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10-02-2012, 10:51 AM
Parkinson's Disease Overview

Symptoms of Parkinson's disease include muscle rigidity, tremors, and changes in speech and gait. Parkinson’s causes are unknown but genetics, aging, and toxins are being researched. After a Parkinson’s diagnosis, Parkinson’s disease treatments are given to help relieve symptoms. There is no cure for Parkinson's and herbal remedies are unproven. Studies on using stem cells to treat Parkinson's disease are under way. The prognosis depends on the patient's age and symptoms.

Here's an easy-to-use guide to a complex illness: Parkinson's disease. This guide offers links brief, to-the-point information on Parkinson's symptoms, tests, treatment, support, and more.
What Is Parkinson’s Disease?

Topic Overview

What is Parkinson's disease? This brief overview will tell you.
Topic Overview
What is Parkinson's disease? Parkinson's disease affects the way you move. It happens when there is a problem with certain nerve cells in the brain.
Normally, these nerve cells make an important chemical called dopamine (http://www.webmd.com/hw-popup/dopamine). Dopamine sends signals to the part of your brain (http://www.webmd.com/brain/picture-of-the-brain) that controls movement. It lets your muscles move smoothly and do what you want them to do. When you have Parkinson’s, these nerve cells break down. Then you no longer have enough dopamine, and you have trouble moving the way you want to.
Parkinson’s is progressive, which means it gets worse over time. But usually this happens slowly, over a period of many years. And there are good treatments that can help you live a full life.
What causes Parkinson's disease (http://www.webmd.com/parkinsons-disease/default.htm)? No one knows for sure what makes these nerve cells break down. But scientists are doing a lot of research to look for the answer. They are studying many possible causes, including aging and poisons in the environment.
Abnormal genes (http://www.webmd.com/hw-popup/gene) seem to lead to Parkinson's disease in some people. But so far, there is not enough proof to show that it is always inherited.
What are the symptoms? The four main symptoms of Parkinson’s are:

Tremor (http://www.webmd.com/hw-popup/tremor), which means shaking or trembling. Tremor may affect your hands, arms, or legs.
Stiff muscles.
Slow movement.
Problems with balance or walking.

Tremor may be the first symptom you notice. It is one of the most common signs of the disease, although not everyone has it. More importantly, not everyone with a tremor has Parkinson's disease. Tremor often starts in just one arm or leg or only on one side of the body. It may be worse when you are awake but not moving the affected arm or leg. It may get better when you move the limb or you are asleep.
In time, Parkinson’s affects muscles all through your body, so it can lead to problems like trouble swallowing or constipation (http://www.webmd.com/digestive-disorders/digestive-diseases-constipation). In the later stages of the disease, a person with Parkinson’s may have a fixed or blank expression, trouble speaking, and other problems. Some people also have a decrease in mental skills (dementia (http://www.webmd.com/hw-popup/dementia)).
People usually start to have symptoms between the ages of 50 and 60. But in some people symptoms start earlier.
How is Parkinson's disease diagnosed? Your doctor will ask questions about your symptoms and your past health and will do a neurological exam. A neurological exam includes questions and tests that show how well your nerves are working. For example, your doctor will watch how you move, check your muscle strength and reflexes, and check your vision (http://www.webmd.com/eye-health/default.htm). In some cases, your doctor may have you try a medicine. How this medicine works may help your doctor know if you have Parkinson's disease. He or she will also ask questions about your mood.

What Happens

Click here to learn what happens when a person develops Parkinson's disease.

Treatment may help control symptoms during the early stages of Parkinson's disease (http://www.webmd.com/a-to-z-guides/parkinsons-disease-classification-topic-overview) and is usually started as soon as symptoms begin to affect a person's ability to work or do daily activities. As the disease progresses, drugs (http://www.webmd.com/drugs/index-drugs.aspx) may become less effective. Parkinson's disease (http://www.webmd.com/parkinsons-disease/default.htm) also can cause a variety of other symptoms (http://www.webmd.com/a-to-z-guides/parkinsons-disease-other-symptoms-topic-overview) as it advances.
Early disease Tremor (http://www.webmd.com/hw-popup/tremor) is usually the first symptom of Parkinson's disease (http://www.webmd.com/hw-popup/parkinsons-disease), appearing in just one limb (arm or leg) or on only one side of the body. Tremor may also occur in the lips, tongue (http://www.webmd.com/oral-health/picture-of-the-tongue), jaw, and eyelids. As the disease progresses, the tremor usually spreads to both sides of the body, although in some cases the tremor remains on just one side. Joint pain (http://www.webmd.com/pain-management/guide/joint-pain), weakness, and fatigue (http://www.webmd.com/a-to-z-guides/weakness-and-fatigue-topic-overview) may occur.

Slow movement, stiff muscles, and poor coordination may occur early on in the disease. Problems with fine motor skills can affect tasks such as writing, shaving (http://men.webmd.com/features/mens-shaving-products), or brushing teeth (http://www.webmd.com/oral-health/picture-of-the-teeth). Changes in handwriting are common. A person in the early stages of Parkinson's disease may move slowly and may not make normal, frequent posture adjustments.
Advanced disease As the disease progresses, problems with posture and balance develop. A person with Parkinson's disease tends to walk in a stooped manner with quick, shuffling steps.
After several years, as muscle stiffness and tremor increase, the person may become unable to care for himself or herself. Weak, stiff muscles eventually may confine the person to a wheelchair or bed.
People who have taken levodopa for several years may not only notice their symptoms getting worse but also may develop additional movement problems. These motor fluctuations (http://www.webmd.com/a-to-z-guides/parkinsons-disease-movement-problems-from-levodopa-topic-overview) can be reduced somewhat by making changes in the person's medicine, but they can be difficult to control and may further complicate treatment.
Dementia (http://www.webmd.com/hw-popup/dementia) may develop in up to one-third of people who have late-stage Parkinson's disease.2 (http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-references#zh1238)Dementia (http://www.webmd.com/alzheimers/guide/alzheimers-dementia) symptoms may include disorientation at night, confusion, and memory loss. Medicines that are used to treat Parkinson's disease can also contribute to this problem.


