Parkinson's Disease Symptoms, Stages and Treatment

Illustration of Parkinson's Disease composite.

What Is Parkinson's Disease?

Parkinson's disease is a fairly common age-related and progressive disease of brain cells (brain disorder) that affect movement, loss of muscle control, and balance. Usually, the first symptoms include a tremor (hand, foot, or leg), also termed a "shaking palsy."

Photo of Muhammad Ali and Michael J Fox.

How Does Parkinson's Progress?

The majority of people develop Parkinson's disease after age 60 (although a few patients like Michael J. Fox develop it at an early age of about 30 and boxer Muhammad Ali at age 42). Men are about 1.5 times more likely to develop it than women. In general, the disease slowly progresses with more pronounced symptoms developing over many years. Although a few patients, especially those who develop it in their younger years may have more rapid symptom development, symptoms slowly increase over many years. Treatments may reduce symptoms in many patients.

Photo of broken pencil tip due to shaky handwriting caused by Parkinson's disease.

Early Signs of Parkinson's Disease

Three key symptoms that develop early in Parkinson's disease are a tremor, usually on one side of the body (hand, foot, arm, or other body part) when the person is at rest. The second symptom is rigidity, or resistance to movement when someone tries to move the person's joint or when the person has difficulty going from a sitting to a standing position. The third symptom is termed bradykinesia, or slowness, and small movements. Bradykinesia is seen in people that have small handwriting (micrographia) and decreased facial expression (the person often only has a somber or serious expression under most circumstances). This condition is termed a "masked face."

Illustration of trembling hands.

Parkinson's Symptom: Tremor

The tremors of Parkinson's disease usually occur first in a single extremity body part (finger, hand, foot) that is at rest in about 70% of patients; the tremor usually stops when the body part is in use by the person. The tremor is fast (4 to 6 cycles per second that shakes rhythmically). Some people will exhibit a fast "pill rolling" action that is a tremor between the thumb and index finger.

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Parkinson's Symptom: Bradykinesia

As stated above, bradykinesia can be an early symptom of Parkinson's disease. It is exemplified by slow initial movements, difficulty getting up from a sitting position, involuntarily slowing or stopping while walking, and little or no change in facial expressions that may seem inappropriate to people who do not know that the person has Parkinson's disease.

Photo of man having difficulty walking due to Parkinson's.

Parkinson's Symptom: Impaired Balance

As Parkinson's disease progresses, other symptoms related to muscles and movement may develop. Patients may develop a poor posture (stooped posture) with drooping shoulders, feet shuffling, and the head extended or jutting forward. This often leads to balance problems and falls.

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Parkinson’s Symptom: Rigidity

Again, since rigidity is a common symptom, muscle groups in affected extremities don't relax so crampy pain may occur. One sign of Parkinson's disease is that one arm may not swing back and forth normally when the person walks.

Photo of man with dementia and Parkinson's.

Symptoms Beyond Movement

The following are symptoms that some patient's with Parkinson's disease may develop especially as the disease progresses; not every patient will have some or all of these symptoms:

  • Bilateral tremors
  • Difficulty sleeping and fatigue
  • Oily skin and dandruff
  • Speech changes (soft voice, word slurring)
  • Constipation,
  • Swallowing problems
  • Mental changes (memory loss, easily confused, dementia)
Photo of a patient with Parkinson's being examined by a doctor.

Parkinson's Diagnosis

Diagnosis of Parkinson's disease is best accomplished by a specialist such as a neurologist. Most diagnoses are made presumptively by doctors by confirming most of the early symptoms listed above and by ruling out other conditions that may produce similar symptoms such as a tumor or stroke. The main things the doctor will look for are a tremor at rest and rigidity (involuntary) when the doctor moves the extremities. The doctor will often check your response to an unanticipated pull from behind. The doctor will tell you what will happen and protect you from a fall as he checks your ability to recover your balance.

There is no definitive test for the disease except for a biopsy of specific brain tissue that is only usually done at autopsy. Other tests (CT scan, MRI) may be used to help physicians distinguish between Parkinson's disease and other medical problems (for example, stroke, brain tumors).

Photo of elderly woman's hands.

Parkinson's or Benign Essential Tremor?

