# data[].attributes.body
People with Parkinsons are all affected differently. Some of these symptoms come off as mild, not even noticeable, or one sided.

The most common symptoms include:

•Poor posture or balance

•Non-motor symptoms

anxiety, depression, and sleep problems

•Speech and writing changes

# data[].attributes.headline
Primary Anatomical Structures Involved in Parkinson's Disease

# data[].attributes.subject
Primary Anatomical Structures Involved in Parkinson's Disease

# data[].attributes.body
The primary anatomical structures involved in Parkinson's Disease are the basal ganglia and the substantia nigra.

(sub-stan-ti-ah, nigh-gra). These are the nerve cells that are located in deep parts of the brain. They are responsible for relaying messages to the brain that are for planning and controlling body movements. But for an unknown reason, the neurotransmitter dopamine in the substantia nigra dies off for some reason which causes symptoms like tremors, slowed movement, stiffness, and balance problems which all correlate to the movement of our bodies.

Source: https://mayfieldclinic.com/pe-pd.htm

# data[].attributes.attachment_link.description
Parkinson's disease (PD) is a progressive disorder that affects nerve cells in the brain responsible for body movement. When dopamine-producing neurons die, symptoms such as tremor, slowness, stiffness, and balance problems occur. Treatments focus on reducing symptoms to enable a more active lifestyle and include medication, diet, exercise, and deep brain stimulation surgery.

# data[].attributes.body
Some social problems that can develop for someone who has Parkinson's Disease are interferences with recognizing other's emotions/expressions and speech production issues. A treatment for this issue is called the Lee Silverman Voice Treatment. This treatment is able to enhance the patient's communication abilities through vocal and respiratory exercises. This would treat the long-term effects of having trouble speaking. This is primarily delivered by LSVT certified clinicians and speech therapists that are able to tailor the treatment to the individual patient.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC7790585/

# data[].attributes.attachment_link.authors[].name
Academic Editor: Fabrizio Stocchi ✉Corresponding author.

# data[].attributes.attachment_link.description
Parkinson’s disease (PD) is typically well recognized by its characteristic motor symptoms (e.g., bradykinesia, rigidity, and tremor). The cognitive symptoms of PD are increasingly being acknowledged by clinicians and researchers alike. However, PD…

# data[].attributes.body
There are a lot of movement impairments to daily functions due to Parkinsons during and after. Here are some long term movement impairments.

Tremors

Resting tremors

Action tremors

Postural tremors

Intention tremors

Rigidity or stiff movement

Bradykinesia (slowness of movement)

Posture instability

Hypomimia (reduced facial expression)

# data[].attributes.body
Age represents the biggest predisposing factor for Parkinson. Genetic causes are becoming more common as gene hunting continues. Loss of estrogen production in women with age may also remove a protective effect and there is some evidence that early menopause, hysterectomy, or removal of the ovaries increases risk in women to that seen in men. The discovery of the toxicity of MPTP to nigral dopaminergic cells generated interest in environmental causes of the disease, although no other MPTP-like toxins have been discovered.

# data[].attributes.headline
Who's most likely to suffer from Parkinson's disease?

# data[].attributes.subject
Who's most likely to suffer from Parkinson's disease?

# data[].attributes.body
Who's most likely to suffer form Parkinson's?

The risk of PD is higher in Men than it is in woman, but woman have a faster progression rate and a higher mortality rate. 5% of people over 85 are likely to get Parkinson's disease, while only 3% of people over 65 get it.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6700650/

# data[].attributes.attachment_link.title
Parkinson’s Disease in Women and Men: What’s the Difference?

# data[].attributes.attachment_link.description
Increasing evidence points to biological sex as an important factor in the development and phenotypical expression of Parkinson’s disease (PD). Risk of developing PD is twice as high in men than women, but women have a higher mortality rate and…

# data[].attributes.body
Symptoms can be different for everyone, and they can be mild, on one side, or not even noticeable. Some symptoms can include:

Tremor: a rhythmic shaking that usually starts in the hands, fingers, foot, or jaw.

Bradykinesia: slowed movement that can make doing tasks more difficult

Rigid Muscles: stiff muscles that can occur in any part of your body

Nonmotor symptoms: these can include anxiety, depression, constipation, and sleep problems

Poor posture or balance

Loss of automatic movement

Speech and writing changes

Source: https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055

# data[].attributes.attachment_link.title
Parkinson’s disease - Symptoms and causes

# data[].attributes.attachment_link.description
There’s no cure for this progressive movement disorder, but treatments can help significantly improve your symptoms.

# data[].attributes.body
Although Parkinson's affects people allover the world in all races in affects most of the white population, even though Parkinson's was originated in black populations.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7029316/#:~:text=EPIDEMIOLOGY%20OF%20PD&text=Most%20studies%20report%20the%20highest,of%20PD%20risk%20than%20ethnicity.

