Parkinson’s Disease

More than 1 million people live with Parkinson’s Disease and approximately 60,000 Americans are diagnosed with PD each year.  The disease is named after the English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy, in 1817. Public awareness campaigns include World Parkinson’s Day (on the birthday of James Parkinson, 11 April) and the use of a red tulip as the symbol of the disease.

Parkinson’s disease is  a long-term degenerative disorder of the central nervous system that mainly affects the motor system and  affects the ability to perform common, daily activities.  The motor symptoms of the disease result from the death of cells in the substantia nigra, a region of the midbrain, leading to a dopamine deficit. The cause of this cell death is poorly understood, but involves the build-up of proteins into Lewy bodies in the neurons.

It is a chronic and progressive disease, meaning that the symptoms become worse over time. It is characterized by its most common of motor symptoms—tremors (a form of rhythmic shaking), stiffness or rigidity of the muscles, and slowness of movement (called bradykinesia)—but also manifests in non-motor symptoms including sleep problemsconstipation, anxiety, depression, and fatigue, among others.

To comprehend the natural progression of the disease, we should understand its five stages, as explained by the Parkinson’s Foundation.

Stage One

Individuals experience mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. They may also experience changes in posture, walking and facial expressions.

Stage Two

Symptoms worsen, including tremor, rigidity and other movement symptoms on both sides of the body. The person is still able to live alone, but daily tasks are more difficult and lengthier. 

Stage Three

This is considered mid-stage. Individuals experience loss of balance and slowness of movements. While still fully independent, these symptoms significantly impair activities such as dressing and eating. Falls are also more common by stage three.

Stage Four

Symptoms are severe and limiting. Individuals may stand without help, but movement likely requires a walker. People in stage four require help with daily activities and are unable to live alone.

Stage Five

Stiffness in the legs may make it impossible to stand or walk. The person requires a wheelchair or is bedridden. Around-the-clock nursing care is needed for all activities. The person may experience hallucinations and delusions.

While the cause of PD is unknown, it is believed to involve both inherited and environmental factors. Those with a family member affected are more likely to get the disease themselves. There is also an increased risk in people exposed to certain pesticides and among those who have had prior head injuries, while there is a reduced risk in tobacco smokers and coffee or tea drinkers.

Parkinson’s Disease typically occurs in people over the age of 60, of whom about one percent are affected. Males are more often affected than females at a ratio of around 3:2.When it is seen in people before the age of 50, it is called early-onset PD. The average life expectancy following diagnosis is between 7 and 15 years.

There is no cure for PD; treatment aims to improve the symptoms. Initial treatment is typically with the medication Levodopa (L-DOPA), followed by dopamine agonists when Levodopa becomes less effective.As the disease progresses, these medications become less effective, while at the same time producing a side effect marked by involuntary muscle movements.Diet and some forms of rehabilitation have shown some effectiveness at improving symptoms.

Below are 10 signs of Parkinson’s Disease.   No single one of these signs means that you should worry, but if you have more than one sign you should consider making an appointment to talk to your doctor.


Have you noticed a slight shaking or tremor in your finger, thumb, hand or chin? A tremor while at rest is a common early sign of Parkinson’s disease.

What is normal?
Shaking can be normal after lots of exercise, if you are stressed or if you have been injured. Shaking could also be caused by a medicine you take.



Small Handwriting

Has your handwriting gotten much smaller than it was in the past? You may notice the way you write words on a page has changed, such as letter sizes are smaller and the words are crowded together. A change in handwriting may be a sign of Parkinson’s disease called micrographia. 

What is normal?
Sometimes writing can change as you get older, if you have stiff hands or fingers or poor vision.


Loss of Smell

Have you noticed you no longer smell certain foods very well? If you seem to have more trouble smelling foods like bananas, dill pickles or licorice, you should ask your doctor about Parkinson’s.

What is normal?
Your sense of smell can be changed by a cold, flu or a stuffy nose, but it should come back when you are better.


Trouble Sleeping

Do you thrash around in bed or act out dreams when you are deeply asleep? Sometimes, your spouse will notice or will want to move to another bed. Sudden movements during sleep may be a sign of Parkinson’s disease.

What is normal?
It is normal for everyone to have a night when they ‘toss and turn’ instead of sleeping. Similarly, quick jerks of the body when initiation sleep or when in lighter sleep are common and often normal.


Trouble Moving or Walking

Do you feel stiff in your body, arms or legs? Have others noticed that your arms don’t swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem “stuck to the floor.”

What is normal?
If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.



Do you have trouble moving your bowels without straining every day? Straining to move your bowels can be an early sign of Parkinson’s disease and you should talk to your doctor.

What is normal?
If you do not have enough water or fiber in your diet, it can cause problems in the bathroom. Also, some medicines, especially those used for pain, will cause constipation. If there is no other reason such as diet or medicine that would cause you to have trouble moving your bowels, you should speak with your doctor.


A Soft or Low Voice

Have other people told you that your voice is very soft or that you sound hoarse? If there has been a change in your voice you should see your doctor about whether it could be Parkinson’s disease. Sometimes you might think other people are losing their hearing, when really you are speaking more softly.

What is normal?
A chest cold or other virus can cause your voice to sound different, but you should go back to sounding the same when you get over your cough or cold.


Masked Face

Have you been told that you have a serious, depressed or mad look on your face, even when you are not in a bad mood? This is often called facial masking. If so, you should ask your doctor about Parkinson’s disease.

What is normal?
Some medicines can cause you to have the same type of serious or staring look, but you would go back to the way you were after you stopped the medication.


Dizziness or Fainting

Do you notice that you often feel dizzy when you stand up out of a chair? Feeling dizzy or fainting can be a sign of low blood pressure and can be linked to Parkinson’s disease (PD).

What is normal?
Everyone has had a time when they stood up and felt dizzy, but if it happens on a regular basis you should see your doctor.


Stooping or Hunching Over

Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease (PD).




Creating a Safer Home for Seniors with Parkinson’s Disease

As a neurodegenerative brain disorder, Parkinson ’s disease (PD) affects an individual’s body movements, which in turn increases falling risks, especially for the elderly. Home safety becomes even more paramount for seniors living with Parkinson’s to ensure they age in place as long as possible without experiencing a debilitating injury.

If you need to create easier navigation and a safer home environment for seniors with PD, you need to remove obstacles in every room that increase falls risks. Here are some home safety tips from The Michael J. Fox Foundation for Parkinson’s Research and the Parkinson’s Foundation.

General Living Area Safety

  • Remove throw rugs as well as extension, phone and computer cords. Individuals with PD tend to shuffle their feet and may get tangled in them
  • Secure carpets. A softer surface can give your loved one more traction to get around the house
  • Secure furniture to ensure its stability
  • Make sure chairs have arm rests and adequate seat height to ease standing
  • Consider investing in an adjustable reclining chair that helps with standing
  • Rearrange furniture to widen openings and create a clear path around the home
  • Install night lights throughout the home with timers
  • Use touch lights or those that respond to sound
  • Install railings along stairs, walls and hallways
  • Check that smoke alarms and carbon dioxide detectors work in all rooms

Bathroom Safety for the Elderly

  • Add grab bars for shower safety for the elderly
  • Add non-skip strips to shower floor
  • Add a shower chair or bench with back support
  • Add seating at sink to perform daily grooming tasks
  • Remove throw rugs
  • Change a conventional toilet for an elevated version

Bedroom Safety

  • Remove clutter to make it a more relaxing space
  • Raise bed height so feet touch floor when seated at side of bed
  • Install a side rail or use a bed pole that helps with rising from the bed
  • Place a phone and flashlight on night stand
  • Add bright nightlights
  • Place a commode bedside for nighttime use

Kitchen Safety

  • Rearrange shelves to make commonly-used foods easily accessible
  • Replace cabinet knobs with handles that are easier to close and open
  • Place spices, pots and pans and other items frequently used for cooking by the stove
  • Add rubber-handled utensils that are easier to grip