Essential tremors may be confused with the tremors in Parkinson's disease. However, essential tremors usually affect both extremities (hands) equally and get worse when the hands are used, in contrast to Parkinson's tremors. Also, Parkinson's tremors are reduced or temporally stopped with carbidopa-levodopa medication while essential tremors respond to other medications. Parkinson's disease does not usually occur in multiple family members but essential tremors do and are more common than Parkinson's tremors.

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Who Gets Parkinson's Disease?

As stated previously, men are about 1.5 times more likely to develop Parkinson's disease than women; however, although the majority of all patients that get the disease are over 60, the total chance of getting the disease is about 2% to 4% in this age group. Consequently, the disease is not rare but the chances of someone age 60 or over developing the disease is not high.

Photo of dopamine and the central nervous system.

Parkinson's Disease Causes?

Cells in the substantia nigra, a part of the brainstem that controls movement, slow down and then stop producing dopamine as the cells die. Dopamine helps nerve cells communicate about movement; without the dopamine, body commands about normal movement are disrupted resulting in Parkinson's disease because the brain does not receive the necessary messages about how and when to move. Unfortunately, the ultimate cause of Parkinson's disease, the reason that the cells in the brainstem become altered and die, is not known but researchers suggest that a combination of both genetic and environmental factors cause about 90% of all Parkinson's disease.

Photos of brain scans showing areas of the brain affected by Parkinson’s.

Parkinson's Disease Stages

Parkinson's disease is usually slowly progressive over time (years). The advancement is assessed by the symptom severity (Hoehn and Yahr Scale) and other measures such as mental function, behavior, mood, motor functions, and the ability to complete daily activities (self-maintenance, independence) as measured by the Unified Parkinson's Disease Rating Scale. These evaluations give physicians clues as how to best manage and treat the individual.

Molecular model diagram of levodopa.

Parkinson’s Treatment: Levodopa

Levodopa, in the form of carbidopa and levodopa combined in a single tablet, has been the most effective medication to reduce or temporarily stop Parkinson's disease symptoms. The brain tissue converts this drug to dopamine. However, over time (about 6 years) the symptomatic reduction caused by the drug starts to fade and higher doses and other medications may be added. In addition, side effects of levodopa may develop (nausea, vomiting, mental changes, and involuntary movements), especially with use over years. These side effects can be reduced by slowly increasing the medication dose over time.

Photo of syringe being filled with dopamine agonist.

Parkinson's Treatment: Dopamine Agonists

Although carbidopa-levodopa is the usual first-choice drug to treat Parkinson's disease, other drugs that mimic the action of dopamine, termed dopamine agonists, may be used when the effects of carbidopa-levodopa wane. Such drugs as Apokyn, Mirapex, Parlodel, and Requip are used; these drugs have side effects similar to carbidopa-levodopa (for example, nausea, vomiting, and psychosis).

Photo of Parkinson's medication.

Parkinson's Treatment: Other Medications

Some drugs are used in combination with carbidopa-levodopa to either inhibit dopamine breakdown by the body or to improve the effectiveness of carbidopa-levodopa. Azilect, Eldepryl,and Zelapar inhibit dopamine breakdown while Entacapone and Tasmar can improve the effect of carbidopa-levodopa.

A color X-Ray showing electrodes in the thalamus.

Parkinson's Surgery: Deep Brain Stimulation

Another treatment method, usually attempted as effectiveness of medical treatments for Parkinson's disease wane, is termed deep brain stimulation. The technique involves surgery to implant electrodes deep into the brain in the globus pallidus, thalamus, or the subthalamic nucleus areas. Then electric impulses that stimulate the brain tissue to help overcome tremors, rigidity, and slow movements are given. Impulses are generated by a battery. This surgery is not for every Parkinson's disease patient; it is done on patients that meet certain criteria. Also, the surgery does not stop other symptoms and does not end the progression of the disease.

Photo of surgeons performing Parkinson's brain surgery.

Parkinson's Surgery: Pallidotomy and Thalamotomy

Another type of surgery used when symptoms are poorly responsive to medications is brain surgery that either removes or destroys brain tissue. The techniques are termed pallidotomy and subthalamotomy. The techniques usually involve radiofrequency to destroy small areas of brain tissue. Some patient's symptoms can be reduced by these techniques but they do not reduce all symptoms and some patients suffer complications when brain tissue is irreversibly destroyed. Deep brain stimulation is replacing these treatments.

Photo of fruit and yogurt.

