Patient information from BMJ

Parkinson's disease

Last published:Sep 14, 2022

It can come as a surprise to find out that you or someone close to you has Parkinson's. You may be worried about what it will mean for the future. But your symptoms may not bother you very much for several years. When they do, there are treatments that can help.

What happens in Parkinson's?

Parkinson's affects how you are able to move. An early sign is often a slight trembling in one hand. Over time you start doing things more and more slowly as your muscles become stiff. You may lose your balance more easily.

Parkinson's happens when your brain stops making enough of a chemical called dopamine. Brain cells need dopamine to send messages around the brain, and to nerves and muscles throughout your body.

For example, dopamine helps to stop you tripping at the kerb as you step into a road. And it helps you move your fingers to tie your shoelaces. With less dopamine you can't control your movements in the usual way.

Doctors don't know why some people stop making enough dopamine. The genes you have inherited from your parents may play a role, as well as things that happen during your life ('environmental factors'). But we do know that the chance of getting Parkinson's increases as you get older.

What are the symptoms?

Parkinson's can affect you in four main ways:

• Shaking (doctors call this tremor): Your hand may shake, especially when you're either relaxing or feeling stressed. Many people rub their thumb and index finger together as if rolling a pill. Shaking can also affect your neck, chin, and head.

• Stiff muscles (rigidity): You might find it difficult to move. For example, you might find it difficult to get out of a chair. Your face might seem less expressive because the muscles there aren't moving as well as they normally would.

• Slow movements (bradykinesia or akinesia): You might find it hard to start moving and you might stay in the same position for longer than you usually would. But your ability to move might come and go, so that you can be moving easily one minute and then suddenly need help.

  Tasks that you once did quickly and easily, such as washing and dressing, might take much longer to do. Your handwriting might look spidery and small.

• Poor balance (postural instability): You might lean forward or backward and fall over easily, and you might have problems walking. You might freeze in mid-stride and not be able to take the next step. (Doctors call this freezing of gait, or FOG for short.) You might take quick, small, shuffling steps.

Parkinson's affects everyone differently. You probably won't get all of these symptoms. And at first your symptoms will probably be mild. They tend to progress slowly and in no particular order.

There are no special tests for Parkinson's. Your doctor will usually make a diagnosis after talking to you about your symptoms and doing a physical examination. Some people might have blood tests or a brain scan, usually to rule out other conditions.

It's important to keep track of your symptoms so that you can tell your doctor how they have changed since your last visit. You might want to keep a diary of your symptoms to show your doctor. This information will help your doctor decide when you should start treatment and when you need to change your treatment.

If your symptoms are mild and don't bother you very much it might be many years before you need any treatment for Parkinson's.

What will happen to me?

No one can say for sure what will happen to you if you have Parkinson's. The way the disease affects you might be very different from the way it affects someone else.

Some people hardly notice their symptoms in the early stages of Parkinson's and lead a full life for many years. But symptoms usually get worse as time goes by and the brain makes less and less dopamine.

Everyone is different. But a typical pattern for many people with Parkinson's goes something like this:

• most people find that treatment makes a big difference for several years. Their symptoms might go away completely

• after about five years, the treatment stops working as well, and symptoms get worse

• the next stage is that symptoms such as freezing, falling, and dementia, might get a lot worse. This can happen within a few more years, or it can take many years.

Some people get other problems related to their Parkinson's, such as:

• depression

• fatigue

• sleep problems

• constipation, and

• reduced mental ability.

Be sure to discuss any problems with your doctor, as there might be treatments that can help.

It's important to stay positive if you can. Take regular exercise and carry on doing the things you enjoy. You might also want to join a support group for people with Parkinson's. All these things can help you cope with your condition.

If you're caring for someone with Parkinson's, you might need support, too. If you feel you can't cope or you become depressed, your doctor or another health professional might be able to put you in touch with local support groups and organisations that offer assistance.