Parkinson’s: what are the symptoms?

Motor symptoms are typical of Parkinson’s disease, but others can be added, such as speech disorders.

Parkinson’s disease, also improperly called Parkinson’s disease, is a chronic disease with a progressive course that involves brain and motor functions, with important consequences on the quality of life.

As for its spread, it is the second most common degenerative disease of the nervous system after Alzheimer’sIn Italy, Parkinson’s disease affects about 250,000 people, with 6,000 new cases every year.

The incidence, which in the male sex is slightly higher than in the female one, is related to advancing age, which is why the number of patients is expected to increase significantly in the coming years.

The average age at diagnosis is around 60 years, but in about 10% of cases it occurs before the age of 50. Rarely the disease appears during childhood or adolescence; in cases with onset between 21 and 40 years of age we speak of early-onset Parkinson’s.

What is it?

The disease takes its name from the English physician James Parkinson who, in 1817, first observed and described it as a “shaking paralysis”. It is a neurodegenerative and slowly progressive disease. Onset is often imperceptible, but the course, although gradual, inevitably leads to cognitive decline and the appearance of immobility and severe disability.

The disease is due to the degeneration of neurons located in an area of the brain called the substantia nigra. Here are located the nuclei responsible for the release of dopamine, a neurotransmitter involved in various functions, including motor and cognitive ones, and in the mechanisms that regulate sleep, mood, memory and attention and which also has the effect of increasing nerve impulses to the muscles.

The compact part of the substantia nigra represents an important functional pathway of movement control: the progressive death of dopaminergic neurons causes the decrease in dopamine production. Hence the onset of problems with movement, posture, coordination and walking.

The appearance of symptoms corresponds to the loss of 70% of the neurons of the substantia nigra. Between the onset of neuron degeneration and the onset of symptoms, five years can pass, according to some studies.

Other conditions, such as cerebrovascular disease, trauma or the use of drugs that block dopamine receptors (such as antipsychotics), have characteristics similar to those of Parkinson’s disease and give rise to phenomena classified as “secondary parkinsonisms”.

Symptoms of Parkinson’s disease

The main motor symptoms of the disease are tremor, slowing of voluntary movements, muscle rigidity, slowness and postural instability.

Resting tremor, usually in one hand, which decreases during movement and disappears with sleep, is typical of the disease and is often the first symptom. This disorder involves thumb and forefinger, with movements similar to those put in place by those who “count coins”.

For 75% of patients, resting tremor may be the first symptom, while 20% of patients never develop it. From the hands, the tremor then extends to the arms and legs and is often most evident on only one side of the body.

Muscle stiffness makes movement difficult and can affect the limbs, neck and trunk. Along with decreased mobility it can contribute to muscle pain and fatigue.

Bradykinesia, or the slowdown in initiating voluntary movements with a progressive reduction in the speed and amplitude of execution, can interfere with many daily activities such as washing, dressing, walking, turning in bed or changing position. Bradykinesia is also related to other manifestations such as the modification of the handwriting, which becomes smaller, the increase in salivation due to the slowing of the muscles involved in swallowing and the modification of the expression of the face, which appears as a mask.

In the course of the disease, language disorders may appear such as a weakening of the voice (but not tremor), which will tend to be low and monotonous, and the tendency to repeat the first syllables of words. Sleep disorders in the REM phase, with agitation and even violent movements resulting from the dream, are present during the disease and can appear years before its onset.

Other motor symptoms that appear in more advanced stages are balance disorders, which become evident during walking and cause the risk of falls, and gait modification: the person assumes a fixed posture, flexed forward and proceeds with a gait similar to a run with a very short step.

Other symptoms and features of Parkinson’s disease are:

– the decrease in the sense of smell, in some cases present before the onset

– dystonia, a movement disorder characterized by involuntary muscle contractions, unusual in early onset but more frequent after levodopa therapy

– symptoms such as frequency and urgency of urination, but rarely incontinence, and constipation.