Nobody knows exactly what causes Parkinson's disease -- but scientists have some important clues.

Low levels of dopamine, a brain chemical (neurotransmitter) involved in controlling movement, cause symptoms of Parkinson's disease. The shortage of this brain chemical occurs when nerve cells in a part of the brain (substantia nigra) that produces dopamine fail and deteriorate. The exact cause of this deterioration is not known.

The links between Parkinson's disease and factors such as genetics, aging, toxins in the environment, and free radicals are all under investigation. Although these studies are beginning to provide some answers, experts do not know the exact cause of the disease.
Studies are ongoing to determine whether there is a genetic cause of Parkinson's disease. Only a small percentage of people with Parkinson's disease have a parent, brother, or sister who has the disease. But abnormal genes do seem to be a factor in a few families where early-onset Parkinson's disease is common.

Are you at Risk?

Who's at risk of Parkinson's disease? This article separates the facts from the fiction.

Risk factors for Parkinson's disease are hard to identify, because the cause of the disease is unknown. Advancing age is the only known risk factor for typical Parkinson's disease (not including early-onset Parkinson's). Most instances of Parkinson's disease occur after age 50, although the illness does occur in people between the ages of 30 and 50, or in rare cases at a younger age.

A very small number of people with Parkinson's have a close relative who also has the disease. But it does not appear that a family history of typical Parkinson's disease significantly increases your risk for the disease. Having a family history of the disease is a more significant risk factor in cases of early-onset Parkinson's disease, but this form of the disease is not common.

Some research suggests that long-term exposure to certain environmental factors such as pesticides, chemicals, or well water may increase a person's risk of developing Parkinson's disease. But this has not been proved.

There are many other causes of parkinsonism, which is a group of symptoms that includes tremor, muscle stiffness, slow movement, and unsteady walking. Parkinsonism mimics Parkinson's disease, but in fact is not Parkinson's disease.


Can Parkinson's disease be prevented? Click here to find out.

There is no known way to prevent Parkinson's disease (http://www.webmd.com/hw-popup/parkinsons-disease).
Research has shown that people who eat more fruits and vegetables (http://www.webmd.com/food-recipes/features/fruits-veggies-more-matters), high-fiber foods, fish, and omega-3 rich oils (sometimes known as the Mediterranean diet (http://www.webmd.com/heart-disease/tc/mediterranean-diet-topic-overview)) and who eat less red meat and dairy may have some protection against Parkinson's disease (http://www.webmd.com/parkinsons-disease/default.htm). But the reason for this is still being studied.4 (http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-references#zh1254)

10-02-2012, 10:52 AM
Symptoms & Types

While still brief and easy to read, these articles cover the details on the signs, symptoms, and stages of Parkinson's disease.


Click here for an excellent description of the symptoms of Parkinson's disease.
The type and severity of symptoms experienced by a person with Parkinson's disease (http://www.webmd.com/hw-popup/parkinsons-disease) vary with each individual and the stage of Parkinson's disease (http://www.webmd.com/a-to-z-guides/parkinsons-disease-classification-topic-overview). Symptoms that develop in the early stages of the disease in one person may not develop until later-or not at all-in another person.

Symptoms of Parkinson's (http://www.webmd.com/parkinsons-disease/guide/parkinsons-symptoms-types) disease typically begin appearing between the ages 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them.
A small number of people have symptoms on only one side of the body that never progress to the other side.

The most common symptoms include:

Tremor (http://www.webmd.com/hw-popup/tremor), or shaking, often in a hand, arm, or leg. Tremor caused by Parkinson's disease (http://www.webmd.com/parkinsons-disease/default.htm) occurs when the person is awake and sitting or standing still (resting tremor) and subsides when the person moves the affected body part.
Stiff muscles (rigidity) and aching muscles. One of the most common early signs of Parkinson's disease is a reduced arm swing on one side when the person is walking that is caused by rigid muscles. Rigidity can also affect the muscles of the legs, face, neck, or other parts of the body and may cause muscles to feel tired and achy.
Slow, limited movement (bradykinesia), especially when the person tries to move from a resting position. For instance, it may be difficult to get out of a chair or turn over in bed.
Weakness of face and throat muscles. Talking and swallowing may become more difficult, and the person may choke, cough, or drool. Speech becomes softer and monotonous. Loss of movement in the muscles in the face can cause a fixed, vacant facial expression, often called the "Parkinson's mask."
Difficulty with walking (gait disturbance) and balance (postural instability). A person with Parkinson's disease is likely to take small steps and shuffle with his or her feet (http://www.webmd.com/pain-management/picture-of-the-feet) close together, bend forward slightly at the waist (stooped posture), and have trouble turning around. Balance and posture problems may result in frequent falls. But these problems usually do not develop until later in the course of the disease.

