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Slideshow: A visual guide to Parkinson's disease

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What is Parkinson's disease?

Parkinson's disease is a brain disorder that causes a gradual loss of muscle control. The symptoms of Parkinson's tend to be mild at first and can sometimes be overlooked. Distinctive signs of the disease include tremors, stiffness, slowed body movements and poor balance. Parkinson's disease was originally called a "shaking palsy," but not everyone with Parkinson's disease has a tremor.

Parkinson's disease progression

While Parkinson's disease can be a frightening diagnosis, life expectancy is about the same as for people without the disease. For some people symptoms evolve slowly over 20 years. Early treatment can provide years that are virtually symptom-free. About 5% to 10% of cases occur before the age of 50. Two supporters of research developed Parkinson's disease early: boxer Muhammad Ali at 42 and actor Michael J. Fox at 30.

Early signs of Parkinson's disease

The early signs of Parkinson's disease may be subtle and can be confused with other conditions. They include:

Slight shaking of a finger, hand, leg or lip
Stiffness or difficulty walking
Difficulty getting out of a chair
Small, crowded handwriting
Stooped posture
A 'masked' face, frozen in a serious expression

Symptom: Tremor

Tremor is an early symptom for about 70% of people with Parkinson's disease. It usually occurs in a finger or hand when the hand is at rest - but not when the hand is in use. It will shake rhythmically, usually four to six beats per second, or in a "pill-rolling" manner, as if rolling a pill between the thumb and index finger. Tremor also can be a symptom of other conditions, so by itself it does not indicate Parkinson's disease.

Symptom: Bradykinesia

As people grow older, they naturally slow down. But if they have "bradykinesia," a sign of Parkinson's disease, the slow movement may impair daily life. When they want to move, the body may not respond right away, or they may suddenly stop or "freeze." The shuffling walk and "mask-like" face sometimes found in those with Parkinson's disease can be due to bradykinesia.

Symptom: Impaired balance

People with Parkinson's disease tend to develop a stooped posture, with drooping shoulders and their head jutted forward. Along with their other movement issues, they may have a problem with balance. This increases the risk of falling.

Symptom: Rigidity

Rigidity occurs when the muscles stay stiff and don't relax. For example, the arms may not swing when a person is walking. There may be cramping or pain in the muscles. Most people with Parkinson's disease experience some rigidity.

Symptoms beyond movement

Other symptoms are common, but not everyone with Parkinson's disease will have all of them. They may include:

Restless sleep or daytime fatigue
A soft voice or slurred speech
Difficulty swallowing
Memory problems, confusion or dementia
Oily skin and dandruff
Constipation

Diagnosing Parkinson's disease

Brain scans are not generally used to diagnose Parkinson's disease, although they may be used to rule out other conditions. Instead, your doctor may ask you to:

Tap your finger and thumb together or tap your foot to check for slowed movement
Rest your hand to observe your tremor
Relax, while he moves your neck, arms and legs to check for rigidity
Stand while being gently pulled from behind to check for balance

Parkinson's disease or essential tremor?

If you have a tremor but no other Parkinson's disease like symptoms, such as rigidity or slow movement, you may have benign essential tremor. This tremor runs in families and is much more common than Parkinson's disease. It usually affects both hands equally. Unlike Parkinson's disease, the tremor is worse when your hand is in motion. Essential tremor does not respond to the commonly-used Parkinson's drug levodopa, but may be treated with other medicines.

Who gets Parkinson's disease?

The average age of onset is 62, but people over 60 still have only a 2% to 4% likelihood of developing the disease. Having a family member with Parkinson's disease slightly increases your risk. Men are more likely to develop Parkinson's disease than women.

What causes Parkinson's disease?

A small area in the brain stem called the substantia nigra controls movement. In Parkinson's disease, cells in the substantia nigra stop producing dopamine, a chemical that helps nerve cells communicate. As these dopamine-producing cells die, the brain does not receive the necessary messages about how and when to move.

Stages of Parkinson's disease

Parkinson's disease is progressive, which means changes continue inside the brain over time. Doctors measure the stages of Parkinson's disease by a careful assessment of your symptoms using different verified scales that look at the severity of symptoms, or assess mental clarity and function, behaviour and mood, activities of daily living and motor functions. Staging can help determine the best treatment.

