Болезнь Паркинсона

Parkinson's disease is a condition in which parts of the brain become progressively damaged over many years.

Symptoms of Parkinson's disease

The main symptoms of Parkinson's disease are:

• involuntary shaking of particular parts of the body (tremor)
• slow movement
• stiff and inflexible muscles

A person with Parkinson's disease can also experience a wide range of other physical and psychological symptoms.

These include:

• depression and anxiety
• balance problems (this may increase the chances of a fall)
• loss of sense of smell (anosmia)
• problems sleeping (insomnia)
• memory problems

Seeking medical advice

See a GP if you're concerned that you may have symptoms of Parkinson's disease.

They'll ask about the problems you're experiencing and may refer you to a specialist for further tests.

Causes of Parkinson's disease

Parkinson's disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson's disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.

Who's affected

Most people with Parkinson's start to develop symptoms when they're over 50, although some people with the condition first experience symptoms when they're under 40.

Men are slightly more likely to get Parkinson's disease than women.

Treating Parkinson's disease

Although there's currently no cure for Parkinson's disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible.

These include:

• supportive treatments, such as physiotherapy and occupational therapy
• medication
• in some cases, brain surgery

You may not need any treatment during the early stages of Parkinson's disease, as symptoms are usually mild.

But you may need regular appointments with your specialist so your condition can be monitored.

Outlook

As the condition progresses, the symptoms of Parkinson's disease can get worse and it can become increasingly difficult to carry out everyday activities without help.

Many people respond well to treatment and only experience mild to moderate disability, whereas the minority may not respond as well and can, in time, become more severely disabled.

Parkinson's disease does not directly cause people to die, but the condition can place great strain on the body, and can make some people more vulnerable to serious and life-threatening infections.

But with advances in treatment, most people with Parkinson's disease now have a normal or near-normal life expectancy.

It may also be useful to read information and advice on: 

• getting a needs assessment

Parkinson's UK

They can help if you're living with the disease and let you know about support groups in the area.

You can contact them by:

• calling their free helpline on 0808 800 0303 (Monday to Friday, 9am to 6pm, and 10am to 2pm on Saturdays)

 Symptoms Parkinson's disease 

The symptoms of Parkinson's disease usually develop gradually and are mild at first.

There are many different symptoms associated with Parkinson's disease.

But the order in which these develop and their severity is different for each individual. 

It's unlikely that a person with Parkinson's disease would experience all or most of these.

Main symptoms

The main symptoms of Parkinson's disease affect physical movement:

• tremor – shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed and resting
• slowness of movement (bradykinesia) – physical movements are much slower than normal, which can make everyday tasks difficult and result in a distinctive slow, shuffling walk with very small steps
• muscle stiffness (rigidity) – stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions, and can result in painful muscle cramps (dystonia)

These main symptoms are sometimes referred to by doctors as parkinsonism.

Other symptoms

Parkinson's disease can also cause a range of other physical and mental symptoms.

Physical symptoms

• balance problems – these can make someone with the condition more likely to have a fall and injure themselves
• loss of sense of smell (anosmia) – sometimes occurs several years before other symptoms develop
• nerve pain – can cause unpleasant sensations, such as burning, coldness or numbness
• problems with peeing – such as having to get up frequently during the night to pee or unintentionally peeing (urinary incontinence)
• constipation
• an inability to obtain or sustain an erection (erectile dysfunction) in men
• difficulty becoming sexually aroused and achieving an orgasm (sexual dysfunction) in women
• dizziness, blurred vision or fainting when moving from a sitting or lying position to a standing one – caused by a sudden drop in blood pressure
• excessive sweating (hyperhidrosis)
• swallowing difficulties (dysphagia) – this can lead to malnutrition and dehydration
• excessive production of saliva (drooling)
• problems sleeping (insomnia) – this can result in excessive sleepiness during the day

Cognitive and psychiatric symptoms

• depression and anxiety
• mild cognitive impairment – slight memory problems and problems with activities that require planning and organisation
• dementia – a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there (visual hallucinations) and believing things that are not true (delusions)

When to seek medical advice

See your GP if you're concerned you may have symptoms of Parkinson's disease.

Your GP will ask about your symptoms and your medical history to help them decide whether it's necessary to refer you to a specialist for further tests.

 Causes Parkinson's disease 

Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.

Nerve cells in this part of the brain are responsible for producing a chemical called dopamine.

Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements.

If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced.

This means the part of the brain controlling movement cannot work as well as normal, causing movements to become slow and abnormal.

The loss of nerve cells is a slow process. The symptoms of Parkinson's disease usually only start to develop when around 50% of the nerve cell activity in the substantia nigra have been lost.

