Parkinson’s Disease: What You Need to Know

According to the Parkinson’s Foundation, Parkinson’s Disease is the second most common neurodegenerative disease in the United States, with Alzheimer’s being the first.

Parkinson’s disease (PD) is a progressive brain disorder caused by a degeneration of nerve cells in an area of the brain that controls many aspects of movement including speech. People with PD move through stages of severity. Resulting movement disorders through these stages range from mild tremors to severe disruption of the nervous system.

Rehabilitation professionals—including physical therapists, can help guide you through a curated treatment plan after a diagnosis. A targeted, therapist-guided exercise program can improve functionality and quality of life.

Whether you’re concerned about risk factors or are actively dealing with Parkinson’s or other neurodegenerative diseases, understanding what Parkinson’s is, how it is treated, and what to expect is critical to getting ahead of this disease.

What Is Parkinson’s Disease?

PD affects the central nervous system, resulting in motor symptoms like tremors, rigidity, and worsening balance. The progression of this disease can result in disability and the need for a caregiver.

Over one million people in the United States are living with Parkinson’s (PD)—more than multiple sclerosis (MS), muscular dystrophy (MD), and amyotrophic lateral sclerosis (ALS) combined.

Men are at a higher risk for developing Parkinson’s disease at about a 1.5 to 1 ratio. (1)

What Causes Parkinson’s?

The onset of Parkinson’s is usually sporadic or idiopathic, meaning it develops without a known cause. While no specific cause has been identified, genetic and environmental factors are assumed to be involved.

Environmental toxins, drugs (antipsychotics or antiemetics), or certain infections may play a role in the development of PD. Only 5-10% of Parkinson’s cases are related to genetics.

Tiny clusters of cells called Lewy bodies are present in the brain of people with Parkinson’s and another related neurodegenerative disease called Lewy Body Dementia. These mysterious cells hold potential clues to the causes of Parkinson’s disease and are the focus of significant research.

Is Parkinson’s an autoimmune disease?

An autoimmune disease occurs when overactive immune cells mistakenly target the body’s healthy functional tissues. Autoimmune conditions can occur in most of the body’s systems and tissues.

There is some recent research indicating that Parkinson’s may at least be, in part, due to autoimmunity. Still, it has not yet been classified as an autoimmune disease. (2)

The Anatomy & Physiology of Parkinson’s

The area of the brain that experiences the most degeneration during Parkinson’s disease is called the substantia nigra. This area of the brain handles the production of dopamine: a neurotransmitter that aids in controlling movement, among other things.

With Parkinson’s, dopamine production slowly degenerates, impacting how the brain sends signals to the rest of your body. This chemical imbalance can result in both physical (motor) and cognitive symptoms, affecting both the central nervous system (the brain and spinal cord) and the peripheral nervous system (arms, legs, and torso). (3)

Symptoms

Motor Symptoms

The various motor symptoms are hallmarks of Parkinson’s disease. Common symptoms are categorized as “parkinsonism.”

Parkinsonism includes:

• Bradykinesia, or slower-than-usual movement

• Cogwheel rigidity, or muscle stiffness accompanied by tremors

• Resting tremors

• Micrographia, or handwriting that gets smaller as you write

• Hypomimia, or dulling of facial expressions.

Parkinson’s gait or Parkinson’s walk tends to become noticeable when walking.

This simplified symptom may include decreased arm swing, shuffling steps, freezing gait, frequent falls, instability, and hunched posture. Similarly, getting up from a chair, out of a car, or standing up from bed may become increasingly difficult over time. (4)

Parkinson’s symptoms almost always start on one side of the body. They do not begin to occur on the other side until later in the disease. This is one of the major early determinants of PD compared to similar neurodegenerative diseases.

Non-Motor Symptoms

Some of the non-motor features of Parkinson’s that you might experience include memory impairments, a decreased sense of smell, internal tremors, fatigue, orthostatic hypotension (low blood pressure leading to fainting), urinary urgency, constipation, swallowing problems, or sleep issues.

These often go less recognized than the more prominent and noticeable motor symptoms but can be just as debilitating for many people with PD.

Other symptoms of late-stage Parkinson’s include depression, anxiety, hallucinations, or psychosis.

Progression

There are five commonly known stages of Parkinson’s disease which outline the typical progression of motor symptoms. Symptoms typically start with a unilateral tremor and can progress over the years.

In the later stages of Parkinson’s, people tend to rely increasingly on assistive devices like walkers, wheelchairs, and even specialized cutlery while eating. You may also later require caregiver support and experience serious cognitive impairments.

Parkinson’s and Other Neurological Conditions

Parkinson’s is similar, but not the same, as many other neurodegenerative diseases, including multiple sclerosis, amyotrophic lateral sclerosis, and Lewy body dementia.

