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What Is Parkinson’s Disease?

Treatments and exercise can improve symptoms for people with this movement disorder

spinner image Close shot of a person with a hand tremor holding a glass of water and the glass is shaking
sruilk / Getty Images

Cathie Baker was 60 years old, heading west on the highway to her job in Seattle. As oldies played on the radio, her right hand, which was holding the wheel, suddenly jerked. Reflexively, Baker slowed down, worried she might lose control of the car in the middle of the morning rush. 

The jolt, which ended as quickly as it came, caught her off guard. But she knew what it was.

“I remember thinking, I can’t believe this is happening,” says Baker, now 71.

Baker’s late father had Parkinson’s disease. He never saw a doctor to treat his illness, and his decline was painful to watch. “But I never thought I would get it. I never even thought about it — until I was driving and my hand started tremoring.”   

A few days later, Baker had tremors in her right thumb. She went to her family doctor, who seemed not to take it seriously. “He kind of laughed and said, ‘Just because your dad had it doesn’t mean you have it,’” Baker recalls.  

But she knew something was wrong. When she mentioned her symptoms later in a routine gynecology visit, the doctor went through a sheet of screening questions.

Baker answered yes to the ones about a shuffling gait, balance problems, constipation and sleep disturbances. So the doctor said she needed to see a neurologist. The neurologist confirmed Baker was in the early stages of Parkinson’s disease. More than 10 years later, Baker credits her consistent, intensive exercise routine for playing a big part in keeping her symptoms from worsening so far.

spinner image Cathie Baker, whale watching in Hawaii in January, and with her granddaughter Hazel.
Cathie Baker, whale watching in Hawaii in January, and with her granddaughter Hazel.
Courtesy Cathie Baker

What is Parkinson’s disease?

Parkinson’s is a brain disease in which nerve cells, or neurons, in the brain die or become impaired. The damage progresses over time. 

“For reasons we don’t entirely understand, certain brain cells begin to die off before they otherwise would,” says Jori Fleisher, M.D., a movement disorder specialist and an associate professor of neurological sciences at Rush University.  “It’s different from normal aging.”  

These cells predominantly affect areas of the brain that control movement and cause the telltale symptoms, such as the tremor in Baker’s hand.

There is no simple blood test or imaging to diagnose Parkinson’s. Researchers recently developed a spinal fluid test and a skin biopsy test, but neither is used commonly and neither changes the course of care. For now, doctors look for physical signs and ask questions about common symptoms. Tremor is a common early sign of Parkinson’s, although about 25 percent of patients don’t experience tremors. Doctors also look for slowed movements, muscle stiffness, posture or speech changes. They may ask about common symptoms that aren’t related to movement as well, such as sleep or mood changes, constipation, smell loss, low blood pressure and urinary problems.

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What causes Parkinson’s disease?

Researchers haven’t completely figured out all that happens in the brain to cause Parkinson’s. But they know that affected brain cells accumulate too much of the protein alpha-synuclein. This clump of excess protein is called a Lewy body. The protein itself is normal and found in all healthy brains — usually at synapses, the connections between neurons.

“In Parkinson’s disease, for some reason, we think this protein goes awry,” says Rebecca Gilbert, M.D., a movement disorders specialist at NYC Health + Hospitals/Bellevue. It forms an aggregation that “sits in the cell and, we think, causes damage to that cell.” Much of the damage is in an area at the base of the brain called the substantia nigra, which makes dopamine, a chemical messenger that helps control muscle movements and is also involved in the body’s pleasure and reward centers. People with Parkinson’s can also have low levels of other messengers, including serotonin and norepinephrine, which may explain some of the symptoms that aren’t related to movement, including mood changes and low blood pressure.

Who is at risk?

About 90,000 U.S. adults 65 and older are diagnosed with Parkinson’s each year, according to a 2022 report in NPJ Parkinson’s Disease. Risk increases with age. Most people with Parkinson’s disease begin to notice symptoms around age 60, like Baker did.

