Parkinson's disease was first described in England in 1817 by Dr. James Parkinson. The disease affects approximately 2 of every 1,000 people and most often develops after age 50. Sometimes Parkinson's disease occurs in younger adults and is rarely seen in children. It affects both men and women and is one of the most common neurologic disorders of the elderly.

In some cases the disease occurs within families, especially when it affects young people. Most late onset cases have no known cause. The term "parkinsonism" refers to any condition that involves a combination of the types of changes in movement seen in Parkinson's disease, which is the most common cause of these symptoms. Parkinsonism may be caused by other disorders or by external factors (secondary parkinsonism) like certain medications used to treat schizophrenia.

Parkinson's disease is caused by progressive deterioration of the nerve cells of the part of the brain that controls muscle movement (the basal ganglia and the extrapyramidal area). Dopamine, which is one of the substances used by cells to transmit impulses, is normally produced in this area. Deterioration of this area of the brain reduces the amount of dopamine available to the body.

Insufficient dopamine disturbs the balance between dopamine and other transmitters, such as acetylcholine. Without dopamine, the nerve cells cannot properly transmit messages, and this results in the loss of muscle function.

The exact reason that the cells of the brain deteriorate is unknown. The disorder may affect one or both sides of the body, with varying degrees of loss of function.

In addition to the loss of muscle control, some people with Parkinson's disease become severely depressed. This may be due to loss of dopamine in certain brain areas involved with pleasure and mood. Lack of dopamine can also affect motivation and the ability to initiate voluntary movements.

Although early loss of mental capacities is uncommon, with severe Parkinson's, the person may exhibit overall mental deterioration (including dementia and hallucinations). Dementia can also be a side effect of some of the medications used to treat the disorder.

Although rare, when Parkinson's is found in children, it appears to be due to decreased sensitivity of the nerves (post-synaptic) to dopamine rather than deterioration of the area of the brain that produces dopamine.

• muscle rigidity
  • stiffness
  • difficulty bending arms or legs
• unstable, stooped, or slumped-over posture
• loss of balance
• gait (walking pattern) changes
• shuffling walk
• slow movements
• difficulty initiating any voluntary movement
  • difficulty beginning to walk
  • difficulty getting up from a chair
• small steps followed by the need to run to maintain balance
• freezing of movement when the movement is stopped, inability to resume movement
• muscle aches and pains (myalgia)
• shaking, tremors (varying degrees, may not be present)
  • characteristically occur at rest, may occur at any time
  • may become severe enough to interfere with activities
  • may be worse when tired, excited, or stressed
  • finger-thumb rubbing (pill-rolling tremor) may be present
• changes in facial expression
  • reduced ability to show facial expressions
  • "mask" appearance to face
  • staring
  • may be unable to close mouth
  • reduced rate of blinking
• voice/speech changes
  • slow speech
  • low volume
  • monotone
  • difficulty speaking
• loss of fine motor skills
  • difficulty writing, may be small and illegible
  • difficulty eating
  • difficulty with any activity that requires small movements
  • movement, uncontrolled - slow
• frequent falls
• decline in intellectual function (may occur, can be severe)
• a variety of gastrointestinal symptoms, mainly constipation.

• depression
• confusion
• dementia
• seborrhea (oily skin)
• muscle function/feeling loss
• muscle atrophy
• memory loss
• drooling
• anxiety, stress, and tension

There is no known cure for Parkinson's disease. Treatment is aimed at controlling the symptoms. Treatment must be tailored to the individual.

Medications control symptoms primarily by increasing the levels of dopamine in the brain. The type of medication, the dose, and the amount of time between doses, or the combination of medications used, may need to be adjusted as symptoms change. Many of the medications can cause severe side effects, so monitoring and follow-up by the health care provider is important.

Deprenyl may provide some improvement to mildly affected patients. Amantadine and/or anticholinergic medications may be used to reduce early or mild tremors. Levodopa is a medication that the body converts to a brain transmitter called dopamine; it may be used to increase the body's supply of dopamine, which may improve movement and balance. Carbidopa is a medication that reduces the side effects of levodopa and makes it work better.

Additional medications to help reduce symptoms or control side effects of primary treatment medications include antihistamines, antidepressants, dopamine agonists, monoamine oxidase inhibitors (MAOIs), and others.

Good general nutrition and health are important. Exercise should continue, with the level of activity adjusted to meet the changing energy levels that may occur. Regular rest periods and avoidance of stress are recommended because tiredness or stress can make symptoms worse. Physical therapy, speech therapy, and occupational therapy may help promote functioning, positive attitude, and independence.

Simple aids, such as railings or banisters placed in commonly used areas of the house or special eating utensils, may be of great benefit to the person experiencing difficulties with daily living activities.

Social workers or other counseling services may help the patient cope with the disorder and with obtaining assistance, such as Meals-on-Wheels, as appropriate.

Experimental or less common treatments may be recommended. For example, surgery to destroy tissues responsible for tremors may reduce symptoms in some people. Transplantation of adrenal gland tissue to the brain has been attempted, with variable results.

• disability, varying degrees
• difficulty swallowing/eating
• difficulty performing daily activities
• injuries from falls
• side effects of medications

• involuntary movements
• nausea/vomiting
• dizziness
• changes in alertness/behavior/mood
• severe confusion or disorientation
• delusional behavior
• hallucinations
• loss of mental functions