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Health Knowledge and Encyclopedia
At your local Pearn's Pharmacy we can offer advice on most general health matters. You can also use our Health Encyclopaedia to provide you with the tools and links you need to pinpoint symptoms and get a full explanation of a suspected condition.
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Parkinson’s disease is a condition in which part of the brain becomes progressively more damaged over many years (a progressive neurological condition).
The three main symptoms of Parkinson’s disease are related to movement:
A person with Parkinson’s disease can also experience a wide range of symptoms unrelated to movement (non-motor symptoms) such as:
Read more about the symptoms of Parkinson’s disease.
Treating Parkinson’s disease
There is currently no cure for Parkinson’s disease though a medication called levodopa has proved effective in relieving symptoms.
Unfortunately after around 3-5 years use the effectiveness of levodopa is reduced.
After this time people can experience a sudden return of symptoms (this is known as an ‘off episode’) as well an involuntary jerking of their muscles (dyskinesias). At this point additional medication is usually required.
There are also a range of non-pharmaceutical treatments that can be used to manage symptoms, such as speech and language therapy and physiotherapy.
Read more about the treatment of Parkinson’s disease.
What causes Parkinson’s disease?
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in the amount of a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body and this reduction in dopamine is responsible for many of the symptoms of Parkinson's disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
Read more about the causes of Parkinson’s disease.
Who is affected
It is estimated that around 1 in 500 people are affected by Parkinson’s disease and there are currently 127,000 people in the UK with the condition.
The average age for the symptoms to start is around 60; although around 1 in 20 cases first develop in people aged under 50.
Men are one-and-half times more likely to get Parkinson’s disease than women.
In the UK, the ethnic group most likely to develop Parkinson’s disease is white people. Rates are significantly lower in black and Asian people.
Parkinson’s disease is not fatal but the condition can place great strain on the body.
Some people respond well to treatments and only experience mild to moderate disability, while others experience severe disability.
Due to the advancements in treatment, people with Parkinson’s disease now often have a normal or near-normal life expectancy.
Parkinson’s UK is the country’s leading charity for people affected by Parkinson’s disease.
Their contact details are as follows:
Their website also contains a range of useful resources for people affected by Parkinson’s disease.^^ Back to top
The symptoms of Parkinson's disease usually begin slowly and develop gradually, often in no particular order.
Parkinson's disease affects people in many different ways with a variety of symptoms and responses to treatment. Severity of the symptoms also varies between people.
It would be unlikely for a person to experience all or most of the symptoms listed in this section.
Types of symptoms
Potential symptoms can vary widely but are within three broad categories:
Common motor symptoms
These three are the most common motor symptoms:
The most common initial symptom is uncontrollable shaking, known as tremor. Shaking usually begins in the hand or arm. It is more likely to occur when the limb is at rest and can be more noticeable when the patient is stressed, anxious or tired. Shaking usually decreases when the limb is being used.
The presence of a tremor does not necessarily mean that you have Parkinson's disease. Tremor is also a symptom of other conditions and is usually due to a harmless condition called essential tremor.
Slowness of movement (bradykinesia)
Parkinson's disease can make your physical movements much slower than normal, particularly when you try to start moving. The medical term for slowness of movement is bradykinesia.
People have reported that they try to move the affected body part at a normal speed but ‘the messages just seem not to get through’.
Often the first sign of bradykinesia is that you no longer swing one of your arms when walking.
Everyday tasks, such as buttoning clothes, writing with a pen and opening jars, can become difficult and time consuming.
Bradykinesia can affect your legs resulting in a distinctive slow and shuffling kind of walk with very small steps. And occasionally, in more advanced cases, a person can temporarily lose the ability to walk and their feet become ‘frozen to the floor’.
Bradykinesia can also affect the face and voice leading to a loss of normal facial expressions. A person also blinks less than usual.
Stiffness of muscles (rigidity)
People with Parkinson's disease also experience stiffness and tension in their arm and leg muscles. This is known as rigidity.
When examining people with Parkinson’s disease, doctors can feel two different types of rigidity:
‘cogwheel rigidity’ – where there is resistance in affected muscles followed by relaxation; as if you were rotating a cogwheel
Other motor symptoms
Some people with Parkinson’s disease can experience involuntary muscle cramps, spasms and contractions. These can occur independently but can also be a response to the dopaminergic drugs.