The disease can also induce a state of depression due to the reduction of certain neurotransmitters that control mood. About 20% of end-stage patients also experience dementia with memory impairment, confusion and visual hallucinations.

Causes of the disease

The causes of the disease have not been identified: it is believed to be due to a combination of genetic and environmental factors. In fact, about 20% of sufferers have a positive family history for the disease, so it is believed that family members of people with Parkinson’s disease have a slightly higher risk of getting sick than the general population. From an environmental point of view, the risk is linked to exposure to substances such as heavy metals, pesticides, solvents.

According to a recent theory, however, the origin of the disease could be to be found not in the brain, but in the intestine. In fact, some studies suggest the existence of a biological link between disease and intestinal microbiome: intestinal bacteria seem to play a key role in the accumulation of those proteins that cause the death of dopaminergic neurons and the consequent appearance of motor disorders. In addition, patients with Parkinson’s disease have an altered gut microbiome and tend to suffer from gastrointestinal disorders, such as constipation, for several years before the onset of the disease.


The diagnosis is made by the neurologist specialist based on the patient’s clinical history and the assessment of neurological symptoms. There are no instrumental examinations that can confirm it directly, but in some cases CT (computed tomography) or MRI (nuclear magnetic resonance), as well as more sophisticated neuroimaging evaluations, are used to identify structural alterations that could cause symptoms.In the elderly, diagnosis can be difficult because other conditions, first of all aging but also the use of certain drugs, can cause very similar symptoms. For example, essential tremor is ten times more frequent than Parkinson’s-induced tremor, from which it differs because it occurs during movement.

In case of doubtful diagnosis, doctors administer levodopa: a positive clinical response suggests the presence of Parkinson’s disease.

Treatment for Parkinson’s disease

To date, there is no definitive cure for Parkinson’s disease, which inevitably evolves towards disability and, for about 20% of patients, dementia with visual hallucinations, confusion and memory difficulties.

With drug therapy, however, it is possible to keep the symptoms under control for several years. The drug of choice is levodopa, a precursor of dopamine that is converted into dopamine in the brain. To counteract its side effects, preventing levodopa from being converted into dopamine in the blood, it is administered in combination with carbidopa.

Drug therapy is started immediately after diagnosis, but the introduction of levodopa is postponed until symptoms become such as to interfere with daily activities. Initially, therefore, the therapy involves the administration of antiparkinsonian drugs, dopamine agonists. These act like dopamine, stimulating the same receptors on brain cells.

Taking levodopa produces drastic improvements in people with Parkinson’s disease, reducing muscle stiffness and tremor and thus improving movement; Some patients return to near-normal activity levels, and those stuck in bed are able to walk again.

The response to therapy also depends on the age of the patient: in elderly patients the remission of symptoms lasts longer, while juvenile forms are generally more aggressive.

A frequent complication of levodopa therapy is dyskinesia, that is, the performance of involuntary movements of the mouth, face and limbs. Ten years after the start of therapy, most patients are affected.

The effectiveness of levodopa also decreases over time and after a few years of treatment patients become subject to phases during which a good response to the drug alternates with the total absence of response. This phenomenon is called the ON (motion release)/OFF effect (corresponding to sudden motor blocks).

Since the beginning of the 90s, the surgical technique of deep brain stimulation has been introduced. This technique, in selected patients, allows to alleviate the symptoms of the disease and complications related to drug therapy. Thanks to microelectrodes implanted in deep structures of the brain and connected to a neurostimulator, it is possible to modulate the activity of brain circuits involved in Parkinson’s disease. In addition to alleviating motor symptoms, deep brain stimulation is able to improve the patient’s quality of life and allows the reduction of drug therapy.

Finally, all patients are advised to practice regular physical activity. In addition to health in general, exercise can improve muscle strength, joint flexibility, coordination of movements, balance and gait with positive effects on the ability to perform normal daily activities.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

Leave a Reply

Your email address will not be published. Required fields are marked *