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NeurologicalICD-10: G20Nearly 1 million people in the US; about 10 million worldwide

Parkinson's Disease

Also known as: PD, Paralysis Agitans

Parkinson's disease is a progressive neurodegenerative disorder resulting from the loss of dopamine-producing neurons in the substantia nigra of the brain. It is characterized by motor symptoms including tremor, rigidity, bradykinesia (slowness of movement), and postural instability, as well as a range of non-motor symptoms. It is the second most common neurodegenerative disease after Alzheimer's, and while there is no cure, treatments can significantly improve quality of life.

Symptoms

Resting tremor, often starting in one hand (pill-rolling tremor)
Bradykinesia (slowness of movement)
Muscle rigidity and stiffness
Postural instability and balance problems
Shuffling gait and freezing of gait
Reduced facial expression (masked facies)
Soft, monotone speech (hypophonia)
Micrographia (small, cramped handwriting)
Loss of smell (anosmia)
Sleep disturbances (REM sleep behavior disorder)
Constipation
Depression and anxiety

Causes

  • Loss of dopamine-producing neurons in the substantia nigra
  • Accumulation of alpha-synuclein protein forming Lewy bodies
  • Genetic mutations (LRRK2, GBA, SNCA, PARK2/Parkin) in familial cases
  • Environmental factors (pesticide and herbicide exposure)

Risk Factors

  • Age (risk increases significantly after 60)
  • Male sex (1.5 times more common in men)
  • Family history of Parkinson's disease
  • Exposure to pesticides and rural living
  • Head trauma
  • Never-smoker status and low caffeine intake (inversely correlated)

Diagnosis

  • Clinical diagnosis based on motor symptoms (UK Brain Bank criteria or MDS criteria)
  • DaTscan (dopamine transporter imaging) to support diagnosis
  • Response to levodopa therapy (positive response supports diagnosis)
  • MRI to exclude other structural causes
  • Neurological examination assessing tremor, rigidity, bradykinesia, and gait

Treatment

  • Levodopa/carbidopa (gold standard for motor symptoms)
  • Dopamine agonists (pramipexole, ropinirole, rotigotine)
  • MAO-B inhibitors (selegiline, rasagiline, safinamide)
  • COMT inhibitors (entacapone, opicapone) to extend levodopa effect
  • Deep brain stimulation (DBS) surgery for advanced disease
  • Physical therapy, occupational therapy, and speech therapy

Prevention

  • No proven prevention, but associated protective factors include:
  • Regular aerobic exercise (may slow disease progression)
  • Caffeine consumption (associated with lower risk in studies)
  • Avoiding exposure to pesticides and industrial chemicals

When to See a Doctor

  • New onset tremor, especially at rest
  • Progressive slowness of movement or difficulty walking
  • Stiffness that does not improve with movement
  • Balance problems or unexplained falls

Frequently Asked Questions

Related Conditions

Alzheimer's Disease

Neurological

Essential Tremor

Neurological

Restless Legs Syndrome

Neurological

Depression

Mental Health

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