What causes the loss of nerve cells?

It's not known why the loss of nerve cells associated with Parkinson's disease occurs, although research is ongoing to identify potential causes.

Currently, it's believed a combination of genetic changes and environmental factors may be responsible for the condition.

Genetics

A number of genetic factors have been shown to increase a person's risk of developing Parkinson's disease, although exactly how these make some people more susceptible to the condition is unclear.

Parkinson's disease can run in families as a result of faulty genes being passed to a child by their parents. But it's rare for the disease to be inherited this way.

Environmental factors

Some researchers also feel environmental factors may increase a person's risk of developing Parkinson's disease.

It's been suggested that pesticides and herbicides used in farming and traffic or industrial pollution may contribute to the condition.

But the evidence linking environmental factors to Parkinson's disease is inconclusive.

Other causes of parkinsonism

"Parkinsonism" is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.

Parkinson's disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.

These include parkinsonism caused by:

• medication (drug-induced parkinsonism) – where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped
• other progressive brain conditions – such as progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration
• cerebrovascular disease – where a series of small strokes cause several parts of the brain to die

 Diagnosis Parkinson's disease 

No tests can conclusively show that you have Parkinson's disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination.

Your GP will talk to you about the problems you're experiencing and may ask you to perform some simple mental or physical tasks, such as moving or walking around, to help with the diagnosis.

In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild.

Referral to a specialist

If your GP suspects Parkinson's disease, you'll be referred to a specialist.

This will usually be:

• a neurologist, a specialist in conditions affecting the brain and nervous system
• a geriatrician, a specialist in problems affecting elderly people

The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.

Special brain scans, such as a single photon emission computed tomography (SPECT) scan, may also be carried out in some cases to try to rule out other causes of your symptoms.

Receiving the diagnosis

Being told you have Parkinson's disease can be emotionally distressing, and the news can often be difficult to take in.

This means it's important that you have the support of your family and a care team who'll be able to help you come to terms with the diagnosis.

You may find it useful to contact Parkinson's UK, the Parkinson's support and research charity.

You can contact them by:

• calling their free helpline on 0808 800 0303 (Monday to Friday, 9am to 7pm, and 10am to 2pm on Saturdays)

 Treatment Parkinson's disease 

There's currently no cure for Parkinson's disease, but treatments are available to help relieve the symptoms and maintain your quality of life.

These treatments include:

• supportive therapies, such as physiotherapy
• medication
• surgery (for some people)

You may not need any treatment during the early stages of Parkinson's disease as symptoms are usually mild.

But you may need regular appointments with your specialist so your condition can be monitored.

You might be offered a device to wear at home that monitors your symptoms. The device shares relevant information with your specialist.

A care plan should be agreed with your healthcare team and your family or carers.

This will outline the treatments and help you need now and what you're likely to need in the future, and should be reviewed regularly.

Supportive therapies

There are several therapies that can make living with Parkinson's disease easier and help you deal with your symptoms on a day-to-day basis.

Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment.

Physiotherapy

A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise.

The physiotherapist aims to make moving easier and improve your walking and flexibility.

They also try to improve your fitness levels and ability to manage things for yourself.

Occupational therapy

An occupational therapist can identify areas of difficulty in your everyday life, such as dressing yourself or getting to the local shops.

They can help you work out practical solutions and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible.

Speech and language therapy

Many people with Parkinson's disease have swallowing difficulties (dysphagia) and problems with their speech.

A speech and language therapist can often help you improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology.

Diet advice

For some people with Parkinson's disease, making dietary changes can help improve some symptoms.

These changes can include:

• increasing the amount of fibre in your diet and making sure you're drinking enough fluid to reduce constipation
• increasing the amount of salt in your diet and eating small, frequent meals to avoid problems with low blood pressure, such as dizziness when you stand up quickly
• making changes to your diet to avoid unintentional weight loss

You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks you may benefit from changing your diet.

Medication

Medication can be used to improve the main symptoms of Parkinson's disease, such as shaking (tremors) and movement problems.

But not all the medications available are useful for everyone, and the short- and long-term effects of each are different.

Three main types of medication are commonly used:

• levodopa
• dopamine agonists
• monoamine oxidase-B inhibitors

Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you.

Regular reviews will be required as the condition progresses and your needs change.

Levodopa

Most people with Parkinson's disease eventually need a medication called levodopa.

Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement.

Increasing the levels of dopamine using levodopa usually improves movement problems.

It's usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa.

These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain.