Tremor is often the first symptom that people with Parkinson's disease or their family members notice. Initially, the tremor may appear in just one arm or leg or only on one side of the body. The tremor also may affect the chin, lips, and tongue (http://www.webmd.com/oral-health/picture-of-the-tongue). As the disease progresses, the tremor may spread to both sides of the body. But in some cases the tremor remains on just one side.
Emotional and physical stress tend to make the tremor more noticeable. Sleep (http://www.webmd.com/sleep-disorders/default.htm), complete relaxation, and intentional movement or action usually reduce or stop the tremor.
Although tremor is one of the most common signs of Parkinson's disease, not everyone with tremor has Parkinson's disease. Unlike tremor caused by Parkinson's disease, tremor caused by other conditions gets better when your arm or hand is not moving and gets worse when you try to move it. The most common cause of non-Parkinson's tremor is essential tremor (http://www.webmd.com/a-to-z-guides/differences-between-essential-tremor-and-parkinsons-disease-topic-overview), a treatable condition that is often wrongly diagnosed as Parkinson's disease.
Other symptoms
Parkinson's disease can cause many other symptoms (http://www.webmd.com/a-to-z-guides/parkinsons-disease-other-symptoms-topic-overview). These can be disabling and may include:

Decreased dexterity and coordination. Changes in handwriting are common, with writing becoming smaller. Athletic abilities decline, and daily activities such as dressing and eating become harder.
Cramps in the muscles and joints.
Oily skin (http://www.webmd.com/skin-problems-and-treatments/picture-of-the-skin) or increased dandruff.
Digestive and urinary problems. Constipation (http://www.webmd.com/digestive-disorders/digestive-diseases-constipation) is common. Controlling urination (incontinence (http://www.webmd.com/hw-popup/urinary-incontinence)) may be difficult, and urination may be frequent and at times urgent. Drugs (http://www.webmd.com/drugs/index-drugs.aspx) used to treat Parkinson's disease may help or may sometimes make these symptoms worse.
Problems with involuntary or automatic body functions, such as increased sweating, low blood pressure (http://www.webmd.com/heart/understanding-low-blood-pressure-basics) when the person stands up (orthostatic hypotension), and problems with sexual function (http://www.webmd.com/a-to-z-guides/parkinsons-disease-and-sexual-problems-topic-overview). These symptoms may also be caused by Parkinson's-plus conditions (http://www.webmd.com/parkinsons-disease/tc/parkinson-plus-syndromes-topic-overview) or drugs used to treat Parkinson's disease.
Freezing (http://www.webmd.com/a-to-z-guides/parkinsons-disease-and-freezing-topic-overview), a sudden, brief inability to move. It most often affects walking.

Problems with sleep, mood, and thought also are common in people who have Parkinson's disease.

Problems falling asleep or staying asleep (insomnia) can result from anxiety (http://www.webmd.com/anxiety-panic/default.htm), depression (http://www.webmd.com/depression/default.htm), or physical restlessness. People with Parkinson's disease may not be able to sleep well because they cannot easily turn over or change position in bed.
A person with Parkinson's disease may slowly become more dependent, fearful, indecisive, and passive. The person may talk less often than he or she used to, withdraw from family and friends, and remain inactive unless encouraged to move about. Depression is very common in people with this disease and can be caused by chemical changes in the brain (http://www.webmd.com/brain/picture-of-the-brain) or can be a reaction to having a disabling disease. Depression often improves with proper treatment.
Up to one-third of people with Parkinson's disease may develop dementia (http://www.webmd.com/hw-popup/dementia) and confusion, similar to Alzheimer's (http://www.webmd.com/alzheimers/default.htm) disease, late in the course of the disease. Depression can further contribute to memory loss (http://www.webmd.com/brain/memory-loss) and confusion. Memory loss, hallucinations (seeing or hearing things that aren't really there), and vivid dreams may sometimes be caused by drugs taken to treat Parkinson's disease.

There are many other conditions with similar symptoms (http://www.webmd.com/parkinsons-disease/other-conditions-with-symptoms-similar-to-parkinsons-disease). Some of these may be reversible.

Warning Signs

Here's when to call a doctor about Parkinson's disease.

Call911or other emergency services immediately if signs of a stroke develop suddenly. These may include:

Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
Sudden vision changes.
Sudden trouble speaking.
Sudden confusion or trouble understanding simple statements.
Sudden problems with walking or balance.
A sudden, severe headache that is different from past headaches.

The symptoms of Parkinson's disease develop slowly over months.

If you think you may have symptoms of Parkinson's disease, see your doctor. Urgent medical care is not needed if you have had a tremor for some time. But you should discuss the tremor at your next doctor's appointment. If a tremor is affecting your daily activities or if it is a new symptom, see your doctor sooner.

If you have been diagnosed with Parkinson's disease, call your doctor if:

You notice any significant change in your symptoms, such as severe episodes of freezing-a sudden loss of mobility-which may affect walking.
Your response to your medicine changes.
Any other symptoms occur.
You have symptoms of depression.
You or your family notice that you have problems with memory and thinking ability.

If you have been diagnosed with Parkinson's disease, you will need to see members of your health care team regularly (every 3 to 6 months, or as directed) for adjustments in your treatment as your condition changes.
Watchful Waiting

If you notice a tremor developing, watch and record its development. Discuss it with your doctor at the next possible opportunity. A written description will help your doctor make a correct diagnosis. In writing your description, consider the following questions:

Did the tremor start suddenly or gradually?
What makes it worse or better?
What parts of your body are affected?
Have there been any recent changes in the medicines you are taking or how much you are taking?

