Parkinson's disease

Parkinson's disease

What is Parkinson's disease?

Parkinson's disease is a progressive neurological disorder that causes muscle tremor, stiffness and slowness of movement. It is most common among older people, affecting more men than women – however younger people can also have the disease. The disorder is named after Dr James Parkinson, a London physician who first described the syndrome in 1817.

What causes Parkinson's disease?

The disease is caused by the degeneration of nerve cells (or ‘neurones’) in a part of the brain that controls movement, called the basal ganglia. Normally, these nerve cells produce dopamine – a chemical messenger or ‘neurotransmitter’, which is used by the brain to control movement. In Parkinson’s disease, the production of dopamine is reduced and muscle tension and movement are affected.

The exact reason for the degeneration of the nerve cells is not completely understood, although hereditary factors, brain injury or infection, exposure to toxins and adverse reactions to drugs may all be risk factors for the disease.

What are the symptoms of Parkinson’s disease?

Early stages:

  • Tremors (involuntary shaking) affecting the hand, arm or leg on one side of the body, especially when resting
  • Muscular stiffness.

Middle stages:

  • Muscle tremor and stiffness affecting both sides of the body
  • Slow movements and stiff, unbalanced walk
  • Stooped posture
  • Unblinking, fixed expression.

Later stages:

  • Slow and hesitant speech
  • Writing difficulties (handwriting is usually very small)
  • Increased salivation and drooling.

The disorder can also lead to bowel and bladder symptoms, such as constipation and increased urination. The onset of Parkinson’s disease is slow, so the disease may go unnoticed for several years.

How is Parkinson's disease diagnosed?

There are no specific tests at present for Parkinson’s disease at present, so making an accurate diagnosis can be difficult.

Your doctor will examine you and ask about your symptoms and your medical history. Tests may be recommended to rule out other diseases that resemble Parkinson's disease and you may be referred to a specialist in neurological disorders.

Specialised brain scans can be carried out which may identify dopamine deficiency in the brain, however these are not done routinely.

How is Parkinson's disease treated?

There is no cure for Parkinson's disease at present, but its symptoms can be controlled. Treatment is based on replacing or enhancing the effects of dopamine in the brain, in order to minimise symptoms.

Medications may work by improving the effects of dopamine in the brain, impeding dopamine breakdown, replacing the dopamine that has been lost or delaying its degeneration by slowing down the enzymes that control this process.

The medications prescribed will depend on the patient’s age and personal circumstances — for example, medication may not be prescribed in mild cases because of potential unpleasant side-effects such as abnormal body movements, nausea, short-term memory loss and confusion. Exercise is important to increase muscle strength, reduce rigidity and improve co-ordination. In severe cases, an operation on the brain may be performed to reduce tremors and rigidity.

What can I do?

  • Exercise — regular exercise and physiotherapy will help to increase mobility and maintain physical strength.
  • Eat well — people with Parkinson's may not eat as often as they did previously. This can be due to their bodies slowing down or difficulties with swallowing. However, it is important to continue to eat nutritious and high-fibre food to counteract the constipation that may come with the disease and to maintain a healthy body weight.
  • Stay active — Parkinson's can be an isolating disease and sufferers can become depressed. It is important that sufferers stay active and continue to work and socialise. Support groups can provide practical information as well as advice on coming to terms with the disease.
  • Take practical steps to help yourself — install handrails in your home and remove anything that might cause a fall. Buy shoes and clothes that use velcro fastenings instead of laces and zips, and develop alternative ways to communicate if speech becomes difficult for you.
  • Join a support group – The Parkinson’s Association of Ireland has a helpline (1 800 359 359), website ( and produces a regular newsletter.

Tips for a Parkinson-friendly house

  1. Throw out those rugs — they are just waiting to trip you up.
  2. Softly, softly — wear low-heeled, comfortable shoes with non-skid soles and opt for wall-to-wall carpeting.
  3. Go for the minimalist approach — clear away clutter and move electrical cords out of your path.
  4. Layout is everything — arrange your furniture to give yourself enough room to move around and plan a route through the house that will always give you something to hold onto in case you lose your balance.
  5. Lighting effects — keep lighting levels consistent throughout the house to avoid false perceptions about floor levels. Ensure that all steps and stairs are well lit and consider night-lights for hallways and bathrooms.
  6. Hold on — install handrails on all staircases and consider adding railings in hallways or in other areas where you don't have something to hold onto.
  7. It's good to talk — but opt for a cordless phone that can be carried from room to room or invest in an answering machine set to the fifth ring or longer, so you don't have to rush to answer it.
  8. Bath time — install hand rails around your bathroom to help you balance as you get in and out of the bath or shower and on the wall next to the toilet.
  9. Cooking up a storm — place a rubber pad or wet dishcloth under bowls and pots to keep them stable, use an electric tin opener and try a wooden cutting board with raised edges to prevent food from scattering when you cut it.
  10. Sleep tight — your bed should be about knee height with the head of the bed slightly elevated (place wooden risers under the legs or a foam cushion under the mattress) to make it easier for you to sit up and get out of bed.

Reviewed: December 4, 2006