Understanding Parkinson's Disease

Parkinson's disease is a gradually progressive degenerative disease of specific areas of the brain. It is identified by tremor when the muscles are at rest (resting tremor), increased muscle tone (stiffness), slowness voluntary movements, and difficulty maintaining balance (postural instability). In many people, thinking becomes compromised, or dementia develops.

The older the age group, the higher the chances of developing Parkinson's disease. According to statistics, in the vast majority of patients, it appears from 55 to 60 years old, and its prevalence increases from 70 to 75 years old.


The main cause of Parkinson's disease is the death of brain cells, especially in the area known as the substantia nigra (SN), responsible for the production of dopamine, a neurotransmitter that, among other functions, controls movement.


Parkinson's disease usually starts asymptomatic and progresses gradually.

The first symptoms are:

  • Tremors, which occurs in about two-thirds of people.

  • Problems with movement or a decreased sense of smell.

Tremors usually have the following characteristics:

  • Rhythmic

  • Have a large amplitude with an irregular and slow oscillation

  • Usually happens in one hand while at rest (resting tremor)

  • They often involve pill-rolling, like you are trying to roll a pill or another small object between your thumb and index finger

  • Worsens by emotional stress or fatigue

  • It may intensify and, over time, move to the other hand, arms, and legs

  • It can also affect the jaws, the tongue, the forehead, and the eyelids, but not the voice

However, there are cases in which tremors never develop.

Other symptoms caused by Parkinson's disease are:

  • Stiffness: Muscles become rigid, making movement difficult. If the doctor tries to flex the forearm or stretch it, the arm resists being moved.

  • Slow movement: The individual start to notice that the movement became slow and challenging to start. Because of that, people with Parkinson's disease tend to move less, thus making the joints stiff, and weakening the muscles.

  • Difficulty maintaining balance and posture: Posture becomes curved, and it is hard to sustain balance. Therefore, people tend to tip forward or backward. Since movements are slow, individuals will not be able to move their hands quickly enough to cushion a fall.

It is difficult to walk, especially, to take the first step, and people usually drag their feet and take short steps. For Parkinson's patients, it becomes challenging to stop or turn when they are walking. As the disease advances, some people stop walking because they feel as if their feet are stuck to the floor.

Stiffness and reduced mobility can contribute to muscle pain and fatigue. Having stiff muscles hinders movement, making it complicated to turn over in bed, get in or out of a car, and get up from a sofa. Normal daily activities take longer.

Since people often find it challenging to control small hand muscles, daily activities, such as buttoning a shirt, tightening the laces on shoes, or starting and maintaining the pen stroke when writing becomes increasingly demanding.

Facial expression may have a lost look with the mouth open, and the eyes may not blink frequently. Stiffness of face and throat may also cause individuals with Parkinson's to drool or choke and make swallowing difficult. Patients usually speak slowly, in a monotonous voice, and sometimes stutter, due to their difficulty articulating words.

Parkinson's disease also causes other symptoms:

  • Sleep problems, including insomnia, are common because the person needs to urinate frequently or because the symptoms worsen at night, making it hard for the person to turn over in bed. Lack of sleep can contribute to depression and drowsiness during the day.

  • Problems with urination may occur. It can be challenging to start and maintain urination. Incontinence is common.

  • It may be difficult to swallow, as the esophagus may move its contents more slowly. As a result, people can inhale (aspirate) secretions from the mouth. Aspiration can cause pneumonia.

  • Constipation can develop, as the intestine can move its contents more slowly. Inactivity and levodopa, the primary medication used to treat Parkinson's disease, can worsen constipation.

  • A sudden and excessive reduction in blood pressure can occur when a person stands up.

  • Dementia will develop in approximately one-third of people with Parkinson's disease. However, in many others, thinking is compromised, but the person may not recognize it.

  • Depression can develop, sometimes years before people start to experience difficulties with movement. Depression tends to get worse as Parkinson's disease becomes severe.

  • Hallucinations (see or hear things that do not exist), delusions (firmly hold certain beliefs instead of clear evidence that contradicts them), and paranoia (become suspicious and think that other people have the intention to hurt them) can occur, especially if dementia develops. These symptoms are considered psychotic symptoms since they represent the loss of contact with reality. Psychotic symptoms are the most common reasons people with Parkinson's disease are admitted to an institution. Having these symptoms increases the risk of death.


Treatment can be medication, psychotherapeutic, and even surgical in some cases.

  • Drug treatment is based on neuroprotective drugs that aim to prevent the progressive decrease in dopamine, a neurotransmitter responsible for transmitting signals in the chain of nervous circuits.

  • Psychotherapeutic treatment occurs due to depression, memory loss, and the onset of dementia and may include the prescription of antidepressant drugs and other psychotropic drugs.

  • Surgical: Deep Brain Stimulation therapy (DBS) can reduce many of Parkinson's disease symptoms. This adjustable and, if necessary, reversible therapy uses an implantable device that electrically stimulates the brain, blocking signals that cause disabling motor symptoms. DBS therapy for Parkinson's disease uses a surgically implanted medical device similar to a cardiac pacemaker to provide electrical stimulation to precise regions of the brain.


  • See a doctor as soon as you notice a slight tremor in your hands or have noticed that your handwriting has decreased in size (micrograph);

  • Maintain intellectual activity; read, follow the news;

  • Do not ignore the loss of facial expression and less frequent blinking of the eyes over the years;

  • Practice physical activity. Regular physical exercise helps to preserve the quality of your movements.

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