Parkinson’s disease

The signs of Parkinson's disease can vary a lot. The typical symptoms are:

• Abnormal movements (akinesia): Those affected can only move slowly. They might walk very hesitantly and only take short, increasingly small steps. It is hard for them to start moving – taking the first step is often particularly difficult. Once they are moving, it also becomes more difficult to stop again, for example to stand still on command. As the disease progresses, they stop swinging their arms when walking. Gripping objects with their hands becomes more difficult, and so do tasks that require a certain degree of dexterity like tying shoelaces. Due to reduced activity of the facial muscles, the face starts to seem mask-like over time. Speech becomes quiet and monotone, and swallowing also becomes harder.
• Muscle stiffness (rigidity): Especially the arms, legs and neck can become stiff and tense all the time. Even if somebody else tries to move the person's arms and legs, it’s hard or even impossible to move them, and they stiffen up even more during such attempts. This excessive tensing of the muscles often causes aches.
• Tremor at rest: Most people with Parkinson's have a tremor (involuntary shaking). It decreases when they move, and is particularly common in the hands. That causes people's handwriting to become smaller and less clear.

The symptoms are often more pronounced on one side of the body. Other possible effects of Parkinson's disease include bladder and digestion disorders, feeling light-headed and faint, increased oil secretion on the skin, difficulties concentrating, and depression.

There are different forms of the disease, depending on what is causing it. Idiopathic Parkinson's is the most common. "Idiopathic" means that no cause can be found. Parkinson's disease damages the nerve cells in the brain responsible for producing the chemical messenger dopamine. One of dopamine's tasks is to transmit electrical signals along the nerves from the brain to the muscles. These signals control our movements. The damage to these cells reduces the ability to begin or coordinate movements. This can result in difficulties keeping your balance, which increases the risk of falls and bone fractures.

But Parkinson's-like symptoms can also be caused by other disorders of the nervous system, such as dementia. Infections, tumors and medications like psychotropic drugs can also cause these kinds of symptoms.

In the overall population, about 1 to 2 out of 1,000 people have Parkinson's. It typically begins after the age of 50. The disease is much more common in older age: Around 20 out of 1,000 people over 70 are affected. It is somewhat more common in men than in women.

There are sometimes first signs of Parkinson's long before the disease is diagnosed. They are often not noticed at all or are considered to be a normal part of aging. For instance, fine motor skills typically deteriorate and handwriting changes. People sometimes lose their sense of rhythm, or their arms no longer swing when walking. Their facial expression often becomes more fixed and mask-like. Constipation, difficulty sleeping and mood swings are also common. Many people experience a deterioration or complete loss of their sense of smell.

It is not unusual for several years to pass between the first signs of Parkinson's and the diagnosis. The course of the disease varies greatly.

The symptoms usually come on gradually. Over time, movements become slower, muscles stiffer and tremors more intense. In early stages, medication can usually considerably improve the symptoms or even make them go away.

After about five to ten years, the symptoms often get worse again. That's because the brain cells are damaged further as the disease progresses. The effects of the medication are no longer strong enough and fluctuate a lot. People may sometimes move extremely slowly for a while and then move normally again. These are referred to as "off" and "on" phases. The disease can also cause involuntary movements, and people with Parkinson’s may occasionally flap their arms, smack their lips or make sudden, jerky movements. Other symptoms like speech difficulties, poor memory, bladder problems, hallucinations and depression can follow. Some people also develop dementia.

In later stages, people with Parkinson's need support with lots of everyday activities like eating and drinking, standing up and moving about, getting dressed and washing. They find it increasingly difficult to move, and some people can only speak very quietly or have trouble swallowing.

Doctors generally make a diagnosis following a physical examination and a detailed discussion of symptoms and medical history. It can be helpful for relatives or friends to go to the doctor with you because they might have noticed symptoms that you haven't noticed yourself. As well as a general physical examination, the doctor will test your reflexes, sensitivity (to pain or pressure, for example) and agility – for instance, whether your joints can be moved normally or if the muscles put up resistance.

To check if the diagnosis is correct, an L-Dopa test is sometimes performed. This test involves taking the medication L-Dopa (Levodopa) to see whether the symptoms improve. A rapid improvement is a sign of Parkinson's.

Particularly in the early stages, it's not easy to differentiate Parkinson's from other diseases. It is then a good idea to observe how symptoms develop for a while. Computed tomography (CT) or magnetic resonance imaging (MRI) scans are sometimes carried out, especially to rule out other diseases.

In the early stages of the disease – when the symptoms aren't causing problems – treatment is sometimes not necessary. If the symptoms get worse, medication can help by making up for the lack of dopamine. That can often relieve the symptoms. But because these medications can't stop the disease from progressing, they become less effective over time. Doctors then have to keep on adjusting the type and dose of the medication. For the medication to have a continuous effect, a special pump can be used. This releases the drug either under the skin or directly into the small intestine.

Occupational therapy is used to practice everyday movements and activities. Because people with Parkinson's disease can move their body less, their muscles become weaker. Special exercises and sports aim to help counteract that and improve movement and coordination. Speech therapy can be an option if your voice becomes quieter and your speech less clear.

If medication doesn't help to relieve the symptoms enough, deep brain stimulation is sometimes recommended. That involves surgery to implant electrodes in certain parts of the brain. They continuously send out electrical signals that influence muscle activity.

Parkinson's affects many areas of life, be it work, relationships, family or leisure activities. Even if everyday life only changes slightly in the early stages of the disease, many people affected are worried about losing their independence and needing nursing care. But it can be possible to continue leading a life that isn't restricted too much by the disease for a long time.

It is still a good idea to be prepared for a time when you will need more help, though. Good medical support is very important. Most people also cope better with their illness if they don't hide away, but rather talk to other people about it from the very beginning. It is also important to involve friends and family members if help is needed in everyday life situations.

Many people with Parkinson's say that staying as active as possible helps them. It is essential to know your own limits and to only ever do as much physical exercise, everyday activities and work tasks as you feel you are able to.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

There are many sources of support for people with Parkinson's, including support groups and information centers. You can use our list to help you find and make use of local services in Germany.