Parkinson’s disease (PD) is a neurodegenerative disorder. The first signs are problems with movement.

Parkinson’s develops when cells in the brain stop working properly and are lost over time. These brain cells produce a chemical called dopamine.

Smooth and coordinated muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is produced in a part of the brain called the “substantia nigra.”

In Parkinson’s, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinson’s start to appear.

There’s currently no cure for Parkinson’s, a disease that is chronic and worsens over time.

Parkinson’s is a progressive neurological condition. Its also called Paralysis agitans, Shaking palsy.


Nerve cells use a brain chemical called dopamine to help control muscle movement. With Parkinson’s disease, the brain cells that make dopamine slowly die. Without dopamine, the cells that control movement can’t send proper messages to the muscles. This makes it hard to control the muscles. Slowly, over time, this damage gets worse. No one knows exactly why these brain cells waste away.

Parkinson’s disease most often develops after age 50. It is one of the most common nervous system problems in older adults.

• The disease tends to affect men more than women, although women also develop the disease. Parkinson’s disease sometimes runs in families.

• The disease can occur in younger adults. In such cases, it is often due to the person’s genes.

• Parkinson’s disease is rare in children.


Parkinson’s signs and symptoms may include:

● Movement: There may be a tremor or shaking in the hands or fingers.

● Coordination: A reduced sense of coordination and balance can cause people to drop items they are holding. They may be more likely to fall.

● Gait: The person’s posture may change so that they lean forward slightly as if they were hurrying. They may also develop a shuffling gait.

● Facial expression: This can become fixed, due to changes in the nerves that control facial muscles.

● Voice: There may be a tremor in the voice, or the person may speak more softly than before.

● Handwriting: This may become more cramped and smaller.

● Sense of smell: A loss of sense of smell can be an early sign.

● Sleep problems: These are a feature of Parkinson’s, and they may be an early sign. Restless legs may contribute to this.

Other common symptoms include:

● mood changes, including depression

difficulty chewing and swallowing

● problems with urination

● constipation

skin problems

● sleep problems


There is no standard treatment for Parkinson’s disease (PD). Treatment for each person with Parkinson’s is based on his or her symptoms.

Treatments include medication and surgical therapy. Other treatments include lifestyle modifications, like getting more rest and exercise.


Almost all patients with Parkinson’s disease eventually need to take medication to help with their motor symptoms.

Physical, occupational and speech therapy

Physical, occupational and speech therapists can be important partners in the treatment of Parkinson’s disease. Physical therapy can improve the gait and direct you to the right exercise regimen. Occupational therapy can be helpful to maximize fine motor skills. Speech therapy can be useful to address speech and language barriers that may arise with Parkinson’s disease.

The surgical option: Deep Brain Stimulation

Some patients with Parkinson’s disease may benefit from deep brain stimulation (DBS), a surgical therapy that has been FDA approved for over a decade. DBS involves implanting an electrode into a targeted area of the brain, usually the subthalamic nucleus (STN) or the globus pallidus internal (GPI). The implants can be done on one side or both sides of the brain as needed. The electrodes are stimulated through a connection to a pacemaker-like device located under the skin in the chest. Patients that are considered good candidates for this procedure are those with a robust response to Levodopa, no significant cognitive or psychiatric problems, and no significant problems with balance. The procedure can help patients with medication-resistant tremors. It can also help patients who have significant motor fluctuations in which medication response varies during the day and dyskinesias or extra movements may occur as a side effect of medication.

Lifestyle changes

A healthy diet can increase energy, maximize the potential of medications, and promote overall well-being.

A proper exercise program can include cardiorespiratory exercise (fitness training), resistance exercises (strength training), flexibility exercises (stretching), and gait and balance training.

Parkinson’s stages

Stage 1

This is the initial stage characterized by mild symptoms such as rigidity, tremors, or slowness of movement in the leg or arm on one side of the body. The symptoms at this stage usually do not affect daily activities. Changes in facial expression may be noticed by the patient’s close relatives and friends.

Stage 1.5

This stage is similar to stage 1. The body axis starts to be affected, but without impairment of balance.

Stage 2

Symptoms start to worsen at this stage with tremor, rigidity, and other movements affecting both sides of the body and the body axis. Problems with walking and poor posture are noticeable. Daily activities become more difficult, but the person is still able to live independently.

Stage 2.5

This stage is similar to stage 2, and body balance starts to become impaired. The patient is, however, still able to recover from the so-called pull test that is used to assess stability. In this test, someone pulls the patient backward on the shoulders, and the patient’s ability to recover shows how severely their balance is affected.

Stage 3

This is the mid-stage of the disease characterized by loss of balance and slowness of movement. Falls become more common during this stage. The patient is, however, still able to live alone, and able to do daily activities such as dressing or eating.

Stage 4

In this stage, symptoms are severe and very limiting. It is still possible for the patient to stand without assistance, but he or she is not able to live alone and needs help with daily activities.

Stage 5

This is the most advanced and debilitating stage of the disease. Patients have great difficulty walking or standing. They are not able to live alone and require a wheelchair to move around. Assistance is needed in all daily activities. Besides motor symptoms, the person may see, hear, or experience things that are not real (hallucinations), or believe things that are not true (delusions).