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Guide to Parkinson’s Disease Symptoms, Stages and Treatment
Updated on: June 2023
Reviewed by: Nancy Leahy, RN, APNP
Parkinson’s disease is a slowly developing degenerative brain disease. It is classified as a “movement disorder” because the damage it does to your brain affects your ability to move parts of your body when you want (or don’t want) them to move.
The disease was named after the doctor, James Parkinson, who detailed the first definitive and descriptive instance of it. In the early 1800s, Parkinson published “An Essay on the Shaking Palsy,” which described a new medical condition as “paralysis agitans,” where he laid out some of the disease’s main qualities. These symptoms included “a slight sense of weakness” and “a proneness to trembling in some certain part” of the body, like your head, arms, or hands. He defined the disease as follows:
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The disease was first generalized as “palsy,” because the main symptoms of the disease include shaking (tremors) and, later on, paralysis—both of which generally make up a palsy diagnosis. Parkinson made the distinction between general palsy and this new disease, as he identified patients who were having tremors while resting and not trying to use the muscles that were shaking, rather than the shaking occuring while the muscles were in use. Eventually, the disease would bear the namesake of its first in-depth descriptor.
The disease has a history of being loosely described in texts for thousands of years, but the 200 years since Parkinson’s work—including Jean-Martin Charcot’s work identifying bradykinesia (the slowness of movement) as one of the main developments in Parkinson’s disease—helped bring clarity to the diagnosis.
In the 21st century, there are more than one million people living with Parkinson’s disease in the U.S. alone. That number balloons to about 10 million when looking at the worldwide population. In general, men are diagnosed more frequently than women, but the difference in diagnostic rates among various races isn’t significant.
In the U.S., the economic impact of Parkinson’s disease is estimated to be around $25 billion every year between treatment for the disease, lost income, and government programs (Medicaid, social security) that help those with the disease live.
As of January 2018, there is one government-funded research program dedicated to Parkinson’s disease research, but there are dozens of Parkinson’s-centric non-profit organizations like the Michael J. Fox Foundation for Parkinson’s Research and the Parkinson’s Research Foundation that have raised billions of dollars to help define, understand, and help find a cure for Parkinson’s disease.
Now that we’ve defined what Parkinson’s disease generally is, let’s take a look at how and when the disease onsets, what the stages of the disease are, your prognosis if diagnosed, and your treatment options.
Symptoms and Signs of Parkinson’s Disease
It’s difficult to directly diagnose Parkinson’s disease. There is no specific test doctors can perform to confirm a diagnosis, which is why it’s important for research to continue to identify the ever-evolving definition of Parkinson’s. In addition to pinpointing many of these symptoms, doctors will also delve through family history and perform an overall examination of the brain to officially diagnose someone.
The rate at which these symptoms onset varies per person, and there’s no specific amount of time you’re guaranteed to lived once diagnosed. It can develop quickly or you can live 30 years before the worst of the disease starts to show. While Parkinson himself identified six main qualities of the disease when he first detailed it, the symptoms of Parkinson’s have developed over time. They include, but aren’t completely limited to, the following:
- Slowness of movement: This is identified as the inability to move the body as quickly as normal, with muscles moving slower in coordination with each other. Known as “bradykinesia” in the medical world, it’s one of the defining symptoms of Parkinson’s disease. Researchers explain that the disease causes the brain to create less of a certain type of brain cell (basal ganglia) that helps part of the brain’s cerebrum tell us to move our muscles. Slowness of movement can take shape in many forms (that we’ll discuss soon), and bradykinesia can force those with the disease to take longer to complete routine activities and eventually lose coordination.
- Decreased facial expressions: As Parkinson’s disease progresses, you may find that a patient’s face starts to get less expressive over time. Someone who used to smile or frown often may not be able to show expression as much as they once used to. Known as “hypomimia,” the condition has some connection with bradykinesia. Patients may not be able to express emotions and facial expressions as well as they used to simply because their body is not allowing them to quickly grin, curl their eyebrows, frown, or use any facial muscles at a given instance. It almost appears as though the person with the disease is wearing a permanent mask that shields their reactionary emotions—you won’t be able to tell how they’re feeling unless they vocalize it.