As for what triggers the damaging brain changes that lead to the disease, gender and genes play a role; men are more likely to be diagnosed with the disease than women, and people with a sibling or parent with Parkinson’s, like Baker, have double the risk. However, Parkinson’s risk is still low, 2 to 4 percent for those with a family history and 1 to 2 percent for the general population.

spinner image A woman's hand being held out in front of her body
Catherine McQueen / Getty Images

Common symptoms of Parkinson’s disease involving movement

  • Shaking or tremor: typically starts on one side, in a finger, hand or arm, and happens at rest, when not engaged in activity
  • Slowed movement, called bradykinesia: taking longer to walk or do activities; struggling to get out of a chair or to do movements that typically happen in one swift action
  • Muscle stiffness anywhere in your body that might hurt and limit range of motion  
  • Changes in walking: shorter steps, foot shuffling or dragging; taking multiple steps to turn around
  • Poor posture and balance 
  • Loss of automatic movements, such as blinking, smiling or swinging the arms when walking
  • Speech changes: talking more softly or quickly, slurring, hesitating or speaking in a monotone 
  • Difficulty writing or writing smaller than previously

Environmental factors are important too. Exposure to various pesticides and other chemicals and pollutants can raise risk, as does a history of blows to the head.

For some people, the disease comes on at a younger age. At least 1 in 25 people who get Parkinson’s are younger than 50, according to the National Institute on Aging. Randy Devitt first noticed at 49 that his left hand could no longer keep up with his right when he tried to play “Linus and Lucy,” the Charlie Brown jazz classic, on the piano. An avid soccer player, he had been taking frequent spills on the field around that time, too. And when he walked, his arms didn’t swing. They hung stiff at his sides.

The disease tends to progress more slowly in people who get this early diagnosis. It also less often leads to memory and thinking changes important enough to affect daily life, a relatively common complication of later-onset Parkinson’s.

But getting Parkinson’s in middle age brings other challenges. “I was scared I was going to lose my job. That’s why I kept it ... close to my chest,” says Devitt, a firefighter when he was diagnosed. Firefighters may face higher risk for Parkinson’s, which may be due to exposure to hazardous chemicals and toxins, according to a 2022 study in the Journal of Basic and Clinical Pharmacy.

Devitt recalls various heavy chemical exposures throughout his life. He was exposed to industrial solvents as a firefighter, and even earlier, at his family’s service station, where he worked from age 13 through college.

In high school and college, Devitt was knocked unconscious multiple times playing soccer or football. “This was many years ago before the world started taking blows to the head more seriously,” he says. “It was called ‘getting your bell rung’ when it should have been labeled ‘repeated and cumulative brain damage as a result of violent trauma to the skull and brain.’”

Devitt plays modified, Parkinson’s-friendly “walking soccer” now.

How is Parkinson’s disease treated?

The main medications for Parkinson’s, such as combination carbidopa and levodopa, work by replacing the dopamine that’s lost when neurons important for movement die. Other medications, such as rotigotine (Neupro), may act like dopamine in the brain; selegiline (Zelapar) and similar drugs prevent the breakdown of dopamine in the brain.

The medications “do a pretty good job of controlling [movement] symptoms,” says Gilbert, who is also chief mission officer at the American Parkinson Disease Association. If symptoms get worse, the doctor might increase the dose, change the medication or add something.

spinner image Randy Devitt, an avid soccer player who was diagnosed with Parkinson's 18 years ago, leads a full, active life.
Randy Devitt, an avid soccer player who was diagnosed with Parkinson's 18 years ago, leads a full, active life.
Courtesy Leanne King Devitt

But whatever medications you take, Gilbert stresses, “They do not stop disease progression. They are only symptom modifiers.” Current research aims to find drugs that could slow or stop the progress of the disease.

Some people get good symptom control from medicine for several years, but eventually, as the disease progresses, the drugs may offer less benefit. Some of those people may be good candidates for a surgical treatment called deep brain stimulation. In this procedure, a surgeon implants an electrode deep in the brain to stimulate the area causing symptoms. It’s been described as a pacemaker for the brain, as it stays in place to offer regular stimulation of key brain areas.

Deep brain stimulation isn’t for everyone. It doesn’t work as well for balance or gait issues as it does for stiffness, slowness and tremor, Gilbert says. And it’s not recommended for people with dementia. But for patients who meet certain criteria, deep brain stimulation may relieve tremor, stiffness, slow movements, muscle spasms and involuntary movements. In a pivotal randomized controlled trial, the procedure offered more relief than medical therapy alone, significantly improving movement for 71 percent of patients versus 32 percent for those who got standard medical therapy, according to a 2009 report in JAMA.