For more questions that will help your doctor make an accurate diagnosis, read about medical history and Parkinson's disease.
Who To See

The following health professionals can help diagnose or treat Parkinson's disease:

Family doctor

Other health professionals who may be involved in your care include:

Physical therapist.
Occupational therapist.
Speech therapist.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

10-02-2012, 10:53 AM
Diagnosis & Tests

These articles tell you how Parkinson's disease is diagnosed, and the tests your doctor may perform.

There's no precise test for Parkinson's disease. This article describes how doctors diagnose the condition.

A diagnosis of Parkinson's disease is based on your medical history and a thorough neurological exam. Your doctor also may check your sense of smell. Sometimes, your doctor will have you try a medicine for Parkinson's disease. If that medicine helps your symptoms, it may help the doctor find out if you have Parkinson's disease.

There are no lab tests that can diagnose Parkinson's disease. If your symptoms and the doctor's findings during the examination are not entirely typical of Parkinson's disease, certain tests may be done to help diagnose other conditions with similar symptoms. For instance, blood tests may be done to check for abnormal thyroid hormone levels or liver damage. An imaging test (such as a CT scan or an MRI) may be used to check for signs of a stroke or brain tumor.

Another type of imaging test, called PET, sometimes may detect low levels of dopamine in the brain, a key feature of Parkinson's disease. But PET scanning is not commonly used to evaluate Parkinson's disease because it is very expensive, is not available in many hospitals, and is only used experimentally.
Early detection

For some diseases, doctors can do tests to look for problems or diseases before you have any symptoms. This is called screening. But there is no screening test for Parkinson's disease at this time.

10-02-2012, 10:53 AM
Treatment & Care

Individual people with Parkinson's need individualized treatment and care. These brief and to-the-point articles offer important information and helpful tips.

Treatment Overview

Parkinson's disease can't be cured, but it can be treated. Learn more from this easy-to-read overview.
No known treatment can stop or reverse the breakdown of nerve cells that causes Parkinson's disease. But drugs can relieve many symptoms of the disease. Surgery also can be effective in a small number of people to treat symptoms of Parkinson's disease.

Treatment is different for every person, and the type of treatment you will need may change as the disease progresses. Your age, work status, family, and living situation can all affect decisions about when to begin treatment, what types of treatment to use, and when to make changes in treatment. As your medical condition changes, you may need regular adjustments in your treatment to balance quality-of-life issues, side effects of treatment, and treatment costs.

Parkinson's disease causes a wide range of symptoms and complications. This topic covers the overall management of the disease. This topic does not discuss managing specific symptoms.
Initial and ongoing treatment

If your symptoms are mild, you may not need treatment for Parkinson's disease. Your doctor may wait to prescribe treatment with drugs until your symptoms begin to interfere with your daily activities. Other treatment methods (such as exercise, physical therapy, and occupational therapy) can be helpful at all stages of Parkinson's disease to help you maintain your strength, mobility, and independence.

There are many measures you can take at home to make dealing with the symptoms of Parkinson's disease easier. Simplify your daily activities so that you have the energy for those that are most necessary. And arrange your furniture and other commonly used items so that it is easier for you to move around and get to things in your home. This can help keep you functioning independently.

Getting regular exercise and eating a healthy, balanced diet are important parts of treating Parkinson's disease. Exercise can help you keep your strength, coordination, and endurance as well as control your weight and reduce the likelihood that you will become constipated. And although a balanced diet is important, people who take levodopa should talk to their doctor about when to eat protein, because levodopa may not work as well if you take it at the same time that you eat protein.

Depression is common in people with Parkinson's disease. Recognizing and dealing with depression is an important part of home treatment. There are medicines that can help the symptoms of depression in people with Parkinson's disease. Your doctor, other health professionals, or Parkinson's disease support groups can help you get emotional support and education about the illness. This is important both early and throughout the course of the disease.

As Parkinson's disease progresses, the symptoms usually become more disabling. Most people develop mild to moderate tremor. Movement is often slow and limited due to muscular rigidity and the slowing down and loss of automatic and spontaneous movement (bradykinesia). Treatment in this stage is determined by weighing the severity of the symptoms against the side effects of drugs.

The symptoms of Parkinson's disease change as the disease progresses. Because of this, your doctor will adjust your drugs to deal with the symptoms as they appear. Levodopa is the most commonly used drug for Parkinson's disease. It works better than any other drug used to treat Parkinson's disease symptoms and has fewer side effects. But after using levodopa for over 5 years, many people start to have problems with motor complications (times when the medicine suddenly stops working or when you have uncontrollable jerking movements). Because of this, your doctor may prescribe dopamine agonists such as pramipexole or ropinirole to delay the point at which you need to begin taking levodopa. Studies have suggested that this may delay the onset of levodopa's side effects.3 But in the longest study done, people who started treatment with a dopamine agonist had just as many problems with motor fluctuations at 14 years as people who started treatment with levodopa.1 Your doctor may also prescribe levodopa along with a dopamine agonist.
Treatment when the condition gets worse

A person in the advanced stages of Parkinson's disease is significantly limited in movement and activity. Symptoms can change daily, and the side effects of drugs can limit their effectiveness. Your doctor may change your drug in order to deal with the symptoms as they arise.

A speech therapist can suggest breathing and speech exercises that can help you overcome the soft, imprecise speech and monotone voice that develop in advanced Parkinson's disease. Changing how and what you eat can help you overcome problems with eating. For example, sitting upright, taking small bites and sips, and eating moist, soft foods can help you avoid nutrition problems and lessen your chance of choking. Keeping your chin up, swallowing often, and not eating sugary foods can help reduce drooling.