- Tremors: Formally known as dyskinesia, tremors are defined as an “involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body” by the National Institute of Health. These contractions can be constant or occur at random times, and they don’t occur in everyone with Parkinson’s. These tremors occur most frequently in hands, arms, legs, and your head/neck area. While doctors can’t explicitly explain why tremors occur in Parkinson’s patients (research has shown that a lack of certain brain chemicals may contribute), but tremors have been found to be a side effect of people using levodopa—a medication used to treat Parkinson’s.
- Unsteady balance: In the later stages of Parkinson’s, your balance may start to fall by the wayside, which can impact basic activities like walking, putting on clothes, and bathing. Like reduced facial expressions, an unsteady balance is partially connected to bradykinesia, in that your body’s inability to move muscles as quickly when reacting to certain movements can cause falls and a general instability. Having an unsteady balance—and trying to overcompensate by bending or leaning a certain way to prevent consistent falls—can result in poor posture. Many of these symptoms are interconnected, as one can start a chain reaction in causing the others.
- Monotonous vocal tone/soft speech: Just as your face can start to get less expressive, so can your voice, because the muscles surroundings your lips and neck provide less opportunity for you to express at a loud and shifting vocal tone. (This is known medically as “dysarthria.”) This can make it more difficult for doctors to treat patients, or for caregivers to understand a patient’s needs. Like bradykinesia, speech impairments come from the disease affecting the part of the brain that produces smooth motor skills like speech. The way a person with Parkinson’s speaks isn’t just limited to a slow, monotonous tone. It’s possible that a patient could exhibit rapidfire speech, also making it difficult to understand. Overall, Parkinson’s patients have a difficult time keeping up in conversations because of all these effects.
- Decreased ability to bend (Rigidity): As the disease progresses, you may find it more difficult to bend your arms, legs, and back, making your overall movements far less fluid. This can make it challenging to put on clothes, get in and out of bed, roll over in bed, walk at a fluid pace, and other daily activities. Overall, Parkinson’s causes your muscles to feel cramped and achy on a consistent basis. While this symptom isn’t completely understood, researchers believe it’s due to the dramatic decrease in dopamine—a chemical that helps brain cells and nerves stay connected—in Parkinson’s patients. Those with the disease have 60 to 80 percent less dopamine than the average person.
- Shuffling walk: A person’s gait—the fluidity in which someone walks—can be affected by Parkinson’s. Though often temporary, patients have reported that it feels like their feet are glued to the floor when trying to move them. And once their feet do move, it’s more of a shuffle than it is picking one foot up and placing in front of the other. Like many of these other symptoms, this is caused by damage to a part of the brain that helps with the fluidity of motor movements. If someone with Parkinson’s isn’t shuffling their feet, their strides may be shorter while walking quicker. All this can occur while overcompensating with poor balance, which can make walking extremely difficult and painful.
Does Parkinson’s Lead to Dementia?
During the final stage of Parkinson’s disease, your symptoms may progress from severe motor function inhibition to memory loss. Generally, any form of memory loss is known as dementia.
There are multiple forms of dementia, such as:
- Alzheimer’s disease (the most common)
- Huntington’s disease
- Vascular dementia
- Dementia with Lewy bodies
- Dementia caused by head trauma
- Dementia caused by alcohol and drug abuse
Parkinson’s disease is listed as a form of dementia simply because memory loss occurs in its later stages. It’s estimated that memory loss doesn’t become a concern until at least 10 years after the initial diagnosis. While memory loss isn’t a cardinal symptom of the disease, more than half of Parkinson’s patients develop some form of dementia. Like Alzheimer’s disease, the dementia associated with Parkinson’s disease progressively grows worse.
The Alzheimer’s Association says that if dementia does stem from Parkinson’s disease, the symptoms are similar to dementia with Lewy bodies. This is because patients start to develop these protein deposits (the Lewy bodies) on the parts of their brain that affect movement and cognition, which can then affect memory.
