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If you think you, or someone close to you, may have Parkinson's, this information looks at the main symptoms and the next steps for you to take.

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Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra.
Nerve cells in this part of the brain are responsible for producing a chemical called dopamine.

Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements.

If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced.

This means the part of the brain controlling movement cannot work as well as normal, causing movements to become slow and abnormal.

The loss of nerve cells is a slow process. The symptoms of Parkinson's disease usually only start to develop when around 50% of the nerve cell activity in the substantia nigra have been lost.

What causes the loss of nerve cells?

It's not known why the loss of nerve cells associated with Parkinson's disease occurs, although research is ongoing to identify potential causes.

Currently, it's believed a combination of genetic changes and environmental factors may be responsible for the condition.

Genetics

A number of genetic factors have been shown to increase a person's risk of developing Parkinson's disease, although exactly how these make some people more susceptible to the condition is unclear.

Parkinson's disease can run in families as a result of faulty genes being passed to a child by their parents. But it's rare for the disease to be inherited this way.

Environmental factors

Some researchers also feel environmental factors may increase a person's risk of developing Parkinson's disease.

It's been suggested that pesticides and herbicides used in farming and traffic or industrial pollution may contribute to the condition.

But the evidence linking environmental factors to Parkinson's disease is inconclusive.

Other causes of parkinsonism

"Parkinsonism" is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.

Parkinson's disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.

These include parkinsonism caused by:

medication (drug-induced parkinsonism) - where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped

other progressive brain conditions - such as progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration

cerebrovascular disease - where a series of small strokes cause several parts of the brain to die

You can read more about parkinsonism on the Parkinson's UK website.

Page last reviewed: 03 November 2022
Next review due: 03 November 2025

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Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra. Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements.

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What is Parkinson's?

Parkinson's is a progressive neurological condition which affects the brain and gets worse over time.

What causes Parkinson's?

Parkinson's develops when nerve cells in the brain die and stop producing dopamine, which controls movement.

What are the symptoms of Parkinson's?

People with Parkinson's will typically see changes in how they talk, walk, swallow and write.

The three main symptoms of Parkinson's are:

A tremor (an uncontrollable movement that affects a part of the body, usually while at rest)

Rgidity (the muscles becoming stiff or inflexible)

A slowness of movement

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Parkinson's is a progressive neurological condition which affects the brain and gets worse over time. Parkinson's develops when nerve cells in the brain die and stop producing dopamine, which controls movement. People with Parkinson's will typically see changes in how they talk, walk, swallow and write.

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Supportive therapies

There are several therapies that can make living with Parkinson's disease easier and help you deal with your symptoms on a day-to-day basis.

There are efforts underway to try to increase the availability of these supportive therapies for Parkinson's patients on the NHS.

Your local authority may be able to advise and help you. Ask your local authority for a care and support needs assessment.

Read about:
Assessing your care and support needs Planning for your future care needs
Physiotherapy

A physiotherapist can work with you to relieve muscle stiffness and joint pain through movement (manipulation) and exercise.

The physiotherapist aims to make moving easier and improve your walking and flexibility.

They also try to improve your fitness levels and ability to manage things for yourself.
Find out more about physiotherapy
Occupational therapy

An occupational therapist can identify areas of difficulty in your everyday life, such as dressing yourself or getting to the local shops.

They can help you work out practical solutions and ensure your home is safe and properly set up for you. This will help you maintain your independence for as long as possible.
Find out more about occupational therapy
Speech and language therapy

Many people with Parkinson's disease have swallowing difficulties (dysphagia) and problems with their speech.

A speech and language therapist can often help you improve these problems by teaching speaking and swallowing exercises, or by providing assistive technology.

Diet advice

For some people with Parkinson's disease, making dietary changes can help improve some symptoms.

These changes can include:

increasing the amount of fibre in your diet and making sure you're drinking enough fluid to reduce constipation

increasing the amount of salt in your diet and eating small, frequent meals to avoid problems with low blood pressure, such as dizziness when you stand up quickly

making changes to your diet to avoid unintentional weight loss

You may see a dietitian, a healthcare professional trained to give diet advice, if your care team thinks you may benefit from changing your diet.

Want to know more?
Parkinson's UK: therapies and Parkinson's management

Medication

Medication can be used to improve the main symptoms of Parkinson's disease, such as shaking (tremors) and movement problems.

But not all the medications available are useful for everyone, and the short- and long-term effects of each are different.

Three main types of medication are commonly used:

levodopa

dopamine agonists

monoamine oxidase-B inhibitors

Your specialist can explain your medication options, including the risks associated with each medication, and discuss which may be best for you.

Regular reviews will be required as the condition progresses and your needs change.

Levodopa

Most people with Parkinson's disease eventually need a medication called levodopa.

Levodopa is absorbed by the nerve cells in your brain and turned into the chemical dopamine, which is used to transmit messages between the parts of the brain and nerves that control movement.

Increasing the levels of dopamine using levodopa usually improves movement problems.

It's usually taken as a tablet or liquid, and is often combined with other medication, such as benserazide or carbidopa.

These medications stop the levodopa being broken down in the bloodstream before it has a chance to get to the brain.

They also reduce the side effects of levodopa, which include:

feeling and being sick

tiredness

dizziness

If you're prescribed levodopa, the initial dose is usually very small and will be gradually increased until it takes effect.

At first, levodopa can cause a dramatic improvement in the symptoms.

But its effects can be less long-lasting over the following years - as more nerve cells in the brain are lost, there are fewer of them to absorb the medicine.

This means the dose may need to be increased from time to time.

Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and "on-off" effects, where the person rapidly switches between being able to move (on) and being immobile (off).

Dopamine agonists

Dopamine agonists act as a substitute for dopamine in the brain and have a similar but milder effect compared with levodopa. They can often be given less frequently than levodopa.

They're often taken as a tablet, but are also available as a skin patch (rotigotine).

Sometimes dopamine agonists are taken at the same time as levodopa, as this allows lower doses of levodopa to be used.

Possible side effects of dopamine agonists include:

feeling and being sick

tiredness and sleepiness

dizziness

Dopamine agonists can also cause hallucinations and increased confusion, so they need to be used with caution, particularly in elderly patients, who are more susceptible.

For some people, dopamine agonists have been linked to the development of compulsive behaviours, especially at high doses, including addictive gambling, compulsive shopping and an excessively increased interest in sex.

Talk to your healthcare specialist if you think you may be experiencing these problems.

As the person themselves may not realise the problem, it's key that carers and family members also note any abnormal behaviour and discuss it with an appropriate professional at the earliest opportunity.

If you're prescribed a course of dopamine agonists, the initial dose is usually very small to prevent feeling sick and other side effects.

The dosage is gradually increased over a few weeks. If feeling sick becomes a problem, your GP may prescribe anti-sickness medication.

A potentially serious, but uncommon, complication of dopamine agonist therapy is sudden onset of sleep.

This generally happens as the dose is being increased and tends to settle once the dose is stable.

People are usually advised to avoid driving while the dose is being increased in case this complication occurs.

Monoamine oxidase-B inhibitors

Monoamine oxidase-B (MAO-B) inhibitors, including selegiline and rasagiline, are another alternative to levodopa for treating early Parkinson's disease.

They block the effects of an enzyme or brain substance that breaks down dopamine (monoamine oxidase-B), increasing dopamine levels.

Both selegiline and rasagiline can improve the symptoms of Parkinson's disease, although their effects are small compared with levodopa. They can be used alongside levodopa or dopamine agonists.

MAO-B inhibitors are generally very well tolerated, but can occasionally cause side effects, including:

feeling sick

headaches

abdominal pain

high blood pressure

Catechol-O-methyltransferase inhibitors

Catechol-O-methyltransferase (COMT) inhibitors are prescribed for people in later stages of Parkinson's disease.

They prevent levodopa being broken down by the enzyme COMT.

Side effects of COMT inhibitors include:

feeling or being sick

diarrhoea

abdominal pain

Want to know more?
Parkinson's UK: drug treatments Parkinson's UK: Parkinson's drugs and compulsive behaviours
Non-oral therapies

When Parkinson's symptoms become difficult to control with tablets alone, a number of other treatments can be considered.

Apomorphine

A dopamine agonist called apomorphine can be injected under the skin (subcutaneously) either by:

a single injection, when required

a continuous infusion using a small pump carried around on your belt, under your clothing or in a bag

Duodopa

If you have severe on-off fluctuations, a type of levodopa called duodopa may be used.

This medication comes as a gel that's continuously pumped into your gut through a tube inserted through your abdominal wall.

There's an external pump attached to the end of the tube, which you carry around with you.

About 25 specialist neuroscience centres in the UK offer this treatment. It's only available if you have very severe on-off fluctuations or involuntary movements.

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There are several therapies that can make living with Parkinson's disease easier and help you deal with your symptoms on a day-to-day basis. There are efforts underway to try to increase the availability of these supportive therapies for Parkinson's patients on the NHS. Your local authority may be able to advise and help you.

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Getting diagnosed with Parkinson’s, particularly in its early stages, can be difficult. Learn the steps you or a loved one can take if you suspect PD.

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The Michael J. Fox Foundation for Parkinson's Research | Parkinson's Disease

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There is no simple way to deal with the life-changing event of a Parkinson’s diagnosis. The good news: Most people find acceptance and quality of life after the initial adjustment period.

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Overview of the unit 383 criteria questions.

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Overview of the unit 383 criteria questions.

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Unit 383 Understanding Parkinsons disease within an adult care service

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We're the Parkinson's charity that drives better care, treatments and quality of life. Because we're here, no one has to face Parkinson's alone.

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There are over 40 symptoms of Parkinson's. From a tremor or stiffness, to problems with sleep and mental health. Everyone's experience is different.