Multiple sclerosis is an autoimmune condition in which the immune system attacks the myelin surrounding nerve fibers throughout the central nervous system, resulting in various nerve problems.

MS is often diagnosed between the ages of twenty and forty, while Parkinson’s is typically diagnosed at sixty and up. While PD is progressive, MS can be more erratic and often comes in “attacks” leading to more steady degeneration.

Amyotrophic lateral sclerosis, widely known as Lou Gehrig’s disease, causes muscle weakness and atrophy alongside similar symptoms to those that people with Parkinson’s might encounter.

ALS patients struggle with specific motor patterns like chewing, talking, and gait. There is no known cure, nor is there a treatment that slows the progression of ALS.

Treatment Options

Unfortunately, there is currently no cure for Parkinson’s. Still, medications and other treatments can help with symptom management as the disease progresses.

Exercise and physical therapy can slow PD symptom progression. Various exercises can help to manage Parkinson’s rigidity, while others can improve Parkinson’s gait and other movement problems.

Medication for Parkinson’s Disease

Many medications can ease your Parkinson’s symptoms.

Levodopa, a drug that converts into dopamine, is helpful in early to moderate PD but becomes less effective in later stages of the disease progression.

Other medications directly target motor or non-motor symptoms. They may include drugs to counter or manage secondary psychological symptoms like depression or psychosis. (5)

Role of Exercise & Neuroplasticity

The only thing that can truly slow down the disease is exercise.

Exercise can actually increase dopamine release in some areas of the brain. It can also prevent excessive dopamine absorption, making it available for use. In fact, people with a history of exercise are actually less likely to develop Parkinson’s in the first place.

Because of its many benefits, the CDC recommends that older adults participate in 150 minutes per week of exercise as a combination of cardiovascular and strength training.

Regular exercise is associated with better quality of life, mobility, physical function, and cognition for all older adults. Still, it is specifically beneficial to those with Parkinson’s. (4)

Physical Therapy

Exercise has been proven to have neuroprotective and disease-modifying capabilities for Parkinson’s. A targeted and supervised medical exercise program can be integral for disease management.

An assessment by a physical therapist might include testing for balance, cognition, strength, posture, and endurance. Treatment goals for PD focus on slowing the progression of the disease and the progression of disability that comes with it.

Critical components of a Parkinson’s exercise program should include cardiovascular exercise and task-specific strength and balance training to maintain normal function for as long as possible.

Ideally, exercise allows independence for all your desired activities. It maintains or improves functional abilities to enhance your quality of life. Additionally, exercise can help to prevent falls and improve stability.

Ongoing Research & Other Promising Treatments

When disability becomes severe, surgical treatment options can help.

For example, deep brain stimulation inserts electrodes into the brain to stimulate dysfunctional areas of brain cells or regions.

Ongoing research is investigating the efficacy of other treatment methods, including injections to improve dopamine production and studies about how gene therapy might impact the development of PD. (3)

Living with Parkinson’s

Being diagnosed at early stages can result in more effective treatments and better quality of life for the duration of the disease progression.

Parkinson’s is a challenging disease for the person diagnosed, loved ones, and caregivers alike. Joining a Parkinson’s support group can help improve the physical and psychological health of everyone affected by a diagnosis.

It can also be helpful to explore community resources, such as fitness groups and exercise classes for those with Parkinson’s.

Please refer to this helpful article for more information about managing Parkinson’s disease with physical therapy and exercise.

Summary 

While a Parkinson’s diagnosis may be daunting, understanding what the disease entails and the treatment options available can make an enormous difference in improving your quality of life.

Exercise and a healthy, balanced lifestyle remain the primary options for slowing the progression of Parkinson’s disease.

Several other treatment options are available, including medication. If you’re dealing with late-stage Parkinson’s, surgical interventions are available for more severe symptoms.

Talk to your doctor or physical therapist today to explore your options or to learn about helpful community resources for managing Parkinson’s for you or someone you love.

Resources

1. Bloem, B. R., Okun, M. S., & Klein, C. (2021). Parkinson’s disease. The Lancet, 397(10291), 2284-2303.

2. Jiang, T., Li, G., Xu, J., Gao, S., & Chen, X. (2018). The Challenge of the Pathogenesis of Parkinson’s Disease: Is Autoimmunity the Culprit?. Frontiers in immunology, 9, 2047. https://doi.org/10.3389/fimmu.2018.02047

3. Lang, A. E., & Lozano, A. M. (1998). Parkinson’s disease. New England Journal of Medicine, 339(16), 1130-1143.

4. Hayes, M. T. (2019). Parkinson’s disease and parkinsonism. The American journal of medicine, 132(7), 802-807.

5. Connolly, B. S., & Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. Jama, 311(16), 1670-1683.