Symptoms of the dementia include:
- Changes in reasoning
- Changing levels of alertness that vary from day to day
- Difficulty interpreting visual information
Dementia may not explicitly be a symptom of Parkinson’s disease. It may just be that people with the disease are at a higher risk of developing dementia than people without it. It also may be that memory loss is occurring separately from the disease. Most Parkinson’s patients who experience dementia are over 70, which is when rates of memory loss start to increase, too. Nevertheless, it’s a significant development in the progression of Parkinson’s and something that doctors need to include in the treatment process.
Stages of Parkinson’s Disease
Because Parkinson’s disease develops over time, there are various stages that help identify how symptoms have progressed and what should be expected next.
Generally, doctors follow a set of five stages as outlined below:
The beginning stage of Parkinson’s disease sometimes doesn’t show any signs at all. If symptoms are noticeable, they’re usually tremors and affect one side of the body. The symptoms usually don’t affect your daily routine, but they should be taken seriously and brought to the attention of your doctor, if they haven’t already.
During this stage, the disease starts to affect your whole body. The tremors and stiffness cause routine activities to take a little longer to complete, and your overall movement starts to be affected. Your posture and facial expressions may should start to change, which can impact your ability to walk at a normal pace or communicate like you used to.
This stage features a worsening of all the symptoms that started to progressively deteriorate in stage 2, but you also start to experience a loss of balance and coordination, as well as how quick your reflexes are. As these symptoms start to come into the fold, people with the disease start to fall more, which can cause their own injuries and debilitations. Activities like getting out of bed, eating, and getting dressed start to get more difficult.
At this stage, it’s nearly impossible to live on your own. Your ability to complete activities of daily living (dressing, taking a shower, eating) become severely inhibited, and you shouldn’t perform them without assistance because it’s dangerous—especially cooking and trying to bathe. Walking is limited, too, with your movement being restricted to a walker (if possible).
This is the final and most severe stage, and you can’t live without assistance by this point. Basically all motor functions are lost, and you’re confined to a bed or a wheelchair for movement. Stage 5 is when dementia, hallucinations, and confusion begin to set in.
In addition to the onset of the disease developing slowly, there is not one singular form of Parkinson’s disease but rather multiple that take effect at different speeds and produce different symptoms. While different forms of the disease have in-depth rating symptoms about how severely the disease is progressing, the aforementioned rating system presents a solid progression of symptoms across all forms of Parkinson’s.
Parkinson’s is not always the explicit cause of death for those with the disease, but rather the dangers and the inhibitions (immobility leading to heart issues, instability leading to fatal falls) of the disease that can become fatal.
Different Types of Parkinson’s Disease
As Parkinson’s begins to take its full effect, the disease can ravage different parts of the brain and cause varying symptoms. The diagnosis of what type of Parkinson’s you have depends on this (symptoms, where it starts, etc.). Sometimes, doctors don’t know the exact cause, either, but they know you exhibit symptoms that line up with Parkinson’s. Let’s dig into the different forms of the wicked disease:
- Vascular Parkinsonism: Vascular Parkinsonism is caused by a restricted blood flow to the brain, particularly the parts of the brain that affect movement and speech. When someone has a massive stroke, or even multiple smaller ones, the immediate restriction of blood to certain parts of the brain can cause Parkinson’s-like symptoms. Contrasting from normal Parkinson’s disease, the symptoms of Vascular Parkinsonism—most commonly, walking problems and memory loss—typically onset very rapidly because of the immediate blood restriction.
- Idiopathic Parkinson’s: The most common form of Parkinson’s disease, this is diagnosed when the root of the disease is unknown. While the loss of motor skills and stability can be explicitly explained in other cases, doctors often don’t know why the disease came to fruition.
- Drug-induced Parkinson’s: You can develop Parkinson’s disease after long exposure to certain forms of medications. Between 5 and 10 percent of people with Parkinson’s develop it because of this. Antipsychotic and neuroleptic drugs that are used to treat conditions like schizophrenia and psychosis may cause Parkinson’s because they affect natural dopamine levels in the brain. While they block dopamine in the immediate term, this long-term depletion can start to proliferate in the form of Parkinson’s symptoms. If the disease does develop due to these type of drugs, it’s often reversible within weeks and months of stopping the medication.