Treatment: Levodopa

Levodopa (L-dopa) is an amino acid that the brain converts into dopamine. It's been used since the 1970s and is still the most effective Parkinson's disease medication. It reduces bradykinesia and rigidity, helping people to move more easily. Eventually, levodopa may wear off quickly. It should not be taken with a high-protein diet. Common side effects are nausea, vomiting and drowsiness. Hallucinations, paranoia and involuntary movements (dyskinesias) may occur with long-term use.

Treatment: Dopamine agonists

Drugs that mimic dopamine, called dopamine agonists, may be used to delay the movement-related symptoms of Parkinson's disease. They include apomorphine, bromocriptine, cabergoline, pergolide, pramipexole, ropinirole and rotigotine. Side effects may include nausea and vomiting, drowsiness, fluid retention and psychosis.

Treatment: Other medicines

Entacapone or tolcapone can improve the effectiveness of levodopa, with a possible side effect of diarrhoea. They belong to a group of drugs called COMT inhibitors and stop levodopa being broken down by your body as quickly as usual. This means your dose of levodopa can work for a longer time. Tocapone was withdrawn from the UK market in 1998 as it can cause major liver problems. It is now available again but has to be prescribed by a specialist and patients need regular monitoring of their liver function.

Surgery: Deep brain stimulation

DBS is a way to inactivate parts of the brain that cause Parkinson's disease and associated symptoms. Electrodes can be implanted into one of three areas of the brain -- the globus pallidus, the thalamus, or the subthalamic nucleus - on one or both sides. A pulse generator goes in the chest near the collarbone. Electric pulses stimulate the brain to help reduce a patient's rigidity, tremors and bradykinesia. It doesn't stop the progression of Parkinson's diseaseor affect other symptoms. Not everyone is a good candidate for this surgery.

Surgery: Pallidotomy and thalamotomy

These surgical procedures use radio-frequency energy to permanently destroy a pea-sized area in the globus pallidus or the thalamus. These areas are associated with tremor, rigidity and bradykinesia, so movement generally improves after surgery with less reliance on levodopa. However, because these operations are irreversible, they have become less common than deep brain stimulation.

A better diet for Parkinson's disease

It's important to have a well-balanced diet, with calcium and vitamin D to help maintain bone strength. Although protein can interfere with levodopa, you can avoid the problem by taking the medicine about a half-hour before mealtimes. If you have nausea, take your medicine with crackers or ginger ale. Eating a high-fibre diet with lots of fluids can help prevent constipation.

Can symptoms be prevented?

Researchers are investigating supplements or other substances that may protect neurons from the damage of Parkinson's disease, but it is too soon to say whether they work. A 2002 study found that 1,200 mg per day of coenzyme Q10 slowed the progression of early Parkinson's disease. Coffee drinkers and smokers may have a lower risk of developing Parkinson's disease (although smoking obviously has other serious health consequences).

The role of environmental toxins

Studies indicate that exposure to pesticides and herbicides may increase the risk of Parkinson's disease. Some people may be genetically more susceptible to environmental exposures. Research in this important area is continuing.

Parkinson's disease and exercise

Exercise may actually have a protective effect by enabling the brain to use dopamine more effectively. It also helps improve motor coordination, balance, gait and tremor. For the best effect, you should exercise consistently and as intensely as you can, regularly throughout the week. Working out on a treadmill or biking have been shown to have a benefit. Tai chi and yoga may help with balance and flexibility.

Living with Parkinson's disease

Parkinson's disease affects many aspects of daily life, but with medicines and other support, you can remain active. Medication can help you cope with mood disorders, such as depression and anxiety. An occupational therapist can provide a home safety evaluation. You may need to remove fall hazards, such as rugs or cords, and add rails in the bathroom. A speech therapist can help with swallowing and speech problems.

A note for caregivers

Caring for a person with Parkinson's disease can be challenging. As motor skills decline, simple tasks may become more difficult, but the Parkinson's disease patient may struggle to maintain independence. Both the medicines and the disease itself can lead to mood changes. The charity Parkinson’s UK can help with advice on benefits and grants. NHS Carers Direct can also help with benefits for carers and their loved ones.