Conditions & Treatments

Parkinson's Disease

Parkinson's disease (PD or, simply, Parkinson's) is a slowly progressing, degenerative disease that is associated with symptoms such as tremor or trembling of the arms, jaw, legs and face, stiffness or rigidity of the limbs and trunk, bradykinesia (slowness of movement), postural instability or impaired balance and coordination.

Parkinson's Disease (PD)

What is PD?

Illustration of Parkinson's disease effect on the brain
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Parkinson's disease (or, simply, Parkinson's) is the most common form of parkinsonism, a group of motor system disorders. It is a slowly progressing, degenerative disease that is usually associated with the following symptoms, all of which result from the loss of dopamine-producing brain cells:

  • Tremor or trembling of the arms, jaw, legs, and face

  • Stiffness or rigidity of the limbs and trunk

  • Bradykinesia (slowness of movement)

  • Postural instability, or impaired balance and coordination

Dopamine is a substance produced in the body that has many effects, including smooth and coordinated muscle movement.

What are the facts about PD?

It is a myth that Parkinson's disease was cured after the introduction of levodopa (L-dopa) in the 1960s. In fact, about 60,000 Americans are newly diagnosed with Parkinson's disease each year, and more than 1 million Americans affected at any one time. in addition, more people suffer from Parkinson's disease than multiple sclerosis, muscular dystrophy, and amyotrophic lateral sclerosis combined.

What causes PD?

The specific cause of PD is unknown; however, medical experts believe the symptoms are related to a chemical imbalance in the brain caused by brain-cell death. Parkinson's disease is chronic (persists over a long period of time), and progressive (symptoms grow worse over time).

Although the disease may appear in younger patients (even teenagers), it usually affects people in late middle age. It is not contagious.

The biggest risk factor for developing PD is advancing age. The average age for the onset of PD is 60 years. In addition, 50 percent more men are affected than women, according to the National Institute of Neurological Disorders and Stroke. However, the reason for this is unclear.

Family history is another important risk factor. Individuals with a parent or sibling who are affected have approximately two times the chance of developing PD. This increased risk is most likely because of a combination of environmental and genetic factors.

Environmental causes are being researched and the strong consistent findings are that rural living, exposure to well water, and exposure to agricultural pesticides and herbicides are related to PD. It is important to remember, however, that these factors do not guarantee the development of PD, nor does their absence prevent it. Having one or more close relatives with PD increases one's risk of developing the disease; however, unless there is a known genetic mutation for PD present, the increased risk is only 2 to 5 percent.

Currently researchers believe that in most individuals the cause of PD is a combination of genetics and environmental exposure.

Parkinson's syndrome, atypical Parkinson's, or parkinsonism

Parkinson's disease is also called primary parkinsonism or idiopathic Parkinson's disease. (Idiopathic is the term for a disorder for which no cause has yet been identified.)

In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another primary neurological disorder that may have both primary and secondary symptoms of Parkinson's disease. These disorders, described as Parkinson's syndrome, atypical Parkinson's, or, simply, parkinsonism, may include the following:

  • Tumors in the brain

  • Repeated head trauma

  • Drug-induced parkinsonism. This occurs due to the prolonged use of tranquilizing drugs, such as the phenothiazines, butyrophenones, reserpine, and the commonly used drug, metoclopramide for stomach upset.

  • Toxin-induced parkinsonism. This occurs due to manganese and carbon monoxide poisoning.

  • Postencephalitic parkinsonism. A viral disease that causes "sleeping sickness."

  • Striatonigral degeneration. The substantia nigra of the brain is only mildly affected, while other areas of the brain show more severe damage.

  • Parkinsonism that accompanies other neurological conditions. Examples of this are Shy-Drager syndrome, (multiple system atrophy, once thought to be a distinct disease, is now commonly thought to be simply an extensive progression of idiopathic PD), progressive supranuclear palsy, Wilson disease, Huntington's disease, Hallervorden-Spatz syndrome, Alzheimer's disease, Creutzfeldt-Jakob disease, olivopontocerebellar atrophy, post-traumatic encephalopathy, and dementia with Lewy bodies.

What are the four primary symptoms of PD?