Freezing, or motor blocks, can be dealt with through purposeful movement. Stepping toward a specific target on the ground and making your first step a precise, long, marching-style stride can help you overcome freezing episodes. A physical therapist or occupational therapist may be able to offer some helpful advice to improve your walking and reduce your risk of falling.

Other common symptoms that appear during Parkinson's disease include depression and sexual dysfunction. Talk to your doctor about ways to overcome these problems. There are medicines that can help these symptoms in people with Parkinson's disease.

You or your family members may notice that you begin to have problems with memory, problem solving, learning, and other mental functions. When these problems keep you from doing daily activities, it is called dementia. There are medicines that can help treat dementia in people with Parkinson's disease.

Surgeries such as deep brain stimulation may be done during this stage of the disease.

Home Treatment

Home care is essential for a Parkinson's patient. Click here to read this important overview.

Early on, Parkinson's disease may not greatly disrupt your life. But for most people, the disease becomes more disabling over time. Home treatment can help you adjust as the disease progresses and help you stay independent for as long as possible. The quality of your life may depend in part on your ability to continue working, take care of a home, care for your family, and remain independent. You may need adaptive devices such as canes or walkers as the disease progresses.

Aspects of home treatment that are important for a person with Parkinson's disease include:

Modifying your activities and your home, such as simplifying your daily activities and changing the location of furniture so that you can hold on to something as you move around the house.
Eating healthy foods, including plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products.
Exercising and doing physical therapy, which have benefits in both early and advanced stages of the disease.
Dealing with tremor, which may include putting a little weight on the hand to help reduce tremor and restore control.
Improving speech quality by working with a speech therapist (also called a speech-language pathologist).
Reducing problems with eating and drooling by changing how and what you eat.
Dealing with "freezing" by various means, such as stepping towards a specific target on the ground.
Dealing with sexual function problems. Talk to your doctor about your specific issues. He or she may be able to suggest a change in your treatment, such as a change in your medicine or exercise.
Dealing with depression. If you are feeling sad or depressed, ask a friend or family member for help. If these feelings don't go away, or if they get worse, talk to your doctor. He or she may be able to suggest someone for you to talk to or give you medicine that will help.
Dealing with dementia. Dementia is common late in Parkinson's disease. Symptoms may include confusion and memory loss. If you or a family member notice that you are confused a lot or have trouble thinking clearly, talk to your doctor. There are medicines that can help dementia in people with Parkinson's disease.


Medication can greatly relieve many of the symptoms of Parkinson's disease. Click here for an overview.

Medicines are the most common treatment for Parkinson's disease. The goal is to correct the shortage of the brain chemical (neurotransmitter) dopamine, which causes the symptoms of Parkinson's disease. Treatment with drugs is usually started when symptoms become disabling or disrupt a person's daily activities.

Drugs for Parkinson's disease are prescribed with specific instructions about when to take them. It is important to follow your doctor's instructions concerning how and when to take your drugs so that they will be effective and safe. Increasing, decreasing, or stopping the medicines you are taking may cause big changes in your symptoms and can be dangerous. Even if a medicine doesn't seem to be working, when you stop taking it, your symptoms of Parkinson's disease may be worse.

Treatments may differ based on a person's symptoms and age and how the person responds to a certain drug. Drugs often improve symptoms, but they also may cause side effects. It may take some time to find the best combination of drugs for a particular person.

Currently, levodopa is thought to be the most effective drug for controlling symptoms of Parkinson's disease and for many years was the preferred drug for treating newly diagnosed people.5 But because long-term use of levodopa at high dosages often leads to motor complications that can be difficult to manage, sometimes doctors use dopamine agonists (such as pramipexole and ropinirole) to treat people during the early stages of Parkinson's disease. Using these drugs in the early stages of the disease may allow treatment with levodopa to be delayed. But dopamine agonists have more side effects and don't control symptoms as well as levodopa. And in the long term, the same amount of people have motor complications no matter what medicine is used first.1

The decision about whether it is better to use levodopa or a dopamine agonist as the first treatment has not been fully resolved. The choice will most likely be different for each person. It is important to work with your doctor to find the medicines that work the best for you.
Medication Choices

Several drugs may be used to treat Parkinson's disease at different stages of the disease.

In general, treatment of early Parkinson's starts with one or more of these medicines:

Levodopa and carbidopa
Dopamine agonists (for example, pramipexole or ropinirole)
COMT inhibitors (entacapone, tolcapone)
MAO-B inhibitors (rasagiline, selegiline)
Anticholinergic agents (for example, benztropine or trihexyphenidyl)

Apomorphine. This medicine is a fast-acting dopamine agonist used for treating occasional episodes of immobility associated with Parkinson's disease. Apomorphine can be injected under the skin when muscles become "stuck" or "frozen" and you are unable to rise from a chair or perform daily activities.
What To Think About

Early in the disease, it might be helpful to take pills with food to help with nausea, which may be caused by some medicines taken for Parkinson's disease. Later in the disease, taking the medicines at least one hour before meals (and at least two hours after meals) may help them work best. Some medicines for Parkinson's disease don't work as well if you take them at the same time you eat food with protein in it, such as meat or cheese. The protein can block the medicine and keep it from working as well as it should.


There are surgical options for Parkinson's disease. Click here for information.

Brain surgery may be considered when drugs fails to control symptoms of Parkinson's disease or cause severe or disabling side effects.

Surgery is not a cure for Parkinson's disease. Drugs are usually still needed after surgery. But surgery can reduce the number and amount of drugs needed to control symptoms. This reduces the side effects caused by drugs while at the same time controlling symptoms.

