Symptoms tend to appear gradually, normally in just one side of the body at first, although both sides will be affected as Parkinson's progresses. Each person will encounter different symptoms, in terms of severity and rate of progression, and there may be fluctuations from day to day, with 'good' and 'bad' days being experienced.
The three main physical, motor-symptoms are:
Balance and posture can deteriorate as Parkinson’s progresses, resulting in problems with walking, turning around, rolling over in bed, and transfers, such as getting in and out of a chair or bed. Postural imbalance is therefore sometimes quoted as the fourth main symptom.
Communication difficulties are also common. Speech, facial expressions, body language and handwriting are affected in many people. Facial expression and body language are very important as they reveal emotions; people with Parkinson’s can be misunderstood because changes in facial expression are slow and limited, and body language is considerably diminished. Some people with Parkinson's say they can’t show on the outside how they feel on the inside.
Other symptoms include sleep disturbances, depression and anxiety, pain, and fatigue. Swallowing and memory problems may also occur in the later stages of the condition.
Progression is usually very gradual. Many people believe they had Parkinson's for some time - often two to three years - before seeking a formal diagnosis. Often it is only when the symptoms become noticeable or begin interfering with daily activities that a visit to the doctor is prompted.
Symptoms and responses to treatment are different for each individual, so it is not possible to accurately predict progression. For some it may take many years for the condition to develop, for others it may take less time.
Since its launch in Mumbai in 2003, The Global Declaration for Parkinson's Disease has received the support and signatures from around the world, including:
Because Parkinson's has symptoms similar to a number of other neurological disorders, and because every case is unique, it is not always easy to diagnose the condition.
A specialist doctor or neurologist will look for two or more of the main three symptoms (tremor, rigidity and slowness of movement/bradykinesia) and the way in which these symptoms have developed. Then, your general medical history will be discussed and a clinical examination made before any diagnosis is given. Sometimes it may take several examinations over a period of time before the diagnosis can be made confidently.
Although the brain is affected, a brain scan is not usually able to positively confirm a diagnosis of Parkinson's. Some scans can be used to eliminate other disorders that cause similar symptoms, but a confirmed diagnosis of Parkinson's disease relies on observation of symptoms and a physical examination.
'Parkinsonism' is an umbrella term used to describe various conditions that all have tremor, rigidity and slowness of movement as their main symptoms. The most common form of 'Parkinsonism' is Parkinson's, but other conditions such as Multiple System Atrophy (MSA), Vascular Parkinsonism and Progressive Supranuclear Palsy (PSP) also exist.
Whilst treatment is constantly improving, researchers have not yet been able to find a way to prevent or cure Parkinson's. But the symptoms can be effectively controlled, often using a combination of the following:
There is no single, optimal treatment because the condition affects each individual differently. You will need to work with your doctor to find the right balance of treatments for your specific symptoms. Regular reviews will be required and adjustments made as symptoms alter.
Although the condition wasn’t called Parkinson's until the 19th century, it has been known for hundreds of years. In the ancient Indian medical system of Ayurveda it was called ‘Kampavata’.
Many different professionals will be able help you. Your ‘Multi-disciplinary Team’ includes a wide range of professionals – some who will help you now, others later on. But your most regular contacts will be your family doctor and a doctor with a special interest in Parkinson’s. They will check your symptoms, prescribe and adjust medication when necessary and give general advice on day-to-day living with Parkinson's. It is important to have a good relationship with them, so you feel comfortable discussing any problems.
The multidisciplinary team is the group of professionals who will be able to provide a complete programme of care that should tend to all your current and future needs. For example, dieticians will help you to eat the right foods to keep healthy, pharmacists will offer advice on taking your medication, and physiotherapists can help you to stay active.
See also section on The Multidisciplinary Team.
Ask your doctor about the services each of these professionals provide and don’t be afraid to request a referral if you think they will help your specific needs.
Launched on 11 April 1997, the World Charter for people with Parkinson's disease has received the support and signatures of influential people from around the world, including:
See also Multiple Focal Points on Parkinson's Disease video.
Rhythmic shaking of part of the body. It is one of the main symptoms of Parkinson's disease, although it is not experienced by everyone.
ET is a common neurological condition, often misdiagnosed as Parkinson’s. Its cause is unknown, but can run in families, resulting in fast, rhythmic trembling in the hands, head, legs, trunk or voice. Whilst the tremors experienced by people with Parkinson’s are apparent during rest periods, ET is an ‘action’ tremor - it is more pronounced when the affected part of the body is being used, for example in the hands when writing.