In cases of Parkinson’s disease dystonia usually affects the muscles in the calves and feet, though occasionally other parts of the body can be affected, such as:
Read more about dystonia.
In some cases of more advanced Parkinson’s disease a person loses much of their natural sense of balance. This is known as postural instability and can be a leading cause of falls and injuries.
Depression is thought to affect up to half of people with Parkinson’s disease and is thought to arise from a number of complex and inter-related factors, such as:
Signs you may be depressed include:
Depression can seriously impact on your quality of life; if it occurs discuss treatment with your GP.
Read more about depression.
Anxiety can also affect people with Parkinson’s disease especially once treatment with levodopa becomes less effective and they start to experience ‘off-episodes’ (a sudden return of their motor symptoms).
The sudden return of symptoms can make people feel anxious, and in the most serious cases, trigger a panic attack.
Read more about anxiety.
Mild cognitive impairment and dementia
If you are in the early stages of Parkinson’s disease you may experience what is known as mild cognitive impairment.
This means your pattern of thinking can become disrupted and you have problems with activities that require planning and organisation.
Around 40% of people with advanced Parkinson’s disease go on to develop a more severe form of cognitive impairment known as dementia.
Symptoms of dementia in people with Parkinson’s disease include:
Having both hallucinations and delusions and being unable to tell the difference between your imagination and reality is known as psychosis.
Read more about dementia.
Insomnia (problems sleeping) is thought to affect around half of those with Parkinson’s disease.
Periods of insomnia often come and go over the course of the disease.
Causes of insomnia are often complex. They can include changes to the brain, side-effects of some of the medications used to treat Parkinson’s disease, breathing difficulties during sleep, abnormal movement during sleep and the natural effects of aging.
Read more about insomnia.
This in turn can cause excessive daytime sleepiness and sudden dozing during the day. Some medications used to treat Parkinson’s disease can also make you feel drowsy during the day.
Your automatic nervous system is the part of your brain and nervous system that regulates functions of your body that you do not have to think about, such as breathing, swallowing, digesting food and passing urine.
The changes in brain chemistry that occur in Parkinson’s disease can disrupt many of these functions and cause the following:
Sense of smell
Often one of the earliest signs of the onset of Parkinson’s disease is a person losing some or all of their sense of smell.
In some cases this has occurred many years before a person develops Parkinson’s disease
Pain and Parkinson’s disease
Around half of people with Parkinson’s disease will experience repeated episodes of pain. This can take a number of forms, such as:
Loss of nerve cells
Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.
Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the brain and the nervous system, and helps control and co-ordinate body movements.
If these nerve cells become damaged or die, the amount of dopamine in the brain is reduced. This means that the part of the brain controlling movement cannot work so well, which causes movements to become slow and abnormal.
The loss of nerve cells is a slow process. The level of dopamine in the brain falls over time. Only when 80% of the nerve cells in the substantia nigra have been lost will the symptoms of Parkinson's disease appear and gradually become more severe.
It is not known why the loss of nerve cells associated with Parkinson's disease occurs.
Research is ongoing to identify potential causes.
In rare cases Parkinson's disease can run in families; in this situation abnormal genes are responsible, but the exact role genetics plays in causing ordinary (sporadic) Parkinson's disease is unclear.
So far at least nine genetic mutations have been identified as increasing a person’s risk of developing Parkinson’s disease (a genetic mutation is when the instructions carried in all living cells become scrambled in some way, meaning that one or more functions of the body does not work as it should).
However it is thought that in most cases genetics is not solely responsible for Parkinson’s disease and there needs to be an environmental factor to trigger it in genetically susceptible people.
Some researchers think that exposure to toxins (harmful chemicals) could be the environmental trigger. Possible toxins could include:
Arguably the most compelling evidence that toxins play a role is that drug users who injected themselves with a heroin substitute called MPTP went on to quickly develop symptoms similar to Parkinson's.
It was found that once MPTP crossed into the brain it started killing brain cells. It is possible other toxins could have a similar effect.^^ Back to top
No tests can conclusively show that you have Parkinson's disease. Your doctor will base a diagnosis on your symptoms, medical history and the results of a clinical examination.
Your GP will question you and may get you to perform a task or walk around. This will help with the diagnosis.
In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild.
