if you tell your employer about your diagnosis. It is illegal in Australia for employers to discriminate against employees or potential employees on the grounds of disability.

How does Parkinson’s disease affect mental health?

Anxiety and depression occur in around 1 in every 2 people with Parkinson’s disease, and can decrease your quality of life.

Separate to depression, apathy, which is a general lack of interest in certain activities and people can also occur as a result of the low dopamine levels. Your family, friends and carers should be advised that this is not you being lazy, but is a specific symptom of Parkinson’s disease.

These mental health conditions need to be treated separately to your movement related symptoms. Ask your doctor for help with any mental health symptoms you notice, as treatments are available.

How can Parkinson’s disease affect relationships and sex?

Some people with Parkinson’s disease experience a decrease in sexual desire, performance or satisfaction. In others, medicines that substitute for dopamine can result in a preoccupation with sexual thoughts and desires.

If you’re worried, speak to your doctor about medical options, or ask for a referral to a professional counsellor for help.

Young onset Parkinson’s disease

Young onset Parkinson’s disease (YOPD) refers to a person who is diagnosed under the age of 50 years.

YOPD is diagnosed the same way as Parkinson’s disease, but with some differences, such as:

• slower disease progression
• increased rate of abnormal movement (dyskinesia)
• increased rate of involuntary muscle contractions that cause repeated movements (dystonia)

If you’ve been diagnosed with YOPD, you may have concerns about how the disease will impact your personal, family and work life. There are many online and in-person support groups for people with YOPD.