The following are the most common symptoms of Parkinson's disease. However, each individual may experience symptoms differently. Symptoms may include:

  • Muscle rigidity. Stiffness when the arm, leg, or neck is moved back and forth.

  • Resting tremor. Tremor (involuntary movement from contracting muscles) that is most prominent at rest.

  • Bradykinesia. Slowness in initiating movement.

  • Postural instability. Poor posture and balance that may cause falls; gait or balance problems.

Are there other symptoms of PD?

Symptoms of Parkinson's disease vary from patient to patient. The symptoms may appear slowly and in no particular order. Early symptoms may be subtle and may progress over many years before reaching a point where they interfere with normal daily activities.

The four cardinal symptoms of PD are listed above. Other symptoms are divided into motor (movement-related) and nonmotor symptoms.

  • Motor symptoms:

    • Tremor

    • Bradykinesia (slow movement)

    • Rigidity and freezing in place

    • Stooped posture

    • Shuffling gait

    • Decreased arm swing when walking

    • Difficulty rising from a chair

    • Micrographia (small, cramped handwriting)

    • Lack of facial expression

    • Slowed activities of daily living (for example, eating, dressing, and bathing)

    • Difficulty turning in bed

    • Remaining in a certain position for a long period of time

  • Nonmotor symptoms

    • Diminished sense of smell

    • Low voice volume (hypophonia)

    • Difficulty speaking (dysarthria)

    • Painful foot cramps

    • Sleep disturbance

    • Depression

    • Emotional changes (fearful and insecure)

    • Skin problems

    • Constipation

    • Drooling

    • Increased sweating

    • Urinary frequency/urgency

    • Male erectile dysfunction

As the disease progresses, walking may become affected, causing the patient to stop in mid-stride or "freeze" in place, and maybe even fall over. Patients also may begin walking with a series of quick, small steps as if hurrying forward to keep balance, a practice known as festination.

The symptoms of Parkinson's disease may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How is PD diagnosed?

Making an accurate diagnosis in the early stages of Parkinson's disease can be difficult, as the beginning signs and symptoms may be considered to be indications of other conditions or the effects of normal aging. For this reason, observation of the patient may be required for some time until the symptoms are consistently present.

Currently, there are no blood or laboratory tests that are useful in the diagnosis of PD. Diagnosis of PD is based primarily on a medical history and thorough neurological examination. Brain scans and/or lab tests may be performed to help rule out other diseases or conditions, but brain scan generally will turn out to be normal with PD.

Methods to assist with the diagnosis of PD include:

  • Neurological examination (including evaluation of symptoms and their severity)

  • Trial test of drugs. When symptoms are significant, a trial test of drugs (primarily levodopa [L-dopa]) may be used to further diagnose the presence of PD. If a patient fails to benefit from levodopa, a diagnosis of Parkinson's disease may be questionable.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

What is the treatment for PD?

Specific treatment for a Parkinson's disease will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Type of condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

With today's medicine, we have yet to find a cure for Parkinson's disease. However, based on the severity of the symptoms and medical profile, the doctor will establish an appropriate treatment protocol. Treatment for Parkinson's disease may include the following:

  • Medications

  • Surgery

  • Complementary and supportive therapies, such as diet, exercise, physical therapy, occupational therapy, and speech therapy

Medication for PD

Once the diagnosis of PD has been made, the next decision is whether a patient should receive medication, which depends on the following:

  • The degree of functional impairment

  • The degree of cognitive impairment

  • Ability to tolerate antiparkinsonian medication

  • The advice of the attending doctor

No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms.

Surgery for PD

Based on the severity of the condition and the medical profile, the doctor may recommend surgery as one treatment option for Parkinson's disease.

There are several types of surgery that may be performed that can help patients with Parkinson's disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms of Parkinson's disease.

There are three types of surgeries that may be performed for Parkinson's disease, including the following:

  • Lesion surgery (burning of tissue). In this procedure, deep parts of the brain are targeted and small lesions are made in critical parts of the brain that help control movement. The surgery may be done while the patient is awake to help determine the exact placement of the lesion. The lesion is placed to help control, or stop, the area of the brain that is causing the tremor.

