Parkinson's Disease: 10 Things Doctors Want You to Know

Medically Reviewed By William C. Lloyd III, MD, FACS

Written By Lorna Collier on December 27, 2020

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  Experts Speak Out About Parkinson's

  More Americans have Parkinson's disease than muscular dystrophy, multiple sclerosis and Lou Gehrig's disease (ALS) combined—about 1 million, with 60,000 new cases diagnosed every year. (The disease affects 1 in 100 of those over 60.) Parkinson's is a movement disorder, causing most people with it to have tremors, stiffness, difficulty walking and other problems. Symptoms worsen over time, and the disease is incurable. Yet experts in the field say treatments today have greatly improved quality of life for many patients, while new therapies on the horizon—even a possible vaccine—offer even more hope. Here’s what doctors who treat Parkinson's disease want you to know about the condition.
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  1. "Parkinson's is a very complicated illness with many different symptoms."

  "Parkinson's is the most complex disease in clinical medicine, period," says Michael Okun, MD, medical director for the Parkinson's Foundation and professor of neurology at the University of Florida. Dr. Okun says there is no other disease that has as many "motor and non-motor features"—with symptoms that are movement-related and others that are not—as well as "many intricacies in terms of treatment with medications and with surgical therapies."
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  2. "Tremors are common in Parkinson's—but not everyone gets them."

  "Tremor is the most commonly recognized sign of Parkinson's," says Melissa Nirenberg, MD, associate professor of neurology at New York University School of Medicine. "But some people with Parkinson's have no tremor (or very minimal tremor) and most people with tremor do not have Parkinson's disease." About 20% of people with Parkinson’s never get tremors, says Dr. Okun. "Just because you don't have a tremor doesn't mean you don't have Parkinson's." Other motor symptoms commonly seen include slowness, stiffness, shuffling gait, reduced facial expression, a quiet voice, and a handwriting that gets progressively smaller, says Dr. Nirenberg.
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  3. "Non-movement symptoms can be early warning signs of the disease."

  Researchers now recognize there are "very early manifestation signs which would make you at risk," says Miran Salgado, MD, a neurologist at New York Methodist Hospital. Dr. Salgado says symptoms such as loss of smell, depression, constipation, impotence and a type of sleep disorder where you act out your dreams can indicate the disease long before movement-related symptoms occur. Five or more years before a Parkinson’s diagnosis, "People will have been screaming and shouting in their dream sleep," says Dr. Salgado.
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  4. "Parkinson's disease has both genetic and environmental causes."

  "There are a number of different genes that have been associated with Parkinson's disease, and more are being discovered each day," says Dr. Nirenberg. Environmental factors also have been linked to the disease—especially exposure to pesticides, says Dr. Nirenberg. Dr. Okun notes that risk factors include rural living and consumption of well water (which could contain pesticides used in farming). Other risks, he says, are head injury, being male, and getting older (average age of onset is 60).
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  5. "Medication can bring dramatic improvement for many patients."

  Parkinson's is most often treated by drugs that replace dopamine, a chemical your brain needs to regulate your body's movement that is depleted with Parkinson's. "This is the gold standard treatment," says Dr. Okun. When the medication wears off, "Patients get stiff, slow, tremulous and have trouble walking," he says. But when the drug is restored, "It's like a miracle, like you see in the movie 'Awakenings,'" with a dramatic reversal of symptoms. About a dozen different kinds of drugs that replace dopamine are available, says Dr. Okun, and many more drugs are currently in development.
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  6. "Surgery, such as deep brain stimulation, can help late-stage patients."

  Some Parkinson's patients are helped by having electrodes planted in their brain; this treatment is generally used for late-stage Parkinson's patients, says Dr. Salgado. Other surgical treatments include implantable dopamine pumps, notes Dr. Okun. These deliver medication directly to the small intestine—an improvement over having to take numerous pills by hand, which can be difficult for advanced Parkinson's patients. Between medication and surgery, "There is more hope now for better quality of life [for Parkinson's patients] than there was years ago," says Dr. Salgado.
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  7. "Exercise can help you stay better longer."

  "Exercise is like a drug for Parkinson's," says Dr. Okun. "Exercise is astounding therapy and there are multiple studies now showing things like tai chi, yoga, stretching and other types of exercise are beneficial.” Indeed, says Dr. Nirenberg, "Exercise has been shown to slow the progression of symptoms." Any type of exercise, she says, is helpful, including walking, stretching, tai chi, yoga and using a recumbent bicycle, as well as an exercise program called LSVT-BIG that is designed specifically for Parkinson’s patients.
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  8. "Drink up: A cup of java can help you fight Parkinson’s symptoms."

  Dr. Salgado advises patients to "drink a few cups of coffee every day." This is because coffee has been shown to improve movement-related symptoms of Parkinson's. Research also shows drinking caffeine may help prevent people from getting the disease in the first place. Dr. Salgado also suggests some patients might find omega-3 fatty acids—"or anything that is antioxidant"—to be helpful. Omega-3 fatty acids are found in fish, among other sources, while antioxidants occur in fruits and vegetables.
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  9. "Look for Parkinson’s specialists—they’re rare but essential."

  Because Parkinson's is such a complex disease, special training to treat it is required—and not all neurologists receive this. In fact, only about 40 to 50 are trained each year, says Dr. Okun. Patients should seek out specialists in their area by checking with the Parkinson's Foundation or at university medical centers. "It's important if possible to try to at least get a doctor with some expertise to make sure the diagnosis is right and to make sure the treatment regimens are reasonable," Dr. Okun says. Patients can then continue their care with a local neurologist.
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  10. "New drugs, and maybe a vaccine, could be here soon."

  Researchers are working to slow, if not reverse the course of Parkinson's—and possibly cure it altogether, though that goal is "a little further out," says Dr. Okun. Targeted treatments are in the works, he says, "precision medicine" that will let doctors focus on each individual patient’s underlying causes of the disease rather than “looking at every Parkinson’s patient as the same." Vaccine research also is progressing, Dr. Okun says, with two studies now in human trials, including one at the University of Florida where he is based. "There’s a lot of hope that this could be a very nice approach," Dr. Okun says.

Parkinson's Disease: 10 Things Doctors Want You to Know

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