If your GP suspects Parkinson's disease, you will be referred to a specialist (a neurologist or geriatrician). If your GP thinks you may be in the early stages of Parkinson’s disease, you should see a specialist within six weeks. If they think you may be in the later stages of Parkinson’s disease, you should see a specialist within two weeks.
The specialist will be likely to ask you to perform a number of physical exercises so they can assess whether you have any symptoms affecting movement (motor symptoms).
A diagnosis of Parkinson’s disease is likely if you have at least two of the three following symptoms:
The medication levodopa is often prescribed to help diagnose Parkinson’s or rule out other conditions.
If your symptoms rapidly improve after taking levodopa then it is highly likely you have Parkinson’s disease.
Receiving the diagnosis
Being told you have Parkinson’s disease can be emotionally devastating, and the news can often be difficult to take in. Therefore, at this time, it is important that you have the support of your family and care team who will be able to help you come to terms with the diagnosis.
You may find it useful to contact Parkinson’s UK which is the country’s leading charity for people affected by Parkinson’s disease.
Their contact details are:
Their website provides a range of useful resources as well as details of any support groups in your local area.
Brain imaging scans
An exception is a newer type of scanner called a DAT scan that uses radio-isotopes (a type of radioactive material) to measure dopamine levels in the brain.
These scanners are becoming more widely available in the NHS and used to support the diagnosis of Parkinson’s disease.^^ Back to top
What is good care for Parkinson’s disease?
The National Institute for Health and Clinical Excellence (NICE) has published a clinical guideline for Parkinson’s disease. The guideline provides comprehensive evidence-based information on the benefits and limitations of the various methods of diagnosing, treating and caring for people with Parkinson’s disease. This helps health professionals and patients decide on the most appropriate treatment.
The NICE guideline states that if you have Parkinson’s disease, a healthcare professional, such as a Parkinson’s disease specialist nurse, should provide you with help. They should:
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You may not need any treatment during the early stages of Parkinson's disease as symptoms are usually mild. However, you could require regular appointments with your specialist so your condition can be monitored.
At the moment, there is no cure for Parkinson's disease. However, numerous treatments are available to help control symptoms and maintain your quality of life. These may be supportive therapies that help you cope with everyday life, or medication to control your symptoms. For some people with a particular pattern of symptoms, surgery may be an option.
You should agree a care plan with your healthcare professionals and your family or carers, and this should be reviewed regularly.
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There are several therapies that can make living with Parkinson's disease easier and can help you deal with your symptoms on a day-to-day basis.
A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise. The physiotherapist aims to make moving easier and improve your walking and flexibility. They also try to improve your fitness levels and your ability to manage things for yourself.
An occupational therapist can identify areas of difficulty in your everyday life, for example dressing yourself or getting to the local shops. They can help you to work out practical solutions and ensure your home is safe and properly set up for you. This will help you carry on as normal for as long as possible.
Speech and language therapy
About half of people with Parkinson's disease have problems communicating, such as slurred speech or poor body language. If you have communication problems, a speech and language therapist can help you improve your speech and use of language. They may use vocal exercises or equipment to help you make yourself understood.
Some people with Parkinson’s can experience constipation (difficulty passing stools). This can be helped by increasing the amount of fibre in your diet and making sure you are drinking enough fluid. Fibre is found in fruit, vegetables and cereals. In the UK, you should be drinking six to eight glasses (1.2 litres) of fluid every day.
Another common problem is orthostatic or postural hypotension. This is low blood pressure when you change position, particularly after standing up too quickly. If you have orthostatic hypotension, your GP may advise that you increase the amount of salt and fluid in your diet.
Hypotension can also be helped by:
Around 50% of people with Parkinson’s disease will experience some unintentional weight loss. Your GP may refer you to a dietitian (a healthcare professional trained to give diet advice) if you may benefit from changing your diet.
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Medicines may be used to treat the symptoms of Parkinson’s disease. Not all medicines are useful for everyone, and the short and long-term effects of each are different. Three main types of medication are commonly used. These are levodopa, dopamine agonists and monoamine oxidase-B inhibitors. Most people with Parkinson's disease will eventually need to have levodopa, which may be taken at the same time as other medicines to boost its effects.