They also reduce the side effects of levodopa, which include:

• feeling and being sick
• tiredness
• dizziness

If you're prescribed levodopa, the initial dose is usually very small and will be gradually increased until it takes effect.

At first, levodopa can cause a dramatic improvement in the symptoms.

But its effects can be less long-lasting over the following years – as more nerve cells in the brain are lost, there are fewer of them to absorb the medicine.

This means the dose may need to be increased from time to time.

Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and "on-off" effects, where the person rapidly switches between being able to move (on) and being immobile (off).

Dopamine agonists

Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect compared with levodopa. They can often be given less frequently than levodopa.

They're often taken as a tablet, but are also available as a skin patch (rotigotine).

Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used.

Possible side effects of dopamine agonists include:

• feeling and being sick
• tiredness and sleepiness
• dizziness

Dopamine agonists can also cause hallucinations and increased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible.

For some people, dopamine agonists have been linked to the development of compulsive behaviours, especially at high doses, including addictive gambling, compulsive shopping and an excessively increased interest in sex.

Talk to your healthcare specialist if you think you may be experiencing these problems.

As the person themselves may not realise the problem, it's key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity.

If you're prescribed a course of dopamine agonists, the initial dose is usually very small to prevent feeling sick and other side effects.

The dosage is gradually increased over a few weeks. If feeling sick becomes a problem, your GP may prescribe anti-sickness medication.

A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep.

This generally happens as the dose is being increased and tends to settle once the dose is stable.

People are usually advised to avoid driving while the dose is being increased in case this complication occurs.

Monoamine oxidase-B inhibitors

Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson's disease. 

They block the effects of an enzyme or brain substance that breaks down dopamine (monoamine oxidase-B), increasing dopamine levels.

Both selegiline and rasagiline can improve the symptoms of Parkinson's disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists.

MAO-B inhibitors are generally very well tolerated, but can occasionally cause side effects, including:

• feeling sick
• headaches
• abdominal pain
• high or low blood pressure

Catechol-O-methyltransferase inhibitors

Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson's disease.

They prevent levodopa being broken down by the enzyme COMT.

Side effects of COMT inhibitors include:

• feeling or being sick
• diarrhoea
• abdominal pain

Non-oral therapies

When Parkinson's symptoms become difficult to control with tablets alone, a number of other treatments can be considered.

Apomorphine

A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) either by:

• a single injection, when required
• a continuous infusion using a small pump carried around on your belt, under your clothing or in a bag

Co-careldopa and foslevodopa-foscarbidopa

Co-careldopa and foslevodopa-foscarbidopa are possible treatments for severe Parkinson's.

They're medicines that are pumped continuously into your tummy through a tube.

There's an external pump attached to the end of the tube, which you carry around with you.

These medicines are only available if you have severe on-off fluctuations or involuntary movements.

Surgery

Most people with Parkinson's disease are treated with medication, although a type of surgery called deep brain stimulation is used in some cases.

This surgery is also available in specialist neuroscience centres around the UK, but it's not suitable for everyone.

If surgery is being considered, your specialist will discuss the possible risks and benefits with you.

Deep brain stimulation

Deep brain stimulation involves surgically implanting a pulse generator similar to a heart pacemaker into your chest wall.

This is connected to 1 or 2 fine wires placed under the skin, and is inserted precisely into specific areas in your brain.

A tiny electric current is produced by the pulse generator, which runs through the wire and stimulates the part of your brain affected by Parkinson's disease.

Although surgery does not cure Parkinson's disease, it can ease the symptoms for some people.

Treating additional symptoms

As well as the main symptoms of movement problems, people with Parkinson's disease can experience a wide range of additional symptoms that may need to be treated separately.

These include:

• depression and anxiety – this can be treated with self care measures such as exercise, psychological therapy or medication; read more about treating depression and treating anxiety
• problems sleeping (insomnia) – this can be improved by making changes to your normal bedtime routine; read more about treating insomnia
• erectile dysfunction – this can be treated with medication; read more about treating erectile dysfunction
• excessive sweating (hyperhidrosis) – this can be reduced using a prescription antiperspirant, or surgery in severe cases; read more about treating hyperhidrosis
• swallowing difficulties (dysphagia) – this can be improved by eating softened food, or by using a feeding tube in more severe cases; read more about treating dysphagia
• excessive drooling – this can be improved with swallowing exercises, or surgery or medication in severe cases
• urinary incontinence – this can be treated with exercises to strengthen the pelvic floor muscles, medication or surgery in severe cases; read more about treating urinary incontinence
• dementia – this can be treated with cognitive therapies and medication in some cases; read more about treating dementia

Clinical trials

Much progress has been made in the treatment of Parkinson's disease as the result of clinical trials, where new treatments and treatment combinations are compared with standard ones.