  • Deep brain stimulation (DBS). With this type of surgery, a small electrode is placed in the critical parts of the brain that help to control movement. The electrode is attached to a small battery in the chest wall and is connected by wires that are placed under the skin. The stimulator is then turned on and interrupts the normal flow of information in the brain and can help to decrease symptoms of Parkinson's disease.

  • Neural grafting or tissue transplants. Experimental research is being done to find a replacement for the part of the brain that functions improperly in Parkinson's disease.

It is important to remember that surgery may help with symptoms of Parkinson's disease, but does not cure the disease or stop the progression of the disease.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Imaging

  • Neuroendovascular Program
    Working as part of the Vascular Center, the interventional specialists of the Neuroendovascular Program perform minimally invasive, image-guided treatments for conditions including stroke and cerebral aneurysm. These same interventionalists also use minimally invasive techniques to treat non-vascular conditions including herniated disc and vertebral fractures. In addition, our specialty-trained radiologists use the latest imaging technologies to provide diagnostic exams for a full range of neurological conditions.
MassGeneral Hospital for Children

  • Psychology Assessment Center
    The pediatric neuropsychology specialists at Massachusetts General Hospital’s Psychology Assessment Center provide neuropsychological assessments to aid in the diagnosis and treatment of neurological, medical, genetic and developmental disorders.
  • Pediatric Dystonia Clinic
    The Dystonia Clinic at MassGeneral Hospital for Children offers comprehensive evaluation and therapies for children and adults with all forms of dystonia as well as other movement disorders.
Department of Neurology

  • Movement Disorders Unit
    Massachusetts General Hospital's Movement Disorders Unit sees patients from around the world for everything from the most common to the rarest of movement disorders.
  • Parkinson's Disease and Movement Disorders Clinic
    The Massachusetts General Hospital Parkinson's Disease and Movement Disorders Center provides comprehensive care for patients with Parkinson's disease and related conditions.
  • General Neurology Program
    Part of the Neurology Department at Massachusetts General Hospital, the General Neurology Program’s board-certified neurologists work with primary care physicians to diagnose and treat a wide variety of neurological conditions.
  • Dystonia Clinic
    The Dystonia Clinic is a regional referral center for adults and children seeking diagnosis and treatment for dystonia and related neurological disorders.
Speech, Language and Swallowing Disorders

  • Cognitive Rehabilitation Therapy
    This therapy approach is designed to help the individual develop skills and learn compensatory strategies to improve how he/she functions at home, school, and/or at work. This type of therapy addresses difficulties with attention, learning new information, memory, time management, planning, organization, and problem-solving. Tailored to meet the individual needs of the patient with cognitive and executive function deficits, our approach emphasizes the development of metacognitive and self-awareness skills.

Parkinson’s singing group offers upbeat therapy

A harmonious collaboration between Massachusetts General Hospital and the Jewish Family and Children’s Service offers a bridge between therapy and the enjoyment of music. It is a new approach to helping Parkinson’s patients.

E Pluribus Unum for Parkinson Disease - Researchers Draw on Sources to Improve Treatment of PD

What do Gaucher’s disease, gout, and amyloid plaques have in common? For researchers at the MGH, each of them may shed light on the causes and treatment of Parkinson’s disease.

Moving beyond Mobility: Non-Motor Symptoms of Parkinson’s Disease

Parkinson’s Disease Patient and Caregiver Symposium

Parkinson's Symposium at MIND- 2008

Momentum in our Pursuit of Cures - Research advances in Parkinson's, Lewy Body dementia, and Parkinson's-Plus disorders. Anne B. Young, MD, PhD, Director, MassGeneral Institute for Neurodegenerative Disease (MIND), formerly Chief of Neurology Service.

Neurology Bicentennial Celebration, 2011 Part I

Neurology Bicentennial Celebration, October 13, 2011. Past History of MGH Neurology; Overview of MGH Neurology; Telestroke and Acute Stroke Service; Neurodegenerative Disorders; Pediatric Neurology.

Neurology Bicentennial Celebration, 2011 Part II

Neurology Bicentennial Celebration, October 13, 2011. Clinical and research presentations on ALS, Stroke, Alzheimer’s Disease, and Parkinson’s Disease

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