Parkinson's Disease

Parkinson’s disease is a progressive neurological condition. It develops when nerve cells in a part of the brain stop working properly and produce less of a chemical messenger called dopamine.

Dopamine helps the brain control movement, so as the amount falls, movements can become slower, stiffer and harder to start. But Parkinson’s is not only about movement. It can also affect sleep, mood, thinking, digestion, bladder function, blood pressure, speech and swallowing.

“Progressive” means the symptoms usually develop gradually and change over time. How quickly that happens varies a great deal from person to person.

Parkinson’s affects people very differently, and not everyone develops every symptom. Two people diagnosed on the same day may have quite different experiences. With the right treatment and support, many people live full and active lives for many years.

The movement symptoms most often associated with Parkinson’s are:

• Shaking or tremor — often starting in one hand or arm while it is resting, and sometimes more noticeable when a person is tired or anxious.
• Slower movement — everyday tasks such as dressing, washing or getting out of a chair take longer than they used to.
• Muscle stiffness — arms, legs or the trunk feel tight or rigid, which can be uncomfortable and limit how far a joint will move.
• Changes in walking, posture or balance — smaller steps, shuffling, less arm swing, a stooped posture, or feeling unsteady and more prone to falls.
• Smaller handwriting — writing becomes cramped and gets smaller across a line or page.
• Reduced facial expression — the face may look blank or serious even when the person feels perfectly cheerful.
• Difficulties with speech or swallowing — a quieter or more monotone voice, slurred words, drooling, or coughing while eating and drinking.

Having a tremor does not automatically mean someone has Parkinson’s. Tremor is common and has many other causes, including essential tremor, anxiety, thyroid problems and the side effects of some medicines. Equally, some people with Parkinson’s never have a prominent tremor at all — slowness and stiffness are the main features for them.

Many people find these “non-motor” symptoms affect daily life just as much as the movement ones. They can appear years before a diagnosis. They include:

• Loss or reduction in the sense of smell.
• Sleep problems and daytime tiredness, including vivid dreams or acting out dreams.
• Constipation and other digestive changes.
• Pain, cramp or aching in muscles and joints.
• Depression, anxiety or apathy — a loss of motivation or interest.
• Memory or thinking difficulties, or trouble concentrating.
• Dizziness or faintness when standing up, caused by a drop in blood pressure.
• Bladder problems, such as urgency or needing the toilet often at night.
• Changes in speech or swallowing.

These symptoms are worth mentioning to a GP or the Parkinson’s team even if they seem unrelated. Many of them can be helped.

There is no single test that proves someone has Parkinson’s. A GP who suspects Parkinson’s will normally refer the person to a specialist — usually a neurologist, or a doctor specialising in the medicine of older people.

Diagnosis is normally based on the person’s symptoms, their medical history and a physical examination. The specialist will look at how the person moves, walks and holds themselves, and ask about how symptoms have changed over time.

Tests or brain scans are sometimes used, mainly to rule out other conditions that can cause similar symptoms rather than to confirm Parkinson’s itself. A review of current medicines may also be needed, as some can cause Parkinson’s-like effects.

It can take more than one appointment before a diagnosis is confirmed, and the specialist may want to see how symptoms change or how the person responds to treatment. That is normal and does not mean anything has gone wrong. Our GP Services page explains how appointments and referrals usually work.

There is currently no cure for Parkinson’s. However, treatment can control symptoms well for many years and help people stay independent, active and comfortable. Care is usually shared between a specialist, a GP and a range of therapists.

• Parkinson’s medicines — several types of medication can increase dopamine levels or mimic its effect, reducing slowness, stiffness and tremor. The specialist chooses and adjusts these to suit the individual. Timing matters a great deal.
• Physiotherapy — helps with movement, walking, balance, posture, stiffness and reducing the risk of falls.
• Occupational therapy — practical advice, equipment and adaptations so that washing, dressing, cooking, working and hobbies remain manageable.
• Speech and language therapy — support for a quiet or unclear voice and for problems with swallowing.
• Support with swallowing or diet — a dietitian or speech and language therapist can advise on safer eating and drinking, weight and constipation.
• Exercise and suitable physical activity — regular activity is one of the most helpful things for movement, mood and confidence. A physiotherapist can advise what is safe and appropriate.
• Mental-health support — depression, anxiety and apathy are common and treatable. Talking therapies and other support are available on the NHS.
• Specialist Parkinson’s nurses — a valuable point of contact for questions about symptoms, medication timing and day-to-day worries.
• Surgery, such as deep-brain stimulation — suitable for a small number of people whose symptoms are not well controlled by medicines. A specialist assesses whether it is appropriate.

Treatment decisions, including which medicines and when, are always made with the specialist team. This page does not give doses, and no one should start, stop or change treatment on their own.

You may also find our Physical Activity and Mental Health pages useful alongside this one.

Small practical steps can make a real difference:

• Keep an up-to-date medication list with names, strengths and exact times. Carry a copy and take it to every appointment or hospital admission.
• Use reminders — a phone alarm, a pill organiser or a written timetable — so medicines are taken on time, which matters more in Parkinson’s than in many other conditions.
• Reduce trip and fall hazards at home — clear clutter, secure loose rugs and trailing cables, improve lighting on stairs and landings, and consider grab rails.
• Ask for physiotherapy or occupational-therapy advice early rather than waiting for a crisis. A GP or the Parkinson’s team can refer.
• Plan extra time for getting up, dressing, meals and journeys so days feel less rushed.
• Seek help for changes in mood, memory, sleep or swallowing. These are part of the condition, not a personal failing, and support is available.
• Discuss driving with a healthcare professional. You must tell the DVLA (or DVA in Northern Ireland) if you are diagnosed with Parkinson’s — see GOV.UK — Parkinson’s disease and driving. Many people continue to drive safely for years.
• Support for family members and carers matters too. Carers can ask their local council for a carer’s assessment, and Parkinson’s UK runs a helpline and local groups for both people with Parkinson’s and those close to them.

If someone is coming out of hospital, our Care After Hospital page explains what support should be arranged, and our Find Local Services page can help you locate a GP, pharmacy or other local service.

• NHS — Parkinson’s disease
• NHS — Parkinson’s symptoms
• NHS — Parkinson’s diagnosis
• NHS — Parkinson’s treatment
• Parkinson’s UK — information and support
• Parkinson’s UK — current statistics
• NICE guideline NG71 — Parkinson’s disease in adults

Important notice: Sixpence Support UK provides general information only. This page is not a diagnosis, medical advice, or a substitute for assessment and treatment by a qualified healthcare professional. Always speak to a GP, pharmacist or another qualified health provider about your own symptoms, medicines and circumstances. In an emergency, call 999.