More information and support is available from the National Tremor Foundation – www.tremor.org.uk
Stiffness of the limbs, joints or body that make movement and bending difficult.
Bradykinesia describes the slow execution of movement and impaired ability to adjust the body's position.
The word bradykinesia is derived from the Greek roots: bradys(slow) and kinesis(movement).
The way we stand or sit. Postural problems, especially a tendency to stoop forwards, are common features of Parkinson’s.
Difficulty with keeping the balance steady when standing, sitting upright or walking.
A condition marked by extreme tiredness, inability to function due lack of energy and a general state of lethargy, usually accompanied by a feeling of weariness, sleepiness, or irritability. Fatigue may be acute or chronic and be both physical and mental.
See section on fatigue.
Health profession that treats people of all ages who have physical problems that occur as a result of injury, illness or ageing. Methods they use include exercise, heat treatments, manipulation and hydrotherapy.
See section on Physiotherapy.
Health profession that helps people of all ages who are disabled, ill or aged to remain independent and lead fulfilling lives at home, in work and through leisure pursuits. The methods they use include specific activities and equipment.
See section on Occupational Therapy.
Health profession who help people of all ages who have problems with communication, swallowing, drooling, eating and drinking.
An ancient practice that uses essential oils (essences from aromatic plants) to improve physical and emotional well-being.
See section on aromatherapy.
Reflexology is based on the principle that the anatomy of the body is reflected in miniature on reflex zones on the feet and to a lesser extent the hands, and that by using specific techniques of holds and pressures on these zones, healing is both initiated and accelerated in the corresponding area of the body.
See section on reflexology.
A system of personal development involving an integrated approach of mind and body control to promote health and inner peace. It usually involves gentle activities designed to maintain fitness, suppleness and muscle tone as well as to strengthen the body’s own healing powers. Breathing is important and together with meditation and visualisation exercises, is thought to help energise body and mind, reduce stress, and improve concentration and clarity.
See section on yoga.
Tai chi, t'ai chi or Tai chi chuan is a healing and fighting art which emphasises the mind/body connection, focussing on developing the ability to centre oneself and not be easily distracted. Practitioners believe the mind is the most important single factor in being able to achieve excellence in all areas of life, including health. The physical side of tai chi is a series of coordinated, rhythmical and seemingly effortless moves that aim to increase the body's movement range, aids relaxation, reduces stress and assists with good balance and posture.
See section on Tai Chi.
MSA is a progressive neurological disorder that causes problems with movement, balance and the automatic functions of the body, such as bladder control, sweating and blood pressure.
More information and support is available from the Sarah Matheson Trust for Multiple System Atrophy – www.msaweb.co.uk
A form of ‘atypical parkinsonism’ in which parkinson-type symptoms are produced by one or more small strokes, rather than by a gradual loss of nerve cells.
Several small strokes in the corpus striatum in the brain (the part that receives information about position and movement) can cause parkinsonism symptoms, such as rigidity and slowness, walking with short, shuffling steps and speech problems. This is known as vascular (arteriosclerotic) parkinsonism and can be difficult to distinguish from Parkinson’s. However, stroke symptoms tend to appear suddenly and do not progress, whereas those of Parkinson’s are gradual in appearance and worsen over time.
More information and support on stroke is available from the Stroke Association – www.stroke.org.uk or the Stroke Alliance for Europe – www.safestroke.org.
PSP is also a progressive neurological disorder. It predominantly affects balance, but also impairs mobility, vision, speech and the ability to swallow. A particular feature that many people with PSP experience is difficulty in moving the eyes when trying to look up or down.
More information and support is available from the Progressive Supranuclear Palsy (PSP-Europe) Association – www.pspeur.org
A mental state of melancholia, unhappiness or sadness characterized by decreased energy, reduced interest in sex, suppressed appetite, too much sleep or sleep disturbance, a pessimistic sense of inadequacy, a despondent lack of activity, despair, and discouragement.
See section on Depression
A dietician advises on a healthy diet and specific dietary needs. They can offer advice on how diet can ease some symptoms, such as constipation. They may also liaise with a speech and language therapist regarding swallowing and eating difficulties.
A person qualified to prepare and dispense drugs, and give advice on prescribed medications.
Physicians specializing in the field of neurology (a branch of medicine dealing with disorders of the nervous system ) are called neurologists and are trained to diagnose, treat, and manage patients with neurological disorders. Most neurologists are trained to treat and diagnose adults with neurological disorders.
Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children.
Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research.
