Definition

Parkinson's disease (PD) is a progressive movement disorder that causes:

• Muscle rigidity
• Tremor at rest
• Slowing down of movements (bradykinesia)
• Difficulty moving and gait instability

Causes

Symptoms are caused by a loss of nerve cells in a part of the brain called the substantia nigra . Genetic, environmental, or a combination of both factors cause this loss. This loss decreases the amount of dopamine in the brain. Low dopamine results in PD symptoms. A small percentage of people with this condition have an early onset form caused by an inherited gene defect.

Substantia Nigra—Yellow Section

© 2008 Nucleus Medical Art, Inc.

Secondary parkinsonism is a condition with similar symptoms. But symptoms can be caused by several factors, including:

• Antipsychotic drugs, such as haloperidol (Haldol), fluphenazine (Prolixin), trifluoperazine (Stelazine), and chlorpromazine (Thorazine)
• Carbon monoxide poisoning
• Manganese poisoning
• Hydrocephalus
• Brain tumors
• Stroke
• Encephalitis
• Meningitis
• Intravenous drug abuse of MPTP (a type of neurotoxin)
• Reserpine
• Insecticide exposure
• Trauma
• AIDS

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

• Age: 50 or older
• History of polio
• Gender: men (slightly more likely to develop PD)
• Family members with PD
• Nonsmokers
• Exposure to toxins, drugs, or conditions listed above

Symptoms

Symptoms of PD begin mildly and worsen over time.

Symptoms include:

• "Pill-rolling" tremor in the hands
• Tremors are present at rest, improve with movement, and are absent during sleep
• Stiffness and rigidity of muscles, usually beginning on one side of the body
• Difficulty and shuffling when walking
• Short steps
• Slowness of purposeful movements
• Trouble performing usual tasks, due to shaking in hands
• Trouble speaking
• Flat, monotonous voice
• Stuttering
• Shaky, spidery handwriting
• Poor balance
• Difficulty with rising from a sitting position
• “Freezing”
• Anxiety
• Seborrhea (a skin problem that causes a red rash and white scales)
• Loss of smell
• Tendency to fall
• Stooped posture
• Increasingly mask-like face, with little variation in expression
• Trouble chewing and swallowing
• Depression
• Dementia
• Difficulty thinking, problems with memory

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. There are no tests to definitively diagnose PD. The doctor will ask many questions to rule out other causes of your symptoms.

Tests to rule out other conditions may include:

• Blood tests
• Urine tests
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the head
• PET scan —a scan that makes images that show the amount of activity in the brain

Treatment

Currently, there are no treatments to cure PD or proven treatments to slow or stop its progression. Some medications are used to improve symptoms. Over time, however, the side effects may become troublesome, and the medications may lose their effectiveness.

Prevention

There are no guidelines for preventing PD.