Parkinson's Disease

What is Parkinson’s Disease?

Parkinson's disease is a degenerative disorder that occurs when certain nerve cells in the middle of the brain either die or become impaired. This interferes with coordinated muscle movements of the body.

The disease is both chronic and progressive, meaning that the symptoms gradually worsen over time. Early symptoms of Parkinson’s are subtle and sometimes can appear and disappear. Diagnosis is often difficult, and there is no cure.

Michigan has a higher prevalence of Parkinson’s Disease than the national average, with an estimated 35,000 people diagnosed with this disease. MyMichigan neurologists see more than 500 patients with Parkinson's disease each year.

Common Symptoms

There are four main symptoms of Parkinson’s Disease.

1. Tremors – pin rolling movement between thumb and forefinger
2. Bradykinesia – slow muscle movement or loss of automatic movement
3. Rigidity – a stiffness or "tightness" of arms, legs and, less often, the trunk
4. Postural instability – impaired balance and coordination

There are many secondary symptoms that occur as the disease progresses, but it is important to note that no one person develops all of these symptoms. Secondary symptoms include:

  • Micrographia – small, cramped handwriting
  • Freezing – a feeling of being stuck in place when attempting to initiate movement
  • Dysarthria – low voice volume or muffled speech
  • Constipation
  • Sleep disturbances
  • Increase in skin oils and dandruff
  • Emotional changes, including depression

Diagnosing Parkinson’s

The course of Parkinson’s Disease varies from person to person, and early symptoms are subtle and occur gradually. Often it is family or friends who notice these changes first. When a diagnosis of PD is suspected, it is important to seek referral to a neurologist to confirm a diagnosis, because symptom management is vital to maintaining function, coordination and balance over time.

There is no definitive diagnostic test to confirm Parkinson’s. However, many neurologists use a standardized assessment tool called the Unified Parkinson Disease Rating Scale (UPDRS) to help diagnose the disease and follow a patient's progress over time. It is a 41-item survey that evaluates motor function, performing activities of daily living, medication side effects and the patient's subjective experience of symptoms. Your doctor or neurologist may also order an MRI, to rule out other potential causes.


Because there is no known cause and no cure, a multidisciplinary approach to treatment is the most beneficial in preventing further complications of Parkinson’s. This approach consists of medications, exercise, adequate nutrition, stress management and relaxation, as well as an overall healthy lifestyle.

Neurologists work closely with other care providers, such as rehabilitation specialists, to help manage the symptoms. Rehabilitation services include:

  • Physical therapy (ambulation, mobility)
  • Occupational therapy (activities of daily living)
  • Speech pathology (speaking, swallowing, memory, reasoning)

MyMichigan also offers treatments with medications to help manage symptoms of Parkinson's disease. The physician and patient work together to identify the best possible combination of medications such as: Levodopa (sinement), Carbidopa – usually given in combination with levodopa to decrease side effects and Dopamine agonists.

In some cases, when all other treatment options have been exhausted, Parkinson’s patients may be referred for surgery or gamma knife treatment.