A Well-Balanced Diet for Parkinson's

As is the case for most medical problems, a well-balanced diet usually benefits the patient. Some of the individual symptoms of Parkinson's disease such as constipation can be treated with a high-fiber diet with increased fluids. Carbidopa-levodopa medication effects can be reduced by proteins in foods, but if the medication is taken with fluid about 30 minutes before a meal, the protein interference can be reduced or eliminated. Some patients may benefit from vitamin and mineral supplements.

Photo of bagel with lox and coffee.

Can Symptoms Be Prevented?

Currently, there is nothing that can prevent symptoms of Parkinson's disease although treatment can reduce symptoms. Statistically, people who drink coffee and smokers have a lower incidence of Parkinson's disease but they may develop other problems due to these habits (especially smokers). Since researchers speculate that about 90% of Parkinson's disease is due to a combination of genetic and environmental causes, avoiding certain environmental triggers may prevent some individuals from developing the disease. In addition, researchers are trying to find medications or supplements that can protect the brain cells that produce dopamine.

Photo of crop duster plane spraying chemical pesticide.

Environmental Toxins

As mentioned, environmental factors such as exposure to pesticides, herbicides, and other toxins, when exposed to people with genetic susceptibility, may increase the risk of developing Parkinson's disease. Statistically, people that live in rural areas, drink well water, are exposed to pesticides, herbicides, and pulp mills have a higher risk of developing the disease. In addition, researchers have demonstrated some drug side effects cause Parkinson's-like symptoms.

Photo of a dance class for people with Parkinson's.

Parkinson's and Exercise

A number of studies suggest that exercise helps reduce and delay the symptoms of Parkinson's disease. Tremor reduction, improved balance, and muscle coordination can be some of the benefits of exercise. Clinicians suggest that consistent exercise about 3 hours per week may provide a reduction in symptoms. Different exercises provide different benefits; exercises like yoga may improve balance while using a treadmill may improve leg strength and weights may help overall extremity strength and balance.

A photo of a woman with Parkinson's at physical therapy.

Living With Parkinson's Disease

Parkinson's disease, especially in the more advanced patients, often requires an adjustment in lifestyle. As symptoms progress, anxiety and depression are often experienced by the patient (and often their caregivers). Items in the home such as throw rugs, electrical cords, and slippery tile may need to be removed to reduce the risk of falls. Bathroom modifications such as handles or grab bars may be needed. The diet might need modification if swallowing or constipation becomes a problem. An occupational and speech therapist may help with other problems.

A caregiver helping a Parkinson's patient.

A Note for Caregivers

Caregivers can be challenged by the increasing needs of a declining Parkinson's patient. It is important that caregivers have a good concept of this progressive disease. Support groups (American Parkinson Disease Association, National Parkinson Foundation, and the Parkinson's Disease Foundation) are available to help caregivers understand the disease process and how to cope with the various problems they face in caring for a Parkinson's disease patient.

Additional Information on Parkinson's Disease

For more information about Parkinson's Disease, please consider the following:



  1. 3D4 Medical
  2. Mark Wilson/Getty Images News
  3. Stephen Marks/The Image Bank
  4. James Cavallini / Photo Researchers, Inc.
  5. EPA/POOL/Corbis
  6. Ed Kashi/Corbis
  7. Charles Ommanney/Getty Images News
  8. Ed Kashi/Corbis
  9. Simon Fraser / Royal Victoria Infirmary, Newcastle upon Tyne / Photo Researchers, Inc
  10. Travis Price/Flickr Select
  11. Corbis
  12. Dennis Kunkel Microscopy, Inc. / Phototake, Roger Harris/Photo Researchers Inc
  13. James Cavallini Copyright © B.S.I.P. / Phototake, ) Pierre Bories Copyright © ISM / Phototake
  14. Leonard Lessin/Photo Researchers Inc
  15. ER Productions/Blend Images
  16. Snap Decision/Photographers Choice RF
  17. ISM/Phototake
  18. David M. Grossman/Phototake
  19. Gregor Schuster/Photographer's Choice
  20. Rita Maas/Food Pix
  21. Frank Whitney/The Image Bank
  22. Scott Hudson/Corbis
  23. Jim Prisching/Chicago Tribune/MCT via Getty Images
  24. John Lund/Photographer's Choice


  • eMedicineHealth: "Parkinson's Disease"
  • Medscape: "Parkinson Disease"
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