How can the symptoms and side effects of Parkinson's disease be most effectively managed? While there is no cure for PD, there are medications available that can significantly ease its movement symptoms, such as tremor and stiffness and a variety strategies and therapies (physical, occupational and speech) available to complement the use of Parkinson's medications.
It is important to note that Parkinson's manifests in many ways other than the more visible movement symptoms. Fatigue, constipation, and sleep problems are a few such examples of common non-motor symptoms of Parkinson's. Many people report that these symptoms are more troubling, and interfere more with daily life, than motor symptoms. For these symptoms too, there are effective therapies.
As Parkinson's progresses, you may experience one or more of the symptoms listed below. Over time, you may find that symptoms may change or worsen. You may also find that there are certain symptoms you never experience at all.
What can a person with Parkinson's disease do to manage symptoms as they change over time? Working with your health care team, stay informed on the latest research and treatment strategies, and browse the information here and available in other PDF resources for tips on taking charge of PD on a daily basis.
Recognizing your symptoms, and understanding how they may affect your quality of life, is a first step toward living well with Parkinson’s.
What Causes Parkinson's?
To date, despite decades of intensive study, the causes of Parkinson’s remain unknown. Many experts think that the disease is caused by a combination of genetic and environmental factors, which may vary from person to person.
Your genes. Researchers have identified specific genetic mutations that can cause Parkinson's disease, but these are uncommon except in rare cases with many family members affected by Parkinson's disease.
However, certain gene variations appear to increase the risk of Parkinson's disease but with a relatively small risk of Parkinson's disease for each of these genetic markers.
Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson's disease, but the risk is relatively small.
Researchers have also noted that many changes occur in the brains of people with Parkinson's disease, although it's not clear why these changes occur. These changes include:
The presence of Lewy bodies. Clumps of specific substances within brain cells are microscopic markers of Parkinson's disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson's disease.
Alpha-synuclein is found within Lewy bodies. Although many substances are found within Lewy bodies, scientists believe an important one is the natural and widespread protein called alpha-synuclein (A-synuclein). It's found in all Lewy bodies in a clumped form that cells can't break down. This is currently an important focus among Parkinson's disease researchers.
Risk factors for Parkinson's disease include:
Age. Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older.
Heredity. Having a close relative with Parkinson's disease increases the chances that you'll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson's disease.
Sex. Men are more likely to develop Parkinson's disease than are women.
Exposure to toxins. Ongoing exposure to herbicides and pesticides may put you at a slightly increased risk of Parkinson's disease.
The progression of Parkinson’s disease varies among different individuals. Parkinson's is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years. Parkinson's is not considered a fatal disease. And the way that it progresses is different for everyone:
Movement symptoms vary from person to person, and so does the rate at which they progress.
Some are more bothersome than others depending on what a person normally does during the day.
Some people with Parkinson's live with mild symptoms for many years, whereas others develop movement difficulties more quickly.
Non-motor symptoms also are very individualized, and they affect most people with Parkinson's at all stages of the disease. Some people with Parkinson's find that symptoms such as depression or fatigue interfere more with daily life than do problems with movement.
Severity of Parkinson's
Below are some descriptions of mild, moderate and advanced Parkinson's. As disease progresses differently in different people, many do not progress to the advanced stage.
Movement symptoms may be inconvenient, but do not affect daily activities
Movement symptoms, often tremor, occur on one side of the body
Friends may notice changes in a person’s posture, walking ability or facial expression
Parkinson's medications suppress movement symptoms effectively
Regular exercise improves and maintains mobility, flexibility, range of motion and balance, and also reduces depression and constipation
Movement symptoms occur on both sides of the body
The body moves more slowly
Trouble with balance and coordination may develop
“Freezing” episodes — when the feet feel stuck to the ground — may occur
Parkinson's medications may “wear off” between doses
Parkinson's medications may cause side effects, including dyskinesias (involuntary movements)
Regular exercise, perhaps with physical therapy, continues to be important for good mobility and balance
Occupational therapy may provide strategies for maintaining independence
Great difficulty walking; in wheelchair or bed most of the day
Not able to live alone
Assistance needed with all daily activities
Cognitive problems may be prominent, including hallucinations and delusions
Balancing the benefits of medications with their side effects becomes more challenging
At all stages of Parkinson's, effective therapies are available to ease symptoms and make it possible for people with Parkinson's to live well.
