Parkinson's Disease - Symptoms, Diagnosis and Treatment

Parkinson's Disease

This illness is a neuro-degenerative disorder that causes movement disorders characterised by tremors, movement difficulty or stiffness, impaired balance and co-ordination. Nonetheless, these symptoms may remain fairly mild for many years.

Essentially, Parkinson's disease affects nerve cells in the region of the brain (subtantia nigra) responsible for controlling muscle movement. This degeneration leads to a lack of a vital brain chemical known as dopamine.

This non-life threatening disease is progressive, meaning that the signs and symptoms gradually worsen over time. Even though it may be disabling, the deterioration is gradual and most live many productive years before that happens.

Although British doctor James Parkinson identified this disorder's distinctive symptoms in 1917, there are some Chinese and Indian medical texts dating back some 4,000 years ago which have described such symptoms in recorded illnesses.

Who are at risk?

Parkinson's disease has been found to afflict 100 to 150 persons per 100,000 of the population. Age is one of the main risk factors for the disease which normally starts in middle or late life.

The early symptoms of Parkinson's disease are usually found in seniors over the age of 50 across the boundaries of race, lifestyle and body type. Still, it can also affect a small percentage of younger adults as well. Generally, the risk increases with age and men are more likely to develop the disease than women.

At the moment it is not possible to predict who would get Parkinson's disease but some researchers theorise that it may be caused by neural damage from genetic or environmental factors.

What are the symptoms?

In the early stages of Parkinson's disease, its symptoms can be subtle and easy to overlook. For instance an arm may not swing when you walk, you experience difficulty getting out of a chair, have a mild tremor in the fingers of one hand or feel shaky at times.

Friends and family members may also notice that you speak softer than usual with a noticeable slur and reduction of facial expression. Often, the people around you are the first to notice the changes in a person afflicted with the early stages of Parkinson's disease.

You may feel tired, anxious, irritable and depressed, and also may have trouble sleeping and doing other routine tasks such as taking a bath or swallowing food.

As the ailment progresses and more brain cells are damaged or die, symptoms become more pronounced. Some Parkinson's disease sufferers also experience trouble with memory but there is no clear indication that Parkinson's disease impairs one's intellectual or reasoning ability. Later symptoms may include:

Sometimes some secondary symptoms from Parkinson's disease may show. Such problems include:

How is it diagnosed?

As ageing populations become more commonplace worldwide, the number of people with Parkinson's disease will inevitably rise. Singapore's ageing population has meant that more resources in terms of expertise and research studies have been allocated to Parkinson's disease.

To date, there are no definitive tests for Parkinson's disease and as such, it is difficult to diagnose, more so in its early stages. Moreover, some of the signs and symptoms such as the unsteady gait or lack of co-ordination may be seen as effects of the ageing process.

For now, a diagnosis of the disease is based on a detailed medical history (e.g. prescribed medication, and family history of the disease etc), symptoms displayed and a neurologic examination.

It is important the neurologist undertaking the examination is not just skilful but also experienced enough to spot any wayward signs. Your walking, co-ordination and balance and some simple tasks of dexterity will be evaluated. A good doctor will also be able to identify signs of reduced facial expressions, a distinctive lack of gestures or a subtle tremor during the examination.

How is it treated?

As Parkinson's disease is a progressive disorder with presently no known cure, doctors leverage on the various options to treat the symptoms.


There are effective medications currently available to treat the symptoms of Parkinson's. These include levodopa, dopamine agonists, anticholinergics, selegiline and COMT inhibitors. Nonetheless, any medication or combinations are individualised to cater for the unique requirements of each patient.


Sometimes, patients are referred to physiotherapists, occupational therapists and speech therapists who will help in the management of the disease and thus further optimise their care.

They also monitor the patient to ensure that he closely keeps to the proposed routine of medication, exercise and diet.


For patients with advanced Parkinson's disease, minimally invasive stereotactic neurosurgery such as Pallidotomy or deep brain stimulation can be carried out by highly-trained neurosurgeons. This may help to improve symptoms.


The objective of a pallidotomy is to control the involuntary movements that occur on some patients. It improves the stiffness or rigidity and slowness (Bradykinesia) in patients who suffer from Parkinson's disease.

Deep Brain Stimulation

Deep brain stimulation involves the insertion of a stimulator within small selective sites deep in the brain. This pacemaker-like stimulator transmits electric impulses through a wire to tiny electrodes placed in a structure deep within the brain. This structure, the subthalamic nucleus, controls many aspects of motor function.

Source : Medi-Info, NHG-Singapore.

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