Surgery Choices

Deep brain stimulation affects movement by using electrical impulses to stimulate a target area in the brain. The electrical impulses are generated by wire electrodes surgically placed in the brain. Deep brain stimulation may be used in addition to therapy with levodopa or other drugs when drugs alone do not control symptoms adequately. This technique is the preferred surgical method of treating most cases of advanced Parkinson's disease. It does not destroy brain tissue and has fewer risks than older, more destructive surgical methods, such as pallidotomy and thalamotomy.
Pallidotomy involves the precise destruction of a very small area in the deep part of the brain (the globus pallidus) that causes symptoms.
Thalamotomy involves the precise destruction of very small area in the deep part of the brain (the thalamus) that causes symptoms.

Neurotransplantation is an experimental procedure being studied for the treatment of Parkinson's disease. It involves implanting cells that produce dopamine into the brain. Information about the effectiveness of neurotransplantation is limited. And it is not a proven treatment or a realistic option for most people at this time.
What To Think About

A neurologist with special training in Parkinson's disease is most often the best kind of doctor to make a decision about surgery. If you might benefit from surgery or deep brain stimulation, your neurologist can refer you to a brain surgeon with experience doing these operations.

People who have extremely advanced Parkinson's or who have other serious conditions (such as heart or lung disease, cancer, or kidney failure) are not usually good candidates for surgery. Surgery is usually not considered for people who have dementia or psychiatric disorders.

(http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-other-treatment)Other Treatment

There's more to treating Parkinson's disease than drugs and surgery. Click here to learn more.
Physical therapy, speech and language therapy, and occupational therapy can all be helpful for people who have Parkinson's disease.

Several nutritional therapies have been suggested as treatments for Parkinson's disease. None of these has been proved effective. But it is important to maintain general health and to eat a balanced diet.

Before trying a complementary treatment, such as a special diet, talk with your doctor about the safety and potential side effects of the treatment. Talking with your doctor can help you both decide whether a treatment is safe and effective. Complementary treatments should not replace the use of drugs to treat Parkinson's disease if you are a candidate for treatment with these drugs.

Depression that does not respond to drugs may improve with electroconvulsive therapy (ECT). ECT can also improve movement for a short period of time, though the reason for this improvement is not understood.

In March 2007 the National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke (NINDS) announced that they are starting a large clinical trial to see if the nutritional supplement creatine can slow the progression of Parkinson's disease. Results from this study are expected in 5 to 7 years.


Parkinson’s and Diet

Click here to learn the basics of good nutrition for Parkinson's patients -- and for some clever tips on how to control some Parkinson's problems with diet.
While there is no special diet required for people with Parkinson's disease, eating a well-balanced, nutritious diet is extremely beneficial. With the proper diet, our bodies work more efficiently, we have more energy, and Parkinson's disease medications will work properly.

This article addresses the basics of good nutrition. Please consult your doctor or dietitian before making any dietary changes. A registered dietitian can provide in-depth nutrition education, tailor these general guidelines to meet your needs, and help you create and follow a personal meal plan.

The Basics of Eating Well

Eat a variety of foods from each food category. Ask your doctor if you should take a daily vitamin supplement.
Maintain your weight through a proper balance of exercise and food. Ask your doctor what your "goal" weight should be and how many calories you should consume per day.
Include high-fiber foods such as vegetables, cooked dried peas and beans (legumes), whole-grain foods, bran, cereals, pasta, rice, and fresh fruit in your diet.
Choose foods low in saturated fat and cholesterol.
Try to limit sugars.
Moderate your use of salt.
Drink eight 8 oz. glasses of water per day.
Ask your doctor about drinking alcoholic beverages (alcohol may interfere with some of your medications).

Parkinson's Medication and Food Interactions

The medication levodopa generally works best when taken on an empty stomach, about ½ hour before meals or at least one hour after meals. It should be taken with 4-5 oz. of water. This allows the drug to be absorbed in the body more quickly.

For some patients, levodopa may cause nausea when taken on an empty stomach. Therefore, your doctor may prescribe a combination of levodopa and carbidopa (called Sinemet) or carbidopa by itself (called Lodosyn). If nausea is a continual problem, your doctor may be able to prescribe another drug to relieve these symptoms. There are also tips listed below that can help relieve nausea.

Also, ask your doctor if you should change your daily protein intake. In rare cases, a diet high in protein limits the effectiveness of levodopa.
Controlling Nausea

There are several ways to control or relieve nausea, including:

Drink clear or ice-cold drinks. Drinks containing sugar may calm the stomach better than other liquids.
Avoid orange and grapefruit juices because these are too acidic and may worsen nausea.
Drink beverages slowly.
Drink liquids between meals instead of during them.
Eat light, bland foods (such as saltine crackers or plain bread).
Avoid fried, greasy, or sweet foods.
Eat slowly.
Eat smaller, more frequent meals throughout the day.
Do not mix hot and cold foods.
Eat foods that are cold or at room temperature to avoid getting nauseated from the smell of hot or warm foods.
Rest after eating, keeping your head elevated. Activity may worsen nausea and may lead to vomiting.
Avoid brushing your teeth after eating.
If you feel nauseated when you wake up in the morning, eat some crackers before getting out of bed or eat a high protein snack before going to bed (lean meat or cheese).
Try to eat when you feel less nauseated.

If these techniques do not seem to ease your queasy stomach, consult your doctor.