Medications & Treatments
There are many medications available to treat the symptoms of Parkinson’s, although none yet that actually reverse the effects of the disease.
It is common for people with PD to take a variety of these medications, all at different doses and at different times of day in order to manage the symptoms of the disease.
While keeping track of medications can be a challenging task, understanding your medications and sticking to a schedule will provide the greatest benefit from the drugs and avoid unpleasant “off” periods due to missed doses.
Possible Preventive Measures
Exercise in middle age reduces the risk of Parkinson's disease later in life. Caffeine also appears protective with a greater decrease in risk occurring with a larger intake of caffeinated beverages such as coffee. Although tobacco smoke causes adverse health effects, decreases life expectancy and quality of life, it may reduce the risk of PD by a third when compared to non-smokers. The basis for this effect is not known, but possibilities include an effect of nicotine as a dopamine stimulant. Tobacco smoke contains compounds that act as MAO inhibitors that also might contribute to this effect.
Antioxidants, such as vitamins C and D, have been proposed to protect against the disease, but results of studies have been contradictory and no positive effect has been proven. The results regarding fat and fatty acids have been contradictory, with various studies reporting protective effects, risk-increasing effects or no effects. Also, there have been preliminary indications of a possible protective role of estrogens and anti-inflammatory drugs.
Exercise programs are recommended in people with Parkinson's disease. There is some evidence that speech or mobility problems can improve with rehabilitation, although studies are scarce and of low quality. Regular physical exercise with or without physical therapy can be beneficial to maintain and improve mobility, flexibility, strength, gait speed, and quality of life.
When an exercise program is performed under the supervision of a physiotherapist, there are more improvements in motor symptoms, mental and emotional functions, daily living activities, and quality of life compared to a self-supervised exercise program at home.
In terms of improving flexibility and range of motion for people experiencing rigidity, generalized relaxation techniques such as gentle rocking have been found to decrease excessive muscle tension.
Other effective techniques to promote relaxation include slow rotational movements of the extremities and trunk, rhythmic initiation, diaphragmatic breathing, and meditation techniques.
As for gait and addressing the challenges associated with the disease such as hypokinesia (slowness of movement), shuffling and decreased arm swing; physiotherapists have a variety of strategies to improve functional mobility and safety. Areas of interest with respect to gait during rehabilitation programs focus on, but are not limited to improving gait speed, the base of support, stride length, trunk and arm swing movement. Strategies include utilizing assistive equipment (pole walking and treadmill walking), verbal cueing (manual, visual and auditory), exercises (marching and PNF patterns) and altering environments (surfaces, inputs, open vs. closed).
Strengthening exercises have shown improvements in strength and motor function for people with primary muscular weakness and weakness related to inactivity with mild to moderate Parkinson's disease. However, reports show a significant interaction between strength and the time the medications was taken.
Therefore, it is recommended that people with PD should perform exercises 45 minutes to one hour after medications when they are at their best. Also, due to the forward flexed posture, and respiratory dysfunctions in advanced Parkinson's disease, deep diaphragmatic breathing exercises are beneficial in improving chest wall mobility and vital capacity. Exercise may improve constipation.
One of the most widely practiced treatments for speech disorders associated with Parkinson's disease is the Lee Silverman voice treatment (LSVT). Speech therapy and specifically LSVT may improve speech. Occupational therapy (OT) aims to promote health and quality of life by helping people with the disease to participate in as many of their daily living activities as possible. There have been few studies on the effectiveness of OT and their quality is poor, although there is some indication that it may improve motor skills and quality of life for the duration of the therapy.