All clinical trials in the UK are carefully overseen to ensure they're worthwhile and safely conducted. Participants in clinical trials sometimes do better overall than those in routine care.

If you're asked if you want to take part in a trial, you'll be given an information sheet about the trial.

If you want to take part, you'll be asked to sign a consent form. You can refuse to take part or withdraw from a clinical trial without it affecting your care.

Complementary and alternative therapies

Some people with Parkinson's disease find complementary therapies help them feel better.

Many complementary treatments and therapies claim to ease the symptoms of Parkinson's disease.

But there's no clinical evidence they're effective at controlling the symptoms of Parkinson's disease.

Most people think complementary treatments have no harmful effects. But some can be harmful and should not be used instead of the medicines prescribed by your doctor.

Some types of herbal remedies, such as St John's wort, can interact unpredictably if taken with some types of medication used to treat Parkinson's disease.

If you're considering using an alternative treatment along with your prescribed medicines, check with your care team first.

 Living with Parkinson's disease 

A diagnosis of Parkinson's disease is life changing. You'll need long-term treatment to control your symptoms, and you may eventually have to adapt the way you do simple everyday tasks.

Everyone's experience of living with Parkinson's is different, but there are lots of issues and challenges shared by many people living with the condition.

You may find some of the advice below helpful if you have been diagnosed with Parkinson's disease.

Keeping well

It's important to do what you can to stay physically and mentally healthy if you have Parkinson's disease.

Exercise and healthy eating

Regular exercise is particularly important in helping relieve muscle stiffness, improving your mood and relieving stress.

There are many activities you can do to help keep yourself fit. If you're newly diagnosed or your symptoms are mild, you could try vigorous activities like team sports, cycling and running.

If your symptoms are complex or progressing, you can try less strenuous activities such as walking, or simple stretching and strengthening exercises.

You should also try to eat a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy.

Vaccinations

Everyone with a long-term condition is encouraged to get a yearly flu vaccination and COVID-19 vaccination each autumn.

Relationships and support

Being diagnosed with a long-term condition like Parkinson's disease can put a strain on you, your family and friends.

It can be difficult to talk to people about your condition, even if they're close to you.

Dealing with the deterioration of symptoms, such as increasing difficulty with movement, may make you feel frustrated and depressed.

Spouses, partners or carers will inevitably feel anxious or frustrated as well.

Be open about how you feel, and let your family and friends know what they can do to help.

Do not feel shy about telling them you need some time to yourself, if that's what you want.

Support

If you have any questions about your condition, your GP or Parkinson's disease specialist nurse may be able to help.

You may also find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your GP surgery will have details of these.

Some people find it helpful to talk to others with Parkinson's disease, either at a local support group or in an internet chat room.

Parkinson's UK

They can offer the support and advice you may need if you're living with Parkinson's disease, and can let you know about support groups in your local area.

You can contact them by:

• calling their free confidential helpline on 0808 800 0303 (Monday to Friday, 9am to 6pm, and 10am to 2pm on Saturdays)

Work and finances

Being diagnosed with Parkinson's does not mean you have to stop working. Many people with the condition keep working for years after their diagnosis.

You may find it hard to cope financially if you do have to stop work or work part-time because of your condition.

But you may be entitled to one or more of the following types of financial support:

• You may be eligible for other benefits if you have children living at home or if you have a low household income.

Driving

If you have been diagnosed with Parkinson's disease, you must inform the Driver and Vehicle Licensing Agency (DVLA) and your insurance company.

You will not necessarily have to stop driving. You'll be asked to complete a form providing more information about your condition, as well as details of your doctors and specialists.

The DVLA will use this to decide whether you're fit to drive.

Complex Parkinson's disease and palliative care

Complex Parkinson's disease is defined as the stage when treatment is unable to consistently control symptoms, or the person has developed uncontrollable jerky movements (disabling dyskinesia).

These problems can still be helped by adjustment or addition of some of the medications used to treat Parkinson's disease, under the supervision of a doctor with a specialist interest in Parkinson's disease.

As Parkinson's disease progresses, you'll be invited to discuss the care you want with your healthcare team as you near the end of your life. This is known as palliative care.

When there's no cure for an illness, palliative care tries to alleviate symptoms, and is also aimed at making the end of a person's life as comfortable as possible.

This is done by attempting to relieve pain and other distressing symptoms, while providing psychological, social and spiritual support for you and your family.

Palliative care can be provided at home or in a hospice, residential home or hospital.

You may want to consider talking to your family and care team in advance about where you'd like to be treated and what care you wish to receive.