Relieving Thirst/Dry Mouth

Some Parkinson's disease medications may make you thirsty. Here are some tips for relieving thirst and dry mouth:

Drink eight or more cups of liquid each day. But, some people with Parkinson's disease who also have heart problems may need to limit their fluids, so be sure to follow your doctor's guidelines.
Limit caffeine (contained in coffee, tea, cola, and chocolate) as it may interfere with some of your medications and may actually make you more dehydrated.
Dunk or moisten breads, toast, cookies, or crackers in milk, decaffeinated tea or coffee to soften them.
Take a drink after each bite of food to moisten your mouth and to help you swallow.
Add sauces to foods to make them soft and moist. Try gravy, broth, sauce, or melted butter.
Eat sour candy or fruit ice to help increase saliva and moisten your mouth.
Don't use a commercial mouthwash. Commercial mouthwashes often contain alcohol that can dry your mouth. Ask your doctor or dentist about alternative mouthwash products.
Ask your doctor about artificial saliva products. They are available by prescription.

I Am Too Tired to Eat in the Evening, What Should I Do?

If you are often too tired to eat later in the day, here are some tips:

Save your energy. Choose foods that are easy to prepare. Don't waste all your energy in preparing the meal because then you'll feel too tired to eat.
Ask your family to help with meal preparations.
Check to see if you are eligible to participate in your local Meals on Wheels Program.
Keep healthy snack foods on hand such as fresh fruit and vegetables, pretzels, crackers, high-fiber cold cereals.
Freeze extra portions of what you cook so you have a quick meal when you're too tired.
Rest before eating so you can enjoy your meal.
Try eating your main meal early in the day so you have enough energy to last you for the day.

I Don't Feel like Eating, What Should I Do?

Here are some tips for improving poor appetite.

Talk to your doctor; sometimes, poor appetite is due to depression, which can be treated. Your appetite will probably improve after depression is treated.
Avoid non-nutritious beverages.
Eat small, frequent meals and snacks.
Walk or participate in another light activity to stimulate your appetite.

Here are some tips to help you eat more at meals.

Drink beverages after a meal instead of before or during a meal so that you do not feel full before you begin eating.
Plan meals to include your favorite foods.
Try eating the high-calorie foods in your meal first.
Use your imagination to increase the variety of food you're eating.

Here are some tips to help you eat snacks.

Don't waste your energy eating foods that provide little or no nutritional value such as potato chips, candy bars, colas, and other snack foods.
Choose high-protein and high-calorie snacks. High calorie snacks include: ice cream, cookies, pudding, cheese, granola bars, custard, sandwiches, nachos with cheese, eggs, crackers with peanut butter, bagels with peanut butter or cream cheese, cereal with half and half, fruit or vegetables with dips, yogurt with granola, popcorn with margarine and parmesan cheese, or bread sticks with cheese sauce.

How Can I Make Eating More Enjoyable?

Make food preparation an easy task. Choose foods that are easy to prepare and eat.
Make eating a pleasurable experience, not a chore. For example, liven up your meals by using colorful place settings and play background music during meals.
Try not to eat alone. Invite a guest to share you meal or go out to dinner.
Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing and appetizing.

Maintaining Your Weight With Parkinson's Disease

Malnutrition and weight maintenance is often an issue for people with Parkinson's disease. Here are some tips to help you maintain a healthy weight.

Weigh yourself once or twice a week, unless your doctor recommends weighing yourself more often. If you are taking diuretics or steroids, such as prednisone, you should weigh yourself daily.
If you have an unexplained weight gain or loss (2 pounds in one day or 5 pounds in one week), contact your doctor. He or she may want to modify your food or fluid intake to help manage your condition.

Here are some tips for gaining weight.

Ask your doctor about nutritional supplements. Sometimes supplements in the form of snacks, drinks (such as Ensure or Boost), or vitamins may be prescribed to eat between meals to help you increase your calories and get the right amount of nutrients every day. But, be sure to check with your doctor before making any dietary changes or before adding supplements to your diet. Some can be harmful or interfere with your medication.
Avoid low-fat or low-calorie products. (unless other dietary guidelines have been recommended). Use whole milk, whole milk cheese, and yogurt.

Here are some high-calorie recipes to try.
Chocolate Peanut Butter Shake

Makes one serving; 1090 calories per serving.


1/2 cup heavy whipping cream
3 tablespoons creamy peanut butter
3 tablespoons chocolate syrup
1 1/2 cups chocolate ice cream

Pour all ingredients into a blender. Mix well.
Super Shake

Makes one serving; 550 calories per serving


1 cup whole milk
1 cup ice cream (1-2 scoops)
1 package Carnation Instant Breakfast

Pour all ingredients into a blender. Mix well.
Super Pudding

Makes four 1/2 cup servings; 250 calories per serving.


2 cups whole milk
2 tablespoons vegetable oil
1 package instant pudding
3/4 cup nonfat dry milk powder

Blend milk and oil. Add pudding mix and mix well. Pour into dishes (1/2 cup servings).

(http://www.webmd.com/parkinsons-disease/guide/parkinsons-exercise)Parkinson’s and Exercise

Parkinson's disease is all about movement. Exercise helps. Get important tips here.

Because Parkinson's disease (http://www.webmd.com/parkinsons-disease/default.htm) affects your ability to move, exercise (http://www.webmd.com/fitness-exercise/guide/default.htm) helps to keep muscles strong and improve flexibility and mobility. Exercise will not stop Parkinson's disease from progressing; but, it will improve your balance and it can prevent joint stiffening.
You should check with your doctor before beginning any exercise program (http://www.webmd.com/fitness-exercise/guide/default.htm). Your doctor may make recommendations about:

The types of exercise best suited to you and those which you should avoid
The intensity of the workout (how hard you should be working)
The duration of your workout and any physical limitations
Referrals to other professionals, such as a physical therapist (http://www.webmd.com/content/article/46/1833_50752.htm) who can help you create your own personal exercise program

The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Generally, exercises that stretch the limbs through the full range of motion are encouraged.
Here are some tips to keep in mind when exercising.

