Parkinsons disease

"Parkinson's disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Parkinsons disease Parkinsons disease About Parkinsons disease Symptoms of Parkinsons disease Causes of Parkinsons disease Diagnosing Parkinsons disease Treating Parkinsons disease Living with Parkinsons disease About Parkinsons disease Parkinsons disease is a condition in which parts of the brain become progressively damaged overmany years. The three main symptoms of Parkinsons disease are: involuntary shaking of particular parts of the body (tremor) slow movement stiff and inflexible muscles A person with Parkinsons disease can also experience a wide range of other physical and psychological symptoms, including: depression and anxiety balance problemsthismay increase the chance of a fall loss of sense of smell anosmis problems sleeping ( insomnia ) memory problems Read more about the symptoms of Parkinsons disease Seeking medical advice See your GP if youre concerned that you may have symptoms of Parkinsons disease. Your GP will ask about the problems youre experiencing and mayrefer you to a specialist for further tests. Read more about diagnosing Parkinsons disease Causes of Parkinsons disease Parkinsons disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. Thisleads to a reductionin a chemical called dopamine in the brain. Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinsons disease. Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible. Read more about the causes of Parkinsons disease Whos affected? Its thought around 1 in 500 people are affected by Parkinsons disease, which meansthere are an estimated 127,000 people in the UK with the condition. Most people with Parkinsons start to develop symptoms when theyre over 50, although around 1 in 20 people with the condition first experience symptomswhen theyre under 40. Men are slightly more likely to get Parkinsons disease than women. TreatingParkinsons disease Although theres currently no cure for Parkinsons disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible. These include: supportive treatments such as physiotherapyand occupational therapy medication in some cases, brainsurgery You may not need any treatment during the early stages of Parkinsons disease, as symptoms are usually mild. However, you may need regular appointments with your specialist so your condition can be monitored. Read more about treating Parkinsons disease Outlook As the condition progresses,the symptoms of Parkinsons diseasecan get worse and it can become increasingly difficult to carry out everyday activities without assistance. Manypeople respond well to treatment and only experience mild to moderate disability, whereas the minority may not respond as well and can, in time, becomemore severely disabled. Parkinsons diseasedoesnt directly cause people to die, but the condition can place great strain on the body, and can make some people more vulnerable to serious and life-threatening infections. However, with advances in treatment, most people with Parkinsons disease now have a normal or near-normal life expectancy. Read more about living with Parkinsons disease It may alsobe useful to read your guide to care and support written for people with care and support needs, as well as their carers and relatives. Symptoms of Parkinsons disease The symptoms of Parkinsons disease usually develop gradually and are mild at first. There are many different symptoms associated with Parkinsons disease. Some of the more common symptoms are described below. However,the order in which these develop and their severity is different for each individual.Its unlikely thata personwith Parkinsons disease would experience all ormost of these. Main symptoms The three main symptoms of Parkinsons disease affect physical movement: tremor shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed andresting slowness of movement (bradykinesia)  where physical movements are much slower than normal, which can make everyday tasks difficult and can result in a distinctive slow, shuffling walk with very small steps muscle stiffness (rigidity)  stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions, and can result in painful muscle cramps ( dystonia ) These mainsymptoms are sometimes referred to by doctors as parkinsonism as there can be causes other than Parkinsons disease. Other symptoms Parkinsons disease can also cause a range of other physical and mental symptoms. Physical symptoms balance problems  these can make someone with the condition more likely to have a fall and injure themselves loss of sense of smell (anosmia) sometimes occurs several years before other symptoms develop nerve pain can cause unpleasant sensations, such as burning, coldness or numbness problems with urination  such as having to get up frequently during the night to urinate orunintentionally passing urine ( urinary incontinence ) constipation an inability to obtain or sustain an erection ( erectile dysfunction )in men difficulty becoming sexually aroused and achieving an orgasm(sexual dysfunction) in women dizziness , blurred vision or faintingwhen moving from a sitting or lying position to a standing onecaused by a sudden drop in blood pressure excessive sweating ( hyperhidrosis ) swallowing difficulties ( dysphagia )this can lead to malnutrition and dehydration excessive production of saliva (drooling) problems sleeping ( insomnia ) this can result in excessive sleepiness during the day Cognitive and psychiatric symptoms depression and anxiety mild cognitive impairment  slight memory problems and problems with activities that require planning and organisation dementia  a group of symptoms, including more severe memory problems, personality changes,seeing things that arent there (visual hallucinations) andbelieving things that arent true (delusions) When to seek medical advice See your GP if youre concerned you may have symptoms of Parkinsons disease. Your GP will ask about your symptoms and your medical history to help them decide whether its necessary to refer you to a specialist for further tests. Read more about diagnosing Parkinsons disease Causes of Parkinsons disease Parkinsons disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra. Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements. If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement cant work as well as normal, causing movements to become slow and abnormal. The loss of nerve cells is a slow process.The symptoms of Parkinsons diseaseusually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost. What causes the loss of nerve cells? Its not known why the loss of nerve cells associated with Parkinsons disease occurs, although research is ongoing to identify potential causes. Currently, its believed a combination of genetic changes and environmental factors may be responsible for the condition. Genetics A number of geneticfactors have been shown toincrease a persons risk of developing Parkinsons disease, although exactly how these make some people more susceptible to the condition is unclear. Parkinsons disease can run in families as a result of faulty genes being passed toa child by their parents. However, its rare for the disease to be inherited this way. Environmental factors Some researchers also feel environmental factors may increase a persons risk of developing Parkinsons disease. Its been suggested that pesticides and herbicides used in farmingand traffic or industrial pollution may contribute to the condition. However, the evidence linking environmental factors to Parkinsons disease is inconclusive. Other causes of parkinsonism Parkinsonism is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement. Parkinsons disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified. These include parkinsonism caused by: medication (drug-induced parkinsonism)  where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped other progressive brain conditions  such as progressive supranuclear palsy, multiple systems atrophy, andcorticobasal degeneration cerebrovascular disease  where a series of small strokes cause several parts of the brain to die You can read more about parkinsonism on the Parkinsons UK website. Diagnosing Parkinsons disease No tests can conclusively show that you have Parkinsons disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination. Your GP willtalk toyouabout the problems youre experiencing and mayask you to perform some simple mental or physical tasks, such as moving or walking around,to help with the diagnosis. In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild. Referral to a specialist If your GP suspects Parkinsons disease, youll be referred to a specialist. This will usually be: a neurologist  a specialist in conditions affecting the brain and nervous system a geriatrician  a specialist in problems affecting elderly people If your GP thinks you may be in the early stages of Parkinsons disease, you should see a specialist within six weeks. If they think you may be in the later stages, you should see a specialist within two weeks. The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement. A diagnosis of Parkinsons disease is likely if you have at least two of the three following symptoms: shaking or tremor in a part of your body that usually only occurs at rest slowness of movement (bradykinesia) muscle stiffness (rigidity) If your symptoms improve after taking a medication called levodopa, its more likely you have Parkinsons disease. Special brain scans, such as asingle photon emission computed tomography (SPECT) scan, may also be carried out in some casesto try torule outother causes ofyour symptoms. Receiving the diagnosis Being told you have Parkinsons disease can be emotionally distressing, and the news can often be difficult to take in. This means its important that you have the support of your family and a care team who will be able to help you come to terms with the diagnosis. You may find it useful to contactParkinsons UK,the Parkinsons support and research charity. They can be contacted by: free helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm onSaturdays) email: hello@parkinsons.org.uk Parkinsons UKbrings people with Parkinsons, their carers and families together througha network of local groups , as well as online resources and a confidential helpline. The Parkinsons UK website provides information and support on every aspect of living with Parkinsons. Treating Parkinsons disease There are several therapies that can make living with Parkinsons disease easier and help you deal with your symptoms on a day-to-day basis. There are efforts underway to try to increase the availability of these supportive therapies for Parkinsons patients on the NHS. Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment. Physiotherapy A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise. The physiotherapist aims to make moving easier, and improve your walking and flexibility. They also try to improve your fitness levels and ability to manage things for yourself. Occupational therapy An occupational therapist can identify areas of difficulty in your everyday lifefor example, dressing yourself or getting to the local shops. They can help you work out practical solutions, and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible. Read more about occupational therapy Speech and language therapy Many people with Parkinsons disease have swallowing difficulties ( dysphagia )and problemswith their speech. A speech and language therapist can often helpyou improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology. Diet advice For some people with Parkinsons disease, making dietary changes can help improve some symptoms. These changescan include: increasing the amount of fibre in your diet and making sure youre drinking enough fluid to reduce constipation increasing the amount of salt in your diet and eating small, frequent meals to avoid problems with low blood pressure , such as dizziness when you stand up quickly making changes to your diet to avoidunintentional weight loss You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks youmay benefit from changing your diet. Medication Medicationcan be used toimprove the main symptoms of Parkinsons disease, such as shaking (tremors) and movement problems. However, not all the medications available are useful for everyone, and the short- and long-term effects of each are different. Three main types of medication are commonly used: levodopa dopamine agonists monoamine oxidase-B inhibitors Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you. Regular reviews will be required as the condition progresses and your needs change. Read on to learn about the treatments you may be offered. You can also see a summary of the pros and cons of treatments for Parkinsons disease, where you can compare your options. Levodopa Most people with Parkinsons disease eventually need a medication called levodopa. Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement. Increasing the levels of dopamine using levodopa usually improves movement problems. Itis usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa. These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain. They also reduce the side effects of levodopa, which include: feeling sick (nausea) or vomiting tiredness dizziness If youre prescribed levodopa, the initial doseis usually very small and will be gradually increased until it takes effect. At first, levodopa can cause a dramatic improvement in the symptoms. However, its effects can be less long-lasting over the following yearsas more nerve cells in the brain are lost, there are fewer of them to absorb the medicine. This means the dose may need to be increased from time to time. Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and on-off effects, where the person rapidly switches between being able to move (on) and being immobile (off). Dopamine agonists Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect comparedwith levodopa. They can often be given less frequently than levodopa. Theyare often taken as a tablet, but are also available as a skin patch (rotigotine). Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used. Possible side effects of dopamine agonists include: nausea or vomiting tiredness and sleepiness dizziness Dopamine agonists can also cause hallucinations andincreased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible. For some people, dopamine agonists have been linked to the development of compulsive behaviours,especially at high doses, including addictive gambling and an excessively increased libido. Talk to your healthcare specialist if you think you may be experiencing these problems. As the person themselves may not realise the problem, its key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity. If youre prescribed a course of dopamine agonists, the initial dose is usually very small to prevent nausea and other side effects. The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication. A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep. This generally happens as the dose is being increased and tends to settle once the dose is stable. People areusually advised toavoid driving while the dose is being increased in case this complication occurs. Monoamine oxidase-B inhibitors Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinsons disease. They block the effects of an enzyme orbrain substance that breaks downdopamine (monoamine oxidase-B), increasing dopamine levels. Both selegiline and rasagiline can improve the symptoms of Parkinsons disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists. MAO-B inhibitors are generally very well tolerated, but can occasionallycause side effects, including: nausea headache abdominal pain high blood pressure Catechol-O-methyltransferase inhibitors Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinsons disease. They prevent levodopa from being broken down by the enzyme COMT. Side effects of COMT inhibitors include: nausea or vomiting diarrhoea abdominal pain Non-oral therapies When Parkinsons symptoms become difficult to control with tablets alone, a number of other treatments can be considered. Apomorphine A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) eitherby: a single injection, when required a continuous infusionusing a small pump carried around on your belt, under your clothing, or in a bag Duodopa If you have severe on-off fluctuations, a type of levodopa called duodopa may be used. This medication comes as a gel thats continuously pumped into your gut through a tube inserted through your abdominal wall. Theres an external pump attached to the end of the tube, which you carry around with you. About 25 specialist neuroscience centres in the UK offer this treatment.This treatment is only available if you have very severe on-off fluctuations or involuntary movements. Surgery Most people with Parkinsons disease are treated with medication, although a type of surgery called deep brain stimulation isused in some cases. This surgery is also available in specialist neuroscience centres around the UK, but its not suitable for everyone. Ifsurgery isbeing considered, your specialist will discuss the possible risks and benefits with you. Deep brain stimulation Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall. This is connected to one or two fine wires placed under the skin, and isinserted precisely into specific areas in your brain. A tiny electric current is producedby the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinsons disease. Although surgery doesnt cure Parkinsons disease, it can ease the symptoms for some people. Treating additional symptoms As well asthe main symptoms of movement problems, people with Parkinsons disease can experience a wide range of additional symptoms that may need to be treated separately. These include: depression and anxiety  this can be treated with self care measures such as exercise, psychological therapy or medication; read more about treating depression problems sleeping (insomnia)  this can be improved by making changes to your normal bedtime routine; read more about treating insomnia erectile dysfunction  this can be treated with medication; read more about treating erectile dysfunction excessive sweating (hyperhidrosis)  this can be reduced using a prescription antiperspirant,or surgery in severe cases; read more about treating hyperhidrosis swallowing difficulties (dysphagia) this can be improved by eating softened food, or by using a feeding tube in more severe cases; read more about treating dysphagia excessive drooling  this can be improved with swallowing exercises, or surgery or medication in severe cases urinary incontinence  this can be treated with exercises to strengthen the pelvic floor muscles, medication, or surgery in severe cases; read more about treating urinary incontinence dementia this can be treated with cognitive therapies and medication in some cases; read more about treating dementia Clinical trials Much progress has been made in the treatment of Parkinsons diseaseas the result ofclinical trials,where new treatments and treatment combinations are compared with standard ones. All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care. If you are asked if you want to take part in a trial, you will be given an information sheet about the trial. If you want to take part, you will be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care. Complementary and alternative therapies Some people with Parkinsons disease findcomplementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinsons disease. However, theres no clinical evidence theyre effective in controlling the symptoms of Parkinsons disease. Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldnt be used instead of the medicines prescribed by your doctor. Some types of herbal remedies, such as St Johns wort, can interact unpredictably if taken with some types of medication used to treat Parkinsons disease. If youre considering using an alternative treatment along with your prescribed medicines, check with your care team first. Living with Parkinsons disease Its important to do what you can to stay physically and mentally healthy if you have Parkinsons disease. Exercise and healthy eating Regular exercise is particularly important in helping relieve muscle stiffness, improving your mood, and relieving stress. There are many activities you can do to help keep yourself fit, ranging from more active sports like tennis and cycling , to less strenuous activities such as walking , gardening and yoga . You should also try to eat a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy. Vaccinations Everyone with a long-term condition is encouraged to get a yearly flu jab each autumn. The pneumococcal vaccination is also usually recommended, which is a one-off injection that protects against a serious chest infection called pneumococcal pneumonia. Relationships and support Being diagnosed with a long-term conditionlike Parkinsons disease can put a strain on you, your family and friends. It can be difficult to talk to people about your condition, even if theyre close to you. Dealing with the deterioration of symptoms, such as increasing difficulty with movement, may make you feel frustrated and depressed. Spouses, partners or carers will inevitably feel anxious or frustrated as well. Be open about how you feel, and let your family and friends know what they can do to help. Dont feel shy about telling them you need some time to yourself, if thats what you want. Support If you have any questions about your condition, your GP or Parkinsons disease specialist nurse may be able to help. You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have details of these. Some people find it helpful to talk to others with Parkinsons disease, either at a local support group or in an internet chat room. Care and support services Its worth taking time to think about your specific needs and what would help you achieve the best quality of life. For example, you may wish to consider equipment, help in your home,and home adaptations. Parkinsons UK Parkinsons UK is the main Parkinsons support and research charity in the UK. They can offer thesupport and advice you may need if youre living with Parkinsons disease, and can let you know about support groups in your local area. They can becontacted by: free confidential helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm on Saturdays) email: hello@parkinsons.org.uk The Parkinsons UKwebsite also features all the latest news, publications and research updates, as well as an online community where you can share your experiences of living with Parkinsons. Work and finances Being diagnosed with Parkinsons doesnt mean you have to stop working. Many people with the condition keep working for years after their diagnosis. You may find it hard to cope financially if you do have to stop work or work part-time because of your condition. However, you may be entitled to one or more of the following types of financial support: You are entitled to Statutory Sick Pay from your employer if you have a job but cant work because of your illness. You may be entitled to Employment and Support Allowance (ESA) if you dont have a job and cant work because of your illness. You may be eligible for Personal Independence Payment (PIP) , which replaced the Disability Living Allowance (DLA) , if youre aged 64 and under and need help with personal care or have walking difficulties. You may be able to get Attendance Allowance if youre aged 65 or over. You may be entitled to Carers Allowance if youre caring for someone with Parkinsons disease. You may be eligible for other benefits if you have children living at home or if you have a low household income. Driving If youve been diagnosed with Parkinsons disease, you must inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance company. You wont necessarily have to stop driving. Youll be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists. The DVLA will use this to decide whether youre fit to drive. Complex Parkinsons disease and palliative care ComplexParkinsons disease is defined as the stage when treatment is unable to consistently control symptoms, or the person has developeduncontrollable jerky movements (disabling dyskinesia). These problems can still be helped by adjustment or addition of some of the medications used to treat Parkinsons disease ,under thesupervisionof a doctor with a specialist interest in Parkinsons disease. As Parkinsons disease progresses, youll be invited to discuss the care you wantwith your healthcare team as you near the end of your life. This is known as palliative care. When theres no cure for an illness, palliative care tries to alleviate symptoms, and is also aimed at making the end of a persons life as comfortable as possible. This is done by attempting to relieve pain and other distressing symptoms, while providing psychological, social and spiritual support for you and your family. Palliative care can be provided at home orin a hospice, residential home or hospital. You may want to consider talking to your family and care team in advance about where youd like to be treated and what care you wish to receive. Source: NHS 24 - Opens in new browser window Last updated: 16 June 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Other health sites Brain and Spine Foundation: Parkinson's disease Healthtalk.org: Parkinson's disease Parkinson's UK NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852"