What Is Parkinson’s Disease, What Causes It, and How Is It Treated?

Parkinson’s disease is the second most common neurodegenerative brain disorder after Alzheimer’s. It progresses slowly over time and is characterized by the gradual loss of brain cells. The most prominent symptoms include slowed movement, resting tremors, and a stooped posture. Though it is more common in men (50% higher incidence than women) and typically appears in individuals over age 60, it can also occur in younger adults aged 20 to 40.

What Is Parkinson’s Disease?

First described in 1817 by British physician James Parkinson, this disorder affects about 1% of the population in Turkey. The symptoms significantly impact quality of life, but with proper diagnosis and treatment, people with Parkinson’s can live many years. Recognizing the signs early and consulting a neurologist promptly is essential.

Parkinson’s disease is a progressive neurological disorder marked by the loss of dopamine-producing brain cells. Commonly referred to as “shaking palsy,” it mostly affects people aged 40 to 70, with men more frequently affected than women.

Although most patients are over 60, about 5% of cases are diagnosed in younger adults. Because it progresses gradually, patients often maintain quality of life for many years with treatment. While tremors and slowed movement are hallmark symptoms, the disease can manifest in a wide range of ways.

Early Symptoms of Parkinson’s Disease (Stage 1)

In the early stage (Stage 1), tremors usually appear in one hand or on one side of the body. On the affected side, the arm may stop swinging naturally during walking. In some people, the tremor may occur in the tongue, jaw, or feet. Changes in facial expressions, posture, or gait may first be noticed by close family members.

As the disease progresses, clinical symptoms worsen. By the third year (Stage 2), symptoms typically affect both sides of the body, and mild disability becomes apparent. Posture and walking begin to deteriorate visibly.

Recognizing early symptoms is crucial for early diagnosis and timely treatment, which can slow disease progression and improve quality of life.

Later Stages of Parkinson’s Disease

• Stage 3: Patients develop more severe motor symptoms like slowed trunk movements, balance issues, and frequent falls. Functional decline becomes moderate and more noticeable.
• Stage 4: The patient may have difficulty walking, experience stiffness, and need assistance with daily tasks. Although tremors might lessen, independence is significantly reduced.
• Stage 5: The patient becomes entirely dependent on others, often bedridden or wheelchair-bound, and in need of continuous care.

To understand why these symptoms appear, it’s essential to know how Parkinson’s develops.

How Does Parkinson’s Develop?

In a healthy brain, a region called the substantia nigra contains cells that produce dopamine—a chemical essential for controlling smooth, coordinated movement.

In Parkinson’s, these dopamine-producing cells gradually die off, especially in the substantia nigra, leading to dopamine deficiency. This disrupts communication between brain regions like the striatum, affecting motor control and coordination. Dopamine loss results in rigid, slow, or uncoordinated movements, and symptoms such as tremors.

Research shows that non-motor symptoms, including changes in smell, constipation, and sleep disturbances, may begin years before classic motor symptoms emerge. This suggests the disease may first affect the enteric nervous system, lower brainstem, and olfactory system, before progressing to the substantia nigra and cortex.

Symptoms of Parkinson’s Disease

Symptoms are typically classified as motor and non-motor:

Motor Symptoms:

• Resting tremor
• Bradykinesia (slowness of movement)
• Akinesia (loss of voluntary movement)
• Muscle rigidity or stiffness
• Stooped posture
• Gait disturbances (e.g., shuffling steps)

Non-Motor Symptoms:

• Loss of sense of smell
• Anxiety and depression
• Constipation
• Sleep disturbances
• Sexual dysfunction

Each individual’s symptoms and progression may vary. Though Parkinson’s can occur at nearly any age, the average onset age is 60. Cases under age 30 are very rare.

The earliest and most common sign is often reduced movement in one hand, possibly accompanied by decreased arm swing or shoulder pain. In some cases, balance issues may be present from the beginning.

While tremor is a well-known symptom, it’s worth noting that 15% of Parkinson’s patients never experience tremors. Nonetheless, its presence can help lead to early diagnosis.

Because symptoms may resemble typical signs of aging, Parkinson’s can sometimes be misdiagnosed. Early signs also include reduced facial expressiveness, softening of voice, and a forward-leaning posture. Depression, anxiety, shoulder/neck pain, and fatigue may also lead to misinterpretation of the condition.

Other Common Symptoms:

• Shuffling walk
• Stiffness in one leg
• Reduced arm swing while walking
• Small handwriting
• Blank or fixed stare
• Shaky or soft voice
• Change in facial expression
• Leaning forward
• Numbness or tingling in limbs, neck, or shoulders

How Is Parkinson’s Diagnosed?

Diagnosis begins with a neurologist reviewing the patient’s history and performing a physical examination. If two of the four major motor symptoms (tremor, slowness, rigidity, postural instability) are present over time, Parkinson’s may be suspected.

The neurologist may order blood tests or imaging (like MRI or PET scans) to rule out other conditions. A final diagnosis is made by evaluating all clinical and diagnostic findings together.

How Is Parkinson’s Treated?

Parkinson’s requires long-term management, and early diagnosis greatly improves treatment outcomes. Raising awareness among patients and their families is vital. Treatment is tailored to the disease stage, with the goal of maintaining independence for as long as possible.

The first-line treatment typically involves dopaminergic medications, which help increase or mimic dopamine activity in the brain. If side effects occur, medication adjustments should always be made under physician supervision.

If medications are no longer effective, surgical options may be considered. One such option is Deep Brain Stimulation (DBS)—commonly referred to as a brain pacemaker. Electrodes are implanted in specific brain regions and connected to a small device placed in the chest or abdomen to regulate abnormal signals.

Supportive Therapies and Rehabilitation

In addition to medications or surgery, doctors often recommend Parkinson-specific exercises, either with a physical therapist or for patients to do at home. These exercises aim to:

• Improve mobility
• Reduce stiffness
• Maintain independence
• Enhance quality of life

In early stages, many patients can perform these exercises easily. In later stages, therapists may develop custom exercise programs to maintain mobility. Sample exercises include:

• Buttoning and unbuttoning clothes
• Getting in and out of bed
• Dressing independently
• Facial expression and speech exercises

For those with speech difficulties, speech therapy may also be advised.

In summary, Parkinson’s is a manageable but progressive condition. With early diagnosis, personalized treatment, and lifestyle support, many people can maintain a high quality of life for years. If you or a loved one are experiencing symptoms, consult a neurologist promptly to explore treatment options.