Always warm-up before beginning your exercise routine and cool down at the end.
If you plan to workout for 30 minutes, start with 10-minute sessions and work your way up.
Exercise your facial muscles, jaw, and voice when possible: Sing or read aloud, exaggerating your lip movements. Make faces in the mirror. Chew food vigorously.
Try water exercise, such as water aerobics (http://www.webmd.com/fitness-exercise/tc/fitness-aerobic-fitness) or swimming (http://www.webmd.com/fitness-exercise/features/fitness-basics-swimming-is-for-everyone) laps. These are often easier on the joints and require less balance.
Work out in a safe environment; avoid slippery floors, poor lighting, throw rugs, and other potential dangers.
If you have difficulty balancing, exercise within reach of a grab bar or rail. If you have trouble standing or getting up, try exercising in bed rather than on the floor or an exercise mat.
If at any time you feel sick or you begin to hurt, stop.
Select a hobby or activity you enjoy and stick with it. Some suggestions include: gardening; walking (http://www.webmd.com/fitness-exercise/walking-for-wellness); swimming; water aerobics; yoga (http://www.webmd.com/balance/the-health-benefits-of-yoga); tai chi (http://www.webmd.com/balance/health-benefits-tai-chi-qigong).

10-02-2012, 10:54 AM
Living & Managing

Many, many people have lived with Parkinson's disease or cared for a Parkinson's patient. Take control: Find out what they have learned.
Living and Coping

10 Important Questions to Ask Your Doctor About Parkinson's Disease (http://www.webmd.com/parkinsons-disease/guide/questions-doctor-parkinsons)
There are 10 important questions to ask your doctor. Click here, print the list, and take it with you on your next doctor visit.
Day Plan for Parkinson’s (http://www.webmd.com/parkinsons-disease/guide/parkinsons-daily-activities)
Don't let Parkinson's disease overwhelm you. Here are some excellent tips on planning daily activities.
Parkinson’s Travel Tips (http://www.webmd.com/parkinsons-disease/guide/parkinsons-travel-guidelines)
Yes, you can travel if you have Parkinson's disease. It just takes some planning. Click here for useful tips.
Parkinson’s Counseling (http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-counseling)
Counseling can help you cope with Parkinson's disease. Click here to get started.
Parkinson’s: Home Preparation (http://www.webmd.com/parkinsons-disease/guide/parkinsons-home-safety)
Home is full of hazards for a person with Parkinson's. This important information will help you make your home safer.
Parkinson’s: Preventing Falls (http://www.webmd.com/parkinsons-disease/guide/preventing-falls)
Falls are a big risk for people with Parkinson's. Here's a great checklist for reducing this risk.
Related Web Site: Parkinson's Disability Benefits (http://www.webmd.com/click?url=http%3a%2f%2fwww.michaeljfox.org%2flivin g_additionalResources_disabilityInformation.cfm)
Disability benefits are a lifeline for the many people with Parkinson's who just can't keep on working. Here's helpful information from the Michael J. Fox Foundation.
Related Guide: A Caretaker's Story (http://www.webmd.com/content/chat_transcripts/1/103258.htm)
In this transcript of a WebMD live event, a man poignantly describes caring for his wife as they struggled with her Parkinson's disease.
Parkinson’s Disease: Driving a Car (http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-and-driving-a-car)
Parkinson’s disease is a type of movement disorder that can significantly impair driving skills, cause safety concerns, and force many patients to stop driving a car.

10-02-2012, 10:55 AM
Support & Resources
Fortunately, nobody has to deal with Parkinson's disease all by themselves. You aren't alone. Help, support, and advice are only a click away.
Finding Help Other Places to Get Help (http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-other-places-to-get-help)
There's a world of help out there for people with Parkinson's disease -- and for their caregivers. These links will take you there.
Tool: Parkinson's Physician Finder (http://doctor.webmd.com/physician_finder/home.aspx?sponsor=core)
Milly Kondracke had a secret weapon in her battle with Parkinson's: her husband, Morton. Mr. Kondracke shares his insights on caregiving here.

Resources References (http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-references)
Click here to see where our Parkinson's disease information comes from.
Credits (http://www.webmd.com/parkinsons-disease/guide/parkinsons-disease-credits)
These are the people responsible for the Parkinson's disease information in this guide.
Related Web Site: National Parkinson Foundation (http://www.webmd.com/click?url=http%3a%2f%2fwww.parkinson.org)
Click here to go to the National Parkinson Foundation, which provides information and support for people with Parkinson's disease
Related Web Site: American Parkinson Disease Association Inc (http://www.webmd.com/click?url=http%3a%2f%2fwww.apdaparkinson.org%2fuse r%2findex.asp)
Click here to go to the American Parkinson Disease Association Inc., a group that advocates for Parkinson's research.
Related Web Site: The Parkinson’s Institute (http://www.webmd.com/click?url=http%3a%2f%2fwww.parkinsonsinstitute.org %2f)
Click here to go to the Parkinson's Institute, dedicated to Parkinson's research.
Related Web Site: We Move (http://www.webmd.com/click?url=http%3a%2f%2fwww.wemove.org)
Click here to go to the We Move web site, a resource for people with Parkinson's disease and other movement disorders.

Related Web Site: Michael J. Fox Foundation (http://www.webmd.com/click?url=http%3a%2f%2fwww.michaeljfox.org%2f)