# data[].attributes.attachment_link.title
Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review

# data[].attributes.attachment_link.description
The global prevalence of Parkinson’s disease is increasing, yet the characteristics, risk factors and genetics of PD in Black, Asian and Hispanic populations is little understood. In this paper we review the published literature on clinical…

# data[].attributes.body
Parkinson's can cause uncontrollable movements such as shaking, difficulty with balance and coordination, and stiffness. This also causes difficulty with walking and talking.

https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments#:~:text=Parkinson's%20disease%20is%20a%20brain,have%20difficulty%20walking%20and%20talking.

# data[].attributes.body
Motor and non-motor are two areas which Parkison can manifest. Motor symptoms manifest like: Slow movement, tremor and/or involuntary movement, for example; The non-motor symptoms manifest like: cognitive impairment, mental health disorders and/or dementia, for example. Day by day this conditioning is manifesting more frequently and more drastically in the people with Parkinson.

https://www.who.int/news-room/fact-sheets/detail/parkinson-disease

# data[].attributes.attachment_link.readable_text
Overview

Parkinson disease (PD) is a brain condition that causes problems with movement, mental health, sleep, pain and other health issues.

PD gets worse over time. There is no cure, but therapies and medicines can reduce symptoms. Common symptoms include tremors, painful muscle contractions and difficulty speaking.

Parkinson disease results in high rates of disability and the need for care. Many people with PD also develop dementia.

The disease usually occurs in older people, but younger people can also be affected. Men are affected more often than women.

The cause of PD is unknown but people with a family history of the disease have a higher risk. Exposure to air pollution, pesticides and solvents may increase risk.

Symptoms

Symptoms of Parkinson disease get worse over time. They can greatly reduce well-being and quality of life.

PD causes motors symptoms including:

Non-motor symptoms:

cognitive impairment

mental health disorders

dementia

sleep disorders

pain

sensory disturbances.

Involuntary movements (dyskinesias) and painful muscle contractions (dystonias) can cause problems speaking and moving. These symptoms lead to high rates of disability and the need for care. Many people with PD also develop dementia during the course of their disease.

While PD is the most common movement disorder, other movement disorders exist such as multiple system atrophy, progressive supranuclear palsy, chorea, ataxia and dystonia. Some movement disorders have similar symptoms to PD such as tremor, slow movement and rigidity. All movement disorders share the same challenges as PD regarding diagnostic and treatment gaps and access to medication, particularly in low- and middle-income countries (LMIC).

Assessment and disease burden

PDis a clinical diagnosis that not only can be made by neurologists but also by trained non-specialist healthcare workers. Assessment and management of PD by trained non-specialized healthcare workers in primary care is particularly important in areas where specialist neurological services are unavailable, such as in some LMIC.

The prevalence of PD has doubled in the past 25 years. Global estimates in 2019 showed over 8.5 million individuals with PD. Current estimates suggest that, in 2019, PD resulted in 5.8 million disability adjusted life years (DALYs), an increase of 81% since 2000, and caused 329 000 deaths, an increase of over 100% since 2000.

Treatment and care

There is no cure for Parkinson disease, but therapies including medicines, surgery and rehabilitation can reduce symptoms.

Levodopa/carbidopa, a combination medicine that increases the amount of dopamine in the brain, is the most common medication for PD (1). Doctors may use other medicines such as anticholinergics to reduce involuntary muscle movement.

Deep brain stimulation and other therapies can help the tremors and reduce the need for medicines.

Rehabilitation including physiotherapy can offer relief for Parkinson disease and other degenerative neurologic disorders. Therapies include:

strength training

gait and balance training

hydrotherapy.

These therapies can help improve functioning and quality of life for people with PD. This can also reduce the strain on carers.

Many medications and surgical resources are not accessible, available or affordable everywhere, particularly low- and middle-income countries.

Impact on families and carers

Informal carers (i.e. most commonly family members and friends) spendmany hours dailyproviding care for people living with PD.This can be overwhelming. Physical, emotional and financial pressures can cause great stress to families and carers, and support is required from the health, social, financial and legal systems. Useful support resources from other conditions can be drawn upon, such as WHO's iSupport programme for dementia.

Human rights

People with PD are often subject to stigma and discrimination, including unjust discrimination within the workplace and lack of opportunities to engage and participate in their communities.

People with PD require accessible health services for general healthcare needs like the rest of the population, including medicine access, promotive and preventive services and prompt diagnosis, treatment and care. A common barrier is created by healthcare providers' inadequate knowledge and understanding of PD and myths that PD is a contagious illness or a normal part of aging.

WHO response

In May 2022, the World Health Assembly endorsed the Intersectoral global action plan on epilepsy and other neurological disorders 2022-2031. The action plan will address the challenges and gaps in providing care and services for people with epilepsy and other neurological disorders such as PD that exist worldwide and ensure a comprehensive, coordinated response across sectors. This includes raising policy prioritization and strengthening governance, providing effective, timely and responsive diagnosis, treatment and care, implementing strategies for promotion and prevention, fostering research and innovation and strengthening information systems.

A WHO technical brief entitled Parkinson disease: a public health approach is available for policy-makers, health programme managers and planners, healthcare providers, researchers, people with PD, carers and other stakeholders. It outlines the important action areas for intervention in PD including global health policies focused on prevention and risk reduction, education and awareness and access to treatment and care at various levels of the health system.

WHO's iSupport, a knowledge and skills training programme for carers of people living with dementia is available as an online course and a hardcopy manual. iSupport Lite includes easy-to-read posters and a brief video that can act as a quick reference or a refresher, reinforcing previously acquired caregiving skills and knowledge.
Notes
Levodopa/carbidopa is on the WHO Model List of Essential Medicines.

# data[].attributes.attachment_link.description
Parkinson disease (PD) is a degenerative condition of the brain associated with motor symptoms (slow movement, tremor, rigidity, walking and imbalance) and a wide variety of non-motor complications (cognitive impairment, mental health disorders, sleep disorders and pain and other sensory disturbances).

# data[].attributes.body
There are also symptoms of Parkinson's that typically start one sided.

For example Tremors (a rhythmic shaking that usually starts in hands, fingers, foot, or jaw). These normally start on one hand or one finger.

Stiffness or slow movement is another symptom.

Facial stiffness, or Facial expressions also become droopy and stiff.

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055

# data[].attributes.body
One common way of diagnosing Parkinson's Disease is by looking at medical history and through specialty tests. These tests include a neurological exam, genetic tests, and an Alpha-Synuclein test.

Neurological Exam: an exam that tests your thinking, mental abilities, senses, coordination, and reflexes.

Genetic Tests: This test looks at your genetics and looks for any family history of Parkinson's Disease or any traits linked to early onset disease.

Alpha-Synuclein Test: also known as "alpha-synuclein amplification assay." This test is beneficial for detecting Parkinson's Disease before detecting symptoms. It looks for clumps typically found in Lewy bodies, which cannot break down and continue to spread and damage brain cells. Further research needs to be done for this test, but recently, it has been highly effective (87.7% of the time) in detecting Parkinson's Disease before symptoms even start.

Source: https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062

# data[].attributes.attachment_link.readable_text
Diagnosis

Currently, there isn't a specific test to diagnose Parkinson's disease. A diagnosis is made by a doctor trained in nervous system conditions, known as a neurologist. A diagnosis of Parkinson's is based on your medical history, a review of your symptoms, and a neurological and physical exam.

A member of your health care team may suggest a specific single-photon emission computerized tomography (SPECT) scan called a dopamine transporter (DAT) scan. Although this can help support the suspicion that you have Parkinson's disease, it is your symptoms and results of a neurological exam that ultimately determine the correct diagnosis. Most people do not require a DAT scan.

Your care team may order lab tests, such as blood tests, to rule out other conditions that may be causing your symptoms.

Imaging tests - such as an MRI, ultrasound of the brain and PET scans - also may be used to help rule out other disorders. Imaging tests aren't particularly helpful for diagnosing Parkinson's disease.

In addition to examining you, a member of your health care team may give you carbidopa-levodopa (Rytary, Sinemet, others), a Parkinson's disease medicine. You must be given a sufficient dose to show the benefit, as getting low doses for a day or two isn't reliable. Significant improvement with this medicine will often confirm your diagnosis of Parkinson's disease.

Sometimes it takes time to diagnose Parkinson's disease. Health care professionals may recommend regular follow-up appointments with neurologists trained in movement disorders to evaluate your condition and symptoms over time and diagnose Parkinson's disease.

However, a new test may be on the horizon. Researchers are studying a Parkinson's test that can detect the disease before symptoms begin. The test is called an alpha-synuclein seed amplification assay. In a 2023 study, researchers tested the spinal fluid of more than 1,000 people to look for clumps of the protein alpha-synuclein. Alpha-synuclein is found in Lewy bodies. It forms clumps that the body can't break down. The clumps spread and damage brain cells.

Alpha-synuclein clumps are a hallmark sign of Parkinson's disease. The test accurately identified people with Parkinson's disease 87.7% of the time. The test also was highly sensitive for detecting people at risk of Parkinson's disease.

This study of the alpha-synuclein seed amplification assay was the largest so far. Some researchers say the study may be a game changer for Parkinson's disease diagnosis, research and treatment trials. But larger studies are needed. There's hope among researchers that in the future, the test could be done using blood samples rather than spinal fluid.

Treatment

Parkinson's disease can't be cured, but medicines can help control the symptoms, often dramatically. In some more advanced cases, surgery may be advised.

Your health care team also may recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching is important. A speech-language pathologist may help improve speech problems.

Medications

Medicines may help you manage problems with walking, movement and tremor. These medicines increase or substitute for dopamine.

People with Parkinson's disease have low levels of brain dopamine. However, dopamine can't be given directly because it can't enter the brain.

You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of medicines frequently diminish or become less consistent. You can usually still control your symptoms well.

Medicines your care team may prescribe include:

Carbidopa-levodopa (Rytary, Sinemet, Duopa, others). Levodopa, the most effective Parkinson's disease medicine, is a natural chemical that passