
What Is Parkinsonâs Disease?
Parkinsonâs disease is a progressive neurological disorder that affects your bodyâs ability to produce dopamine, a chemical found in your brain that helps you initiate and control your movements. This causes symptoms like uncontrollable shaking in your limbs (known as a tremor), slow movement, a rigid, stiff feeling in your body, unsteady gait and posture, as well as symptoms unrelated to movement like loss of smell, constipation, difficulty sleeping, fatigue, cognitive challenges and blood pressure issues. Parkinsonâs most frequently develops in people over age 50, but can also appear in younger individuals, too.
Learn More About Parkinsonâs Disease:Â Overview |Â Symptoms | Diagnosis | Treatment | Resources
Medically reviewed by Kristin Andruska, M.D., Medical Director of the Parkinsonâs Institute and Clinical Center
What Causes Parkinsonâs Disease? | Who Gets Parkinsonâs Disease? | Why Do People Get Parkinsonâs Disease? | Is Parkinsonâs Disease Hereditary? | Celebrities With Parkinsonâs Disease | Long-Term Outlook of Parkinsonâs Disease | Parkinsonâs Disease Statistics
You might feel stiff, like itâs hard to move your muscles, and maybe you have uncontrollable shaking in one or more of your limbs or fingers. You might also feel fatigued and have difficulty feeling motivated to get up. Everyday tasks like brushing your teeth, putting on your clothes, cooking and driving a car might be a struggle due to the stiffness and slowness of your muscles. Perhaps family members have noticed you donât swing one of your arms when you walk.
Feeling unsteady when you walk and feeling like you canât move as quickly as you want could be everyday occurrences along with other challenges like constipation, chronic pain, difficulty sleeping and concentrating, a weak sense of smell, having a soft voice and a bent-over posture. Taking certain medications helps wake your muscles up and gets you moving with more ease and less sluggishness. Without that help, though (and, sometimes despite taking medications), moving the way you used to is challenging, as you constantly feel a sense of slowness, stiffness and/or shaking (you might experience some or all of these symptoms). If this describes your experience, you may be living with Parkinsonâs disease.
When people think of Parkinsonâs disease, the first (and often only) thing that comes to mind is its most well-known symptom: a tremor in your hand. But as anyone who has Parkinsonâs disease knows, thereâs so much more to the condition than that. This is a condition that can cause both invisible and visible symptoms, physical and emotional impacts. It affects each person in a unique way. Two people can have two completely different experiences â and both are completely valid.
What Causes Parkinsonâs Disease?
Parkinsonâs disease occurs when there isnât enough dopamine produced in the part of the brain called the substantia nigra, which helps you initiate muscle movement. The substantia nigra part of your midbrain normally produces dopamine, a chemical called a neurotransmitter that signals other brain cells to start movement. But in Parkinsonâs disease, the brain cells (aka neurons) that produce dopamine degenerate and die, meaning less and less dopamine is produced. Without dopamine in the substantia nigra, you have a harder time initiating and controlling your movements.
Another key feature of Parkinsonâs disease is when a protein found in the brain called alpha-synuclein (abbreviated a-synuclein) clumps together with other proteins to form Lewy bodies. Lewy bodies are toxic, and can form in many areas of the brain, including the substantia nigra and cerebral cortex (the âthinkingâ part of the brain). Lewy bodies disrupt the functioning of these areas of the brain â neurons canât work properly and send the signals they are supposed to. The neurons eventually die, making it impossible for them to carry out their intended functions.25
As a result, Parkinsonâs disease is characterized by three hallmark movement, or motor, symptoms:
- Tremor, or uncontrolled shaking of typically a hand, leg, foot, head, chin, lips, jaw or tongue while the limb is at restÂ
- Bradykinesia, or slowness of movement
- Rigidity, or stiffness in the body
Other common motor symptoms include an unsteady gait, balance problems, soft voice, small handwriting, stooped posture, âfreezingâ of feet and lower limbs while walking, and taking very small steps.
Parkinsonâs disease also causes symptoms unrelated to movement. Dopamine-producing neurons are found in parts of the brain besides the substantia nigra such as areas that control your mood and sense of motivation to do things. Lewy bodies can also be found in parts of the brain that affect things like your sense of smell, thinking, constipation, sleep, and depression, which causes symptoms in these areas, too.
Non-motor symptoms can be just as challenging to live with as motor symptoms, sometimes more. These symptoms often show up months or even years before the motor symptoms, suggesting perhaps the disease can begin in parts of the brain outside the dopamine-producing neurons of the substantia nigra, cause non-motor symptoms and gradually progress to include the motor symptoms as well.28
Some of the non-motor symptoms you experience can include:
- Loss of smell
- Constipation
- Sexual dysfunction
- Anxiety
- Depression
- Apathy, or the lack of desire to move or do things
- Sleep problems
- Cognitive problems
- Fatigue
- Sweating
- Autonomic dysfunction, or trouble with automatic body functions like blood pressure fluctuations, dizziness or feeling faint
Parkinsonâs disease is degenerative, which means over time, symptoms get worse. There is no cure. However, it is not considered a terminal illness. There are a number of treatments that can help you manage your symptoms, including:
- Medication
- Exercise
- Physical, occupational and speech therapy
- Surgery
Parkinsonâs disease is named after James Parkinson, an English scientist who wrote the first paper describing its symptoms. His paper, âAn Essay on the Shaking Palsy,â was published in 1817.24
Who Gets Parkinsonâs Disease?
An estimated 6.1 million people worldwide had Parkinsonâs disease in 2016, up from 2.5 million people in 1990. Between 2005 to 2030, the number of people with Parkinsonâs disease is expected to double.9 This is because people, in general, are living longer, and Parkinsonâs becomes more common as you get older.
Age of Onset
Age is the biggest risk factor for Parkinsonâs disease. It affects about 1% of the population over age 60, and 5% over age 85.26 Your risk of developing Parkinsonâs increases with each decade. However, anywhere from 5-20% (research is inconsistent) of cases are considered early-onset, which is defined as presenting with symptoms before age 50.36
We donât know for sure why Parkinsonâs becomes more common with age but research suggests some people experience a decline over time in the processes required for the functioning of the substantia nigra. As some people age, they become less able to produce dopamine, neurons become less effective and toxic Lewy bodies develop that cause neurons to die. When all these factors combine, some people experience the symptoms of Parkinsonâs disease.26
Gender Differences
Parkinsonâs is more common in men than women, with a ratio of about 1.5 men to every 1 woman. The ratio appears to increase with age.17 Why more men are diagnosed with Parkinsonâs than women is not completely clear. There may be a relationship between dopamine and estrogen, the female sex hormone. Some research suggests estrogen might help protect against the loss of dopamine, which could explain why women are less likely to have Parkinsonâs and also why Parkinsonâs symptoms are sometimes worse for women after menopause, when estrogen levels decrease.32 There is also evidence that women with Parkinsonâs are less likely than men to seek out a specialist for care, which means they may be underrepresented in research and not receive the same quality of care.35
Another theory is male-dominated industries are associated with environmental factors that may increase Parkinsonâs risk â for example, being exposed to pesticides and heavy metals (such as manganese exposure from welding, iron, steel and mining2). It also could be that women are simply not diagnosed with Parkinsonâs as readily as men are. Women may experience more non-motor symptoms, which can be harder to diagnose as Parkinsonâs than motor symptoms because they still arenât as recognized.10
Related: These stories shares womenâs perspectives on living with Parkinsonâs.
- Is There Anything Good About Living With Parkinsonâs? These Women Say Yes!
- Choosing Parenthood With Juvenile Parkinsonâs Disease
Why Do People Get Parkinsonâs Disease?
The first thing you might ask after getting the diagnosis is why did I get Parkinsonâs disease? Scientists donât know for sure what causes some people to develop Parkinsonâs while others donât. If you ask your doctor why you have Parkinsonâs, they will likely not be able to give you a definitive answer. But scientists have pinpointed a couple of factors that may increase your risk of Parkinsonâs: genetics and environmental factors.
Is Parkinsonâs Disease Hereditary?
Historically, Parkinsonâs was not thought of as a hereditary or genetic condition. Newer research, however, indicates Parkinsonâs disease can run in families, though it is rare. These cases are called familial Parkinsonâs disease and account for about 15% of all Parkinsonâs cases.23 Scientists have identified several genes that can cause or increase your risk of Parkinsonâs. Itâs possible for mutations or changes in these genes to be passed down among family members. In very rare cases, they can appear at random, causing Parkinsonâs disease in someone who did not inherit the gene from a family member and has no family history of the condition.
Genetic FactorsÂ
Several genes increase your risk of developing Parkinsonâs. Experts believe a gene called LRRK2 is linked to Parkinsonâs because studies have found several types of mutations in LRRK2 that people with Parkinsonâs disease have in common. It may explain at least 5% of familial Parkinsonâs disease cases and 1-2% of âsporadic,â or non-familial, Parkinsonâs cases.27 The LRRK2 gene makes a protein called LRRK2 (also called dardarin), found in the brain, which is believed to be involved in several functions, including regulating other proteinsâ abilities to interact with each other, transmit signals and build the framework of other cells. We donât know exactly why LRRK2 mutations lead to Parkinsonâs symptoms specifically, but we know that mutations to LRRK2 result in the protein being hyperactive, which disrupts how effectively it can work and can cause brain cells to die.27
One particular type of LRRK2 mutation, called G2019S, appears to be particularly concentrated in certain ethnic groups. It accounts for:
- 13.3% of sporadic and 29.7% of familial Parkinsonâs disease among Ashkenazi Jews
- 40.8% of sporadic and 37% of familial Parkinsonâs disease among North African Arabs12
A gene called GBA is also associated with Parkinsonâs â an estimated 10% of people with Parkinsonâs have a GBA mutation.13 The GBA gene makes an enzyme â a type of protein that helps brain chemicals communicate more efficiently â that breaks down toxic substances in neurons, digests bacteria and breaks down worn-out cells. Scientists donât know the exact connection to Parkinsonâs, but in theory, if there is a mutation on GBA, toxic substances in neurons may not be able to break down, which could kill dopamine-producing neurons.8
Another gene, called PRKN, is associated with developing early-onset Parkinsonâs in particular. The PRKN gene is responsible for the production of the parkin protein, which is believed to help get rid of damaged cell parts, like mitochondria â the part of the cell that produces energy.22 PRKN gene changes may allow a buildup of toxic proteins and damaged mitochondria, which causes the death of dopamine-producing cells.31
Also, damaged mitochondria in dopamine-producing cells could prevent them from working properly since they canât produce energy.21 Some studies have found that PRKN mutations are found in 40-50% of early-onset familial Parkinsonâs cases and 1-20% of sporadic Parkinsonâs cases.20 Hispanic individuals are more likely than non-Hispanic individuals to carry this gene.1
Mutations in the SNCA gene are also believed to increase your risk of developing Parkinsonâs disease since SNCA produces a-synuclein, the protein that builds up in people with Parkinsonâs.20 A-synuclein clumps are also called Lewy bodies, and the presence of Lewy bodies in the brain is a hallmark sign of Parkinsonâs disease. Lewy bodies in the brain can disrupt the functioning of neurons, leading to Parkinsonâs symptoms.
Environmental Factors
There is some evidence that certain external factors could increase your risk of developing Parkinsonâs disease. One of these factors is exposure to pesticides. One study found people exposed to pesticides rotenone and paraquat were 2.5 times more likely to develop Parkinsonâs.33
Rotenone is a chemical used mostly by organic farmers to kill insects (itâs considered organic because it is found naturally in some plants), and it is also used in some household insecticide products; for example, products with the brand name Bonide. Itâs also used by fishermen to kill non-native fish species.29 Paraquat is used as a commercial herbicide, to kill weeds and grass. It can only be used by people who have a license to do so.3
Genetics may influence the impact pesticide exposure has on your Parkinsonâs risk.11 For example, if you have a gene that does not produce the enzyme supposed to protect against the toxic effects of the pesticide paraquat, your body will be more sensitive to paraquat exposure, leading to a higher risk of Parkinsonâs disease.11 Pesticides may also explain why Parkinsonâs is more common among men since pesticides are used more often in male-dominated farming industries.10
Another potential environmental factor is smoking. Studies show smokers have a lower incidence of Parkinsonâs than non-smokers, possibly because nicotine protects dopamine neurons.19 Unfortunately, this may not be a useful protective factor, since smoking can lead to serious health problems like cancer and heart disease. Caffeine may also have a protective effect against Parkinsonâs disease.14
Head injuries may also increase your risk of Parkinsonâs. Research suggests head trauma is associated with the formation of abnormal clumps of the protein a-synuclein, called Lewy bodies. Lewy bodies are toxic to brain cells and are found in the brains of people with Parkinsonâs disease4 (however, they are also found in people with other neurodegenerative diseases and in people with normal brains). Other theories are that head trauma simply âuncoversâ underlying Parkinsonâs disease that would have surfaced anyway, or that trauma damages dopamine-producing brain cells.5 One recent study of military veterans found having a mild traumatic brain injury increased their risk of developing Parkinsonâs by 56%.7
Celebrities With Parkinsonâs Disease
When youâre living with Parkinsonâs, it can be comforting to know of other people who are going through the same diagnosis you are. Celebrities who have Parkinsonâs are also often active in advocacy work, which may offer great opportunities for you and your loved ones to get involved. In addition, celebrities tend to increase awareness of Parkinsonâs disease, helping the general public, who may know very little about it, learn what the condition is. A few notable people with Parkinsonâs disease are:
Michael J. Fox
Actor Michael J. Fox, best known for his appearances in âBack to the Future,â âFamily Ties,â âSpin Cityâ and âThe Good Wife,â was diagnosed with Parkinsonâs disease in 1991 at age 29. He publicly announced his diagnosis in 1998, and soon after founded the Michael J. Fox Foundation, a nonprofit dedicated to funding Parkinsonâs research.16
Alan Alda
Alan Alda is an actor best known for his appearances in âM*A*S*H,â âThe West Wingâ and in movies like âThe Aviatorâ and âBridge of Spies.â In 2018 at age 82, Alda revealed he had been diagnosed with Parkinsonâs disease three-and-a-half years earlier, after he noticed he had begun to act out dreams, a common indicator of Parkinsonâs disease.18
Muhammed Ali
Boxer Muhammed Ali was diagnosed with Parkinsonâs in 1984 at age 42. He became an advocate for Parkinsonâs research and even founded an annual Celebrity Fight Night to raise money, along with the Muhammed Ali Parkinson Center in Phoenix, Arizona.15 He died in 2016 at age 74 of sepsis, which is not typically linked with Parkinsonâs but could have been exacerbated by his physical condition.34
Rev. Jesse Jackson
Civil rights activist Rev. Jesse Jackson announced he was diagnosed with Parkinsonâs in 2016 at age 76. At the time of his diagnosis, he said he and his family had begun noticing âchangesâ three years earlier, and said he intended to make lifestyle changes and dedicate himself to physical therapy.30 His father also had Parkinsonâs disease.
Neil Diamond
Neil Diamond, best known for songs like âSweet Carolineâ and âAmerica,â revealed his Parkinsonâs diagnosis in 2018 at age 76. He stopped touring but says he hopes to continue performing. When he announced his diagnosis, he said he is feeling good, staying active and taking his medications. He said he is feeling âvery positiveâ about it and wants to keep the music coming.6
Related: Discover more celebrities who live with Parkinsonâs.
- 9 Celebrities Whoâve Been Diagnosed With Parkinsonâs Disease
- BBC Correspondent Shares Diagnosis After Viewers Notice Symptoms During Broadcast
Long-Term Outlook of Parkinsonâs Disease
The long-term outlook of Parkinsonâs has improved since James Parkinsonâs essay was published. From a medication standpoint, there are several drugs you can try, including one considered the gold standard since the 1960s. These drugs can improve your motor symptoms. Deep brain stimulation surgery is also an effective treatment option for motor symptoms.
Doctors are also becoming more aware of Parkinsonâs non-motor symptoms and can work with you to find appropriate medications and treatments to manage these symptoms. Other types of treatments, most importantly exercise, can also help lessen your motor symptoms.
Parkinsonâs disease is progressive, so symptoms get worse over time. However, the rate of progression varies significantly among people with Parkinsonâs, so itâs difficult for any guide such as this one to predict how quickly you will progress and whether you will need mobility devices or caregivers. But the rate of progression for a single person tends to remain stable and predictable throughout your life, so your own doctor may be able to give you some insight.
Still, Parkinsonâs is not considered a terminal illness. Rather, there are a few symptoms that can lead to life-threatening complications like pneumonia, loss of balance that can lead to serious falls, and Parkinsonâs dementia. Rather than try to predict how quickly you will progress and worry about the future, itâs more productive to focus on managing your symptoms and lifestyle as well as you can right now.
Related: These stories share more about what itâs like living with Parkinsonâs disease.
Parkinsonâs Disease Statistics
Check out these facts and figures for a quick look at the scope, causes and demographics of Parkinsonâs disease.
- The average age at diagnosis is 60 years old.16
- About 6.1 million people worldwide are diagnosed with Parkinsonâs disease.9
- About 1 million people in the United States have Parkinsonâs disease.9
- 15% of Parkinsonâs cases are caused by genetics.23
- The ratio of men with Parkinsonâs to women with Parkinsonâs is 1.5 to 1.
- An estimated 5-20% of Parkinsonâs cases are considered early-onset, which is when symptoms present at age 50 or younger.23
Learn More About Parkinsonâs Disease:Â Overview |Â Symptoms | Diagnosis | Treatment | Resources
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