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Parkinson’s Disease (PD)

Brief Overview: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that primarily affects movement due to loss of dopamine-producing neurons (especially in the substantia nigra). Core motor features include bradykinesia (slowness) plus rest tremor and/or rigidity; many patients also develop important non-motor symptoms (sleep problems, constipation, mood changes, cognitive changes). PD management is long-term and focuses on symptom control, safety, function, and quality of life using medications plus rehab therapies and support.

Prevalence: According to UpToDate, “Globally, the age-standardized prevalence is estimated at 129 cases per 100,000 people. The yearly incidence of new cases in North America ranges from 108 to 212 per 100,000 person-years age 65 years and older.”

Etiology: Most PD is idiopathic (no single cause), with contributions from genetic susceptibility and environmental factors. According to UpToDate, “The central defect in PD is dopamine depletion from the basal ganglia as a result of degeneration of dopamine-producing neurons in the substantia nigra. This results in major disruptions in the connections to the basal ganglia, motor cortex, and other brain areas, including the cerebellum, leading to classic parkinsonian motor signs of tremor, bradykinesia, rigidity, and gait and balance difficulties.”

Risk Factors:

  • Advancing age
  • Males
  • Genetics, family history
  • Depression
  • Medical comorbities:
    • Diabetes
    • History of TBI
    • History of prostate cancer or melanoma
    • Constipation
    • Overweight/obesity, metabolic syndrome
  • Environmental exposures (including, but not limited to):
    • Use of well water
    • Low vitamin D
    • High dietary intake of iron
    • Living near a golf course
    • Exposure to pesticides
    • High consumption of dairy products
    • Farming/agriculture work

Commonly Associated Conditions:

  • Depression/anxiety, apathy
  • Sleep disorders (REM sleep behavior disorder, insomnia, daytime sleepiness)
  • Constipation and other autonomic symptoms (orthostatic hypotension, urinary urgency)
  • Cognitive impairment/dementia (risk increases over time)
  • Falls, frailty, dysphagia/aspiration risk in later stages

Common Medications: According to UpToDate,

Common Labs, Imaging, and Tests:

  • According to UpToDate, “There are no physiologic, radiologic, or blood tests for confirming the clinical diagnosis of PD.”
  • Diagnosis is based on neurological exam
  • Brain imaging: SPECT, MRI, DaT scan
  • Response to dopaminergic therapy may support diagnosis
  • Screening/monitoring often includes: orthostatic vitals, fall risk screening, cognition and mood screening, swallowing evaluation if symptoms present

Common Symptoms:

  • Tremor
  • Bradykinesia
  • Rigidity
  • Postural instability
  • Shuffling gait, reduced arm swing, freezing of gait
  • Constipation, loss of smell, sleep disturbance, fatigue
  • Depression/anxiety, cognitive changes
  • Autonomic symptoms (orthostasis, urinary urgency)

Common Treatments:

  • Medication optimization (timing matters; avoid missed doses)
  • Physical therapy (gait/balance, strength), occupational therapy (ADLs/home safety), speech therapy (voice/swallowing)
  • Exercise as a core therapy, as directed/approved by healthcare provider (walking, cycling, tai chi, resistance training—adapt to ability)
  • Deep brain stimulation (DBS) or other advanced therapies for selected patients with motor fluctuations/tremor despite optimized meds (specialist).
  • Caregiver support, fall prevention, driving safety counseling, advance care planning as disease progresses.

Physical Findings:

  • Resting tremor, cogwheel rigidity, bradykinesia, hypomimia (masked facies)
  • Stooped posture, shuffling gait, reduced arm swing
  • Soft voice (hypophonia), micrographia
  • Orthostatic hypotension may be present

Potential Complications and Contraindications:

  • Complications
    • Falls/fractures, aspiration pneumonia (dysphagia), weight loss
    • Dementia, hallucinations/psychosis (disease- or medication-related)
    • Motor fluctuations (“wearing off”) and dyskinesias with long-term levodopa
  • Medication cautions
    • Dopamine agonists: sleep attacks, hallucinations, impulse-control behaviors
    • Anticholinergics: can worsen confusion/constipation/urinary retention—often avoided in older adults
    • Patients should avoid abrupt stopping of dopaminergic meds (risk of severe worsening; coordinate with prescriber).

General Health and Lifestyle Guidance:

  • Encourage consistent medication timing; don’t run out—plan refills early.
  • Exercise most days as tolerated and approved by healthcare provider; PT can tailor a safe plan.
  • Fall prevention: remove trip hazards, use night lighting, wear supportive footwear; consider mobility aids.
  • Swallowing safety: report coughing/choking with meals to healthcare provider; consider SLP evaluation.
  • Constipation routine: hydration, fiber, movement; bowel regimen as ordered.
  • Encourage sleep hygiene
  • Caregiver check-ins and community resources (Parkinson’s Foundation, local support groups).

Suggested Questions to Ask Patients:

  • What symptoms are most bothersome right now (tremor, stiffness, slowness, walking, freezing)?
  • Any recent falls, near-falls, dizziness on standing?
  • Any wearing off before the next dose? Any involuntary movements (dyskinesia)?
  • Medication adherence: are doses taken on time? Any missed doses? Any side effects (hallucinations, sleepiness, nausea)?
  • Any mood changes (depression/anxiety), memory changes, new confusion?
  • Swallowing: coughing with liquids/foods? Weight loss?
  • Bowel/bladder: constipation severity, urinary urgency, nocturia?
  • Sleep: vivid dreams/acting out dreams, insomnia, daytime sleepiness?

Suggested Talking Points:

  • Parkinson’s is chronic and progressive, but symptoms can often be managed well with the right combination of medication timing, exercise, and therapy.
  • Taking medications on schedule is one of the biggest keys to smoother symptom control.
  • Tell your healthcare provider right away if you develop falls, hallucinations, severe sleepiness, or new swallowing trouble. Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  
  • Physical, occupational, and speech therapy aren’t ‘extra’—they’re core treatments that help maintain independence.
  • If symptoms are changing or you’re having involuntary movements, your clinician can adjust the plan—don’t change doses on your own.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.