Each medicine is prescribed to suit the individual needs of the person taking it. Factors that can influence which medicine is prescribed include:
When people do not take their medication on time, or stop taking it completely, they can become very ill. If you have to go into hospital, tell the hospital staff about your medication. If you have a stomach bug or are vomiting, tell your GP as this may affect the levels of medicine in your body.
Your specialist can explain your medication options and discuss which may be best for you. Regular reviews will be required as the disease progresses and your needs change.
Levodopa is absorbed by the nerve cells in your brain and turned into dopamine. It is usually taken as a tablet or liquid. Levodopa is often combined with other medication, such as benserazide or carbidopa. These drugs stop the levodopa being broken down in the gut before it has a chance to get to the brain. They also reduce the side effects of levodopa, which include nausea, vomiting, tiredness and dizziness.
If you are prescribed levodopa, the initial dose will usually be very small and will be gradually increased until it takes effect. At first, levodopa can cause a dramatic improvement in the symptoms. However, it usually becomes less effective over time. This happens because as more nerve cells in the brain die, there are fewer of them to absorb the medicine. This means that the dose may need to be increased from time to time.
Long-term use of levodopa is linked to certain side effects. These include "on-off" effects, where you can suddenly switch between being able to move (on) and being immobile (off), and muscle problems that cause uncontrollable, jerky muscle movements (dyskinesias).
This is a specialist treatment used for patients with severe on-off swings. A tube is inserted through the abdominal wall into the gut. Levodopa gel is continuously fed through the tube by a mini-pump, which is worn on your belt. Only a few centres in the UK offer this treatment, which needs the support of your primary care trust to finance it.
Dopamine agonists act as a substitute for dopamine in the brain and have a similar effect to levodopa. They are used to treat early Parkinson’s disease as they are less likely to cause muscle problems (dyskinesias) than levodopa. They are often taken as a tablet, but can also be injected into a vein (intravenously). Sometimes, dopamine agonists are taken at the same time as levodopa. This allows lower doses of levodopa to be used.
Possible side effects of dopamine agonists include nausea, vomiting, tiredness and dizziness. Dopamine agonists can cause episodes of confusion or hallucinations, so they need to be used with caution, particularly in elderly patients who are more susceptible.
For some people, dopamine agonists, especially at high doses, have been linked to the development of compulsive behaviours, including pathological gambling, increased libido and hypersexuality. These are very complex disorders. Talk to your healthcare specialist if you think you may be experiencing them. As the person themselves may not realise the problem, it is key that carers and family members note any abnormal behaviour and discuss it with the appropriate professional at the earliest opportunity.
If you are prescribed a course of dopamine agonists, the initial dose will usually be very small to prevent nausea. The dosage is gradually increased over a few weeks. If nausea becomes a problem, your GP may prescribe anti-sickness medication, such as domperidone. You may need blood tests and a chest X-ray before some types of dopamine agonist are prescribed.
Monoamine oxidase-B inhibitors
Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson's disease. They block the effects of a chemical called monoamine oxidase-B in the brain. This chemical destroys dopamine. By blocking it, MAO-B inhibitors allow dopamine to last longer in the brain.
Both selegiline and rasagiline can improve the symptoms of Parkinson’s disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists.
MAO-B inhibitors can cause a wide range of side effects, including nausea, headache and abdominal pain, though not everyone will experience them.
Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson’s disease. They prevent levodopa from being broken down by the enzyme COMT.
Side effects of COMT inhibitors include nausea, vomiting, diarrhoea and abdominal pain. If the COMT inhibitor tolcapone is used, you will need liver tests every two weeks.
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Most people with Parkinson’s disease are treated with medication. However, surgery is sometimes used to treat long term patients.
This surgery is available in specialist centres around the UK. However, it is not suitable for everyone and your specialist will discuss the risks and benefits of this type of treatment with you.
Deep brain stimulation
Deep brain stimulation is a surgical technique sometimes used to treat Parkinson's disease. A pulse generator (similar to a heart pacemaker) is inserted in your chest wall and a fine wire placed under the skin and attached to your brain. A tiny electric current is produced from the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinson's disease.
Although surgery does not cure Parkinson's disease, it can ease the symptoms for some.
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Much progress has been made in the treatment of Parkinson’s disease due to clinical trials, in which new treatments and treatment combinations are compared with standard ones.
All clinical trials in the UK are carefully overseen to ensure they are worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.
If you are asked to take part in a trial, you will be given an information sheet about the trial and asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.
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Some people with Parkinson’s disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease. However, there is no clinical evidence they are effective.
Many people think complementary treatments have no harmful effects. However, they can be harmful, and as such it is a bad idea to use them instead of the medicines prescribed by your doctor. If you decide to use an alternative treatment along with your prescribed medicines, it is important to let your doctor know.
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A diagnosis of Parkinson’s disease is life changing. You will need long-term treatment to control your symptoms and you may have to adapt the way you do simple daily tasks.
Self-care is an integral part of daily life. It means you take responsibility for your own health and wellbeing with support from the people involved in your care. Self-care includes things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions.
People living with long-term conditions can benefit enormously if they receive support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent.
Because Parkinson’s disease is a long-term condition, you will be in regular contact with your healthcare team. A good relationship with the team will allow you to easily discuss your symptoms or concerns. The more the team knows, the more they can help you.
Everyone with a long-term condition such as Parkinson’s disease is encouraged to get a flu jab each autumn to protect against flu (influenza). They are also recommended to get an anti-pneumococcal vaccination, which protects against a serious chest infection called pneumococcal pneumonia.
Healthy eating and exercise
Regular exercise and a healthy diet are recommended for everyone, not just people with Parkinson’s disease. They can help prevent many conditions, including heart disease and many forms of cancer. Eat a balanced diet containing all the food groups to give your body the nutrition it needs. Exercising regularly can help relieve stress and reduce fatigue.
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As well as the symptoms caused by the condition itself, people with Parkinson’s disease may also experience other symptoms which need to be treated.
People with Parkinson’s disease often have depression. This is caused by the changes in the levels of chemicals in the brain. There are many different treatment options for depression. Discuss which is the best for you with your healthcare team.
Psychosis is a mental condition where somebody is unable to distinguish between reality and their imagination. Sometimes, medication you are taking to treat the symptoms of Parkinson’s disease can cause psychosis. As with all medication for Parkinson’s disease, do not stop taking it suddenly. If you have any concerns, talk to your healthcare team.
One in five people with Parkinson’s disease will develop dementia as they get older. Any treatment of dementia should take into account your Parkinson’s disease. Your healthcare team can discuss this with you.
Many people with Parkinson’s disease have problems with sleeping. You may be tired in the daytime, have difficulty moving at night or have problems with restless legs syndrome. If you have problems with sleep, talk to your healthcare team. They may suggest a change to your medicine(s) or there may be practical changes that can help.
Loss of stability in later stages of Parkinson’s disease can lead to falls. There are many ways to prevent falls. Your physiotherapist and occupational therapist may be able to help with this.
Coming to terms with a long-term condition such as Parkinson’s disease can put a strain on you, your family and friends. It can be difficult to talk to people about your condition, even if they're close to you.
Dealing with the deterioration of symptoms, such as increasing difficulty with movement and tremor, can make people with Parkinson’s disease feel very frustrated and depressed. Their spouse, partner or carer will inevitably feel anxious or frustrated too.
Be open about how you feel and let your family and friends know what they can do to help. Do not feel shy about telling them you need some time to yourself, if that is what you want.
If you have questions, your GP or Parkinson’s disease specialist nurse may be able to reassure you. You may find it helpful to talk to a trained counsellor or psychologist, or to someone at a specialist helpline. Your GP surgery will have details of these.
Some people find it helpful to talk to others with Parkinson's disease, either at a local support group or in an internet chatroom.
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Money and Financial Support
If you have to stop work or work part-time because of Parkinson’s disease, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support:
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If you have been diagnosed with Parkinson’s disease, you must inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance company.
You will not necessarily have to stop driving. You will be asked to complete a form providing more information about your condition as well as details of your doctors and specialists. The DVLA will use this to decide whether you are fit to drive.
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Advanced Parkinson's disease
As Parkinson’s disease progresses, you will be invited to discuss with your healthcare team the care you want as you near the end of your life.
What is palliative care?
Palliative care is the support and care of symptoms when no cure for the disease is possible, usually when the person is dying. Your doctor or nurse may suggest you see a specialist or nurse in palliative care, or a counsellor.
A palliative care team will focus on controlling your symptoms, keeping you as comfortable and pain-free as possible, as well as offering physical, psychological, spiritual and social support for you and your family.^^ Back to top
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