- Corticobasal Degeneration: A rarer form of the disease, it occurs when a protein called tau builds up on certain parts of the brain. Corticobasal degeneration develops more slowly and often affects one side of the body before slowly taking effect to the whole body over the course of a couple years. It can be diagnosed in your 40s, but people most commonly develop the disease between 50 and 70 years old.
There are other generations of the disease, but they are the most rare forms. Nevertheless, they carry similar symptoms as all other forms of the disease.
Parkinson’s Disease Treatment and its Future
Parkinson’s disease has no cure. However, millions of dollars are going into research every year to help better understand the disease, from how it’s defined to how it’s treated. The ultimate end goal is developing a cure for Parkinson’s, but in the meantime, doctors and researchers have developed treatment plans based on what they presume is causing the disease in the first place—most often the lack of certain brain chemicals and cells like dopamine.
The plans vary per patient, and some of these treatment options include:
- Levodopa: This is the primary medication used to treat Parkinson’s disease symptoms. Those diagnosed with the disease have been found to have significantly lower levels of dopamine, and levodopa addresses that issue and stimulates the nervous system. Levodopa increases the dopamine levels in your body and aims to qualm issues rooted in the nervous system like tremors, muscle control, and coordination. Typically, levodopa is taken in conjunction with a drug called carbidopa, which acts as a protector for levodopa so it actually reaches the brain and allows it to be effective. Unfortunately, levodopa has some drawbacks that include vomiting, nausea, insomnia, and diarrhea, among other side effects. Long-term, levodopa can actually make tremors and other muscle spasms worse. The combination of these medications is taken multiple times per day.
- Dopamine agonists: As opposed to taking levodopa, which turns into dopamine, some patients are prescribed with dopamine agonists, which mimic the effects of dopamine. These agonists activate the dopamine receptors in your brain and make it seem as if your dopamine receptors are acting normally. In some cases, dopamine agonists are taken in conjunction with levodopa to help find a healthy balance between the two medications and limit the side effects from both treatments. Side effects of dopamine agonists are similar to levodopa, but there are other severe side effects including hallucinations and sporadic behavior outside of your personality.
- Surgery/brain stimulation: Surgical options are available for Parkinson’s patients. The primary form of surgery that those with Parkinson’s receive is deep brain stimulation (DBS), which aims to address specific parts of the brain like the cortex. During the surgery, electric waves are sent to the brain in order to stimulate the parts of the organ that are suffering as a result of Parkinson’s. The end goal is to relieve some of the symptoms the disease causes. Another surgery Parkinson’s patients can get is an implant that consistently emits dopamine agonists or levodopa to make sure the drug is taken on schedule.
- Medical marijuana: Medical marijuana has not been officially recommended as a treatment for Parkinson’s by the Food and Drug Administration, as it’s not been scientifically proven that cannabinoids explicitly help fight the disease. However, it has been used for decades in order to treat diseases like the ones exhibited by Parkinson’s, such as tremors and slowness of movement. To learn more, read our complete guide to medical marijuana for seniors.
- Other medications: There are other medications including Eldepryl, Zelapar, Duopa (a combination of levodopa and carbidopa), Azilect, and dozens more that address dopamine levels in the brain and various symptoms you may be experiencing because of the disease.
There isn’t any real way to definitively prevent the disease, either. As with prevention for any disease or malady, it’s suggested that you maintain a healthy lifestyle before and after a diagnosis. Remaining physically engaged through activities like running, yoga, and weight lifting and eating healthy are both ways to provide your body with the best opportunity for a healthy life.
Clinical trials are also viewed as a “treatment option” because they may give you as good of a chance of relieving symptoms as other already-existent treatments. There are clinical trials happening year-round with various institution and foundations, and your demographic may fit a trial in its beginning pre-clinical stage or an advanced stage.
Talk to your doctor about any available clinical trials that you may qualify for and how to become a part of them. Also stay in contact with your doctor regarding any concerns that you may have with Parkinson’s or how to get it treated.