Another surgical procedure, called focused ultrasound, may be an option for some, too. This procedure uses ultrasound waves to alter areas of the brain that cause movement symptoms. It’s currently available for use only on one side of the brain, which means it helps symptoms on only one side of the body. Research continues on this and other therapies, such as continuous, under-the-skin medication infusions, to better treat Parkinson’s as symptoms progress.

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The key role of exercise for symptom relief

Because Parkinson’s symptoms can start out minor and medications come with potential side effects, including additional movement problems or hallucinations, not everyone takes medicine right away.

“We balance how much a person needs the medicine with [the risk of] side effects,” Gilbert says.

At first, a person might only make lifestyle changes to help manage symptoms.

spinner image A woman sitting with a cane in her hands and looking away into the distance
fizkes / Getty Images

Parkinson’s affects more than movement

You might also have:

  • Anxiety, depression
  • Vision problems
  • Cognitive problems, dementia
  • Fatigue
  • Sleep trouble, including acting out dreams while sleeping
  • Excessive or not enough sweating, poor body temperature regulation
  • Low blood pressure
  • Constipation
  • Bladder control problems
  • Sexual dysfunction
  • Seeing or hearing things that aren’t there (hallucinations)
  • Loss of smell

“Exercise is one of the most powerful ways to change someone’s course with Parkinson’s,” Fleisher says. “Even if you are a never-exerciser, that’s OK. Start today.”

Baker says she started intensive workouts as soon as she learned she had the condition. Now, 11 years later, in addition to carbidopa-levodopa every day, Baker still exercises “like crazy.”

Her daily routine includes 100 pushups spread across the day; jumping rope; hula hooping; hitting a punching bag 200 times; and exercise classes.

“My neurologist said, ‘You are my slowest-progressing patient. I’m convinced it’s because of your crazy exercise,’” Baker says. “If you’re around me for a short period of time, you can’t even really tell that I have it.”

When it comes to movement symptoms, Parkinson’s seems to a be a “use-it-or-lose-it” kind of condition. Research suggests you may be able to hold onto your ability to move for longer if you keep moving. According to the Parkinson’s Foundation, 2.5 hours of physical activity per week can slow the progress of the disease.

“Newly diagnosed people often curtail their activity because they’re just traumatized,” Devitt says. “I’m lucky I’ve always enjoyed working out. For my money, exercise is absolutely the best thing you can do for Parkinson’s disease.” After 18 years with the disorder, he still plays soccer and water-skis.

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What can you expect with Parkinson's?

Your doctor might struggle to give you a clear answer about your future with Parkinson’s. Everyone has a unique experience.

“If you’ve met one person with Parkinson’s, you’ve met one person with Parkinson’s,” Fleisher says. Some people who have Parkinson’s do well for 30 years. But, she says, those with a more quickly progressing form of the disease might be disabled in less than 10 years.

You might meet regularly with a physical therapist or occupational therapist to help stave off new movement problems or learn to work around them.

Though it does progress over time and it can slightly lower life expectancy, Parkinson’s itself is not considered fatal. But two common complications of the disease — falls and pneumonia — can be. Falls are the leading cause of injury-related death in U.S. adults over 65, according to the Centers for Disease Control and Prevention. The balance problems that can come with Parkinson’s make falls more likely. The pneumonia risk comes from difficulty swallowing, a common problem in progressing Parkinson’s disease. Food or saliva going down the wrong pipe can cause an infection.

Your doctor and physical, occupational and speech therapists can help you manage and reduce both of these risks.

Devitt calls himself a living example of the possibilities of living a full life after a diagnosis. “Most people newly diagnosed, all they can think about is the end, crippled up in a wheelchair.... But there’s an amazing amount of life between now and then — if that ever happens.” His advice: “Keep moving, keep walking, keep exercising, keep socializing. I keep talking, I keep singing to keep my voice strong. I take control of everything I can.... You’ve got a lot of life to live despite your illness.”  

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