Parkinson’s Disease

The part of the brain that is affected is called the basal ganglia, which functions like the autopilot of your brain, facilitating subconscious (automatic) movements. Because PD causes the brain cells in this deep circuitry to deteriorate, patients’ natural movements become slow and stiff. Many patients describe feeling as if they had aged overnight.

Everyday tasks such as getting dressed, writing, picking something up off the floor take twice as long as they used to. Some people describe the feeling of slowness and stiffness as walking through molasses or moving in slow-motion. Because subconscious muscle movements of the face are responsible for one’s facial expressions and others’ interpretation of our mood, patients can be thought to be upset or depressed when they are not. This is known as having a masked face.

The voice is affected too, because the voice box is ultimately controlled by the basal ganglia as well. Thus the voice becomes soft, slurred and hushed. Others may comment that the patient is mumbling. The mumbling goes away temporarily once the patient becomes aware of it but soon returns to the soft, slurred state.

This temporary improvement when attention is paid is true of many of the motor symptoms of PD because the condition primarily affects subconscious movements, and does not directly affect nerve or muscle control at the most basic level. Thus, conscious awareness can override the slowness to a certain extent. This fact is one reason why physical therapy and physical activity are so useful and necessary in treating PD.

Bradykinesia (Slow Movements)

• Slowness of walking and other movements
• Trouble with dexterity
• Delayed reactions physically
• Reduced arm swing or stride length
• Reduced facial reactions (“masked face”)
• Softer or slurred speech
• Smaller handwriting
• Delayed responses mentally

Rigidity

• Stiffness of limb(s)
• Sometimes associated with pain

Rest Tremor

• Tremor in one or both limbs with the limb at rest
• Sometimes also tremor with holding a posture or with actions
• Usually asymmetric

Imbalance, Loss of Balance Reflexes

• May fall backwards

• Anxiety
• Depression
• Fatigue
• Lightheadedness from blood pressure dropping upon standing
• Urinary difficulties such as increased frequency, increased urgency, trouble making it to the bathroom on time (incontinence)
• Hallucinations
• Cognitive difficulties including dementia
• Sleep disturbances, vivid dreams, acting out dreams, REM sleep behavior disorder (RBD)
• Gastrointestinal changes such as constipation, delayed stomach emptying, loss of sense of smell or taste (may precede symptoms by many years)

• The best form of treatment is exercise, exercise, exercise!
• Depending on the patient, this may mean physical therapy, participation in PD-specific exercise classes, working with a personal trainer, use of fitness videos, or independent exercise. The idea is to tailor the medical and surgical treatment to maximize the ability of the patient to exercise.
• Speech therapy can be helpful for slow, soft, or slurred speech.
• Medication for motor symptoms
• Management for non-motor symptoms
• Physical Therapy
• Focused ultrasound for tremor-dominant PD
  • Focused ultrasound is an incisionless treatment for patients with tremor-dominant Parkinson’s disease (TDPD) who have not responded to medication. It targets a small area of the brain called the ventral intermediate nucleus, resulting in reduced tremors. For patients who cannot undergo surgical procedures due to medical contraindications, FUS avoids surgical risks such as infection and bleeding.

This is advised when the disease progresses and the medications are no longer controlling the symptoms of PD adequately.

• As the disease progresses, Levodopa still works, but the brain’s response to the medication becomes less predictable. Levodopa may take longer to kick in and may wear off earlier, requiring patients to take medication more frequently during the day. Higher doses of levodopa are associated with abnormal involuntary movements, known as dyskinesias (this does not include tremor). Unpredictable medication effect results in “OFF” time when patients feel stiff, rigid, stuck, frozen, slow, or fatigued, compared to “ON” time when movements are smooth and closer to normal.
• Treatment options as the disease progresses include taking levodopa more frequently; making the medication last longer by adding medications to reduce the metabolism of levodopa, or dopamine (Comtan, Azilect) adding or changing to long-acting forms of levodopa (Sinemet CR, Rytary), or adding or changing to long-acting forms of dopamine agonist (Neupro patch). Amantadine can be added to reduce dyskinesia. As these options are being considered and implemented, it’s time to consider deep brain stimulation surgery (DBS).
• Deep brain stimulation surgery is FDA-approved for the treatment of motor complications in Parkinson’s disease and is not experimental. DBS is not a last-resort treatment. It has been shown that DBS is more beneficial when performed earlier in the course of the disease compared to waiting for disability.

Yes. Parkinson’s disease itself is not typically life-threatening, and many people live for decades after diagnosis. Life expectancy can be close to normal, especially with early diagnosis, proper treatment, and healthy lifestyle habits. While symptoms will progress over time, treatments—especially when managed by a movement disorder specialist—can help maintain independence and quality of life for many years.

Life with Parkinson’s disease varies from person to person. In the early stages, many people continue to work, drive, travel, and enjoy hobbies with few limitations. As the condition progresses, motor symptoms (like tremor, stiffness, and slowness) and non-motor symptoms (like fatigue, sleep issues, or mood changes) may require adjustments. Staying active, socially connected, and following a personalized care plan can help people live fulfilling, engaged lives.

The best approach combines medication, regular exercise, therapy, and ongoing medical care. Evidence strongly supports daily physical activity—such as walking, cycling, boxing, tai chi, or swimming—to slow functional decline. Medications like levodopa help control motor symptoms, while speech therapy, occupational therapy, and counseling can address communication, daily living skills, and mood. Seeing a movement disorder specialist ensures your care plan evolves as symptoms change.

After a diagnosis, your neurologist will create a treatment plan tailored to your symptoms, lifestyle, and goals. This may include starting medications, beginning an exercise program, and scheduling follow-up visits to monitor your progress. You’ll also learn about the condition, available therapies, and support resources. Early diagnosis is an opportunity to take proactive steps that can significantly improve long-term outcomes.

Parkinson’s disease progression is different for everyone. For some, it may take more than 10–15 years to advance from stage 1 (mild symptoms) to stage 4 (more advanced symptoms affecting independence). Others may progress more quickly, depending on factors like age at onset, overall health, and response to treatment. Staying active, following your treatment plan, and addressing non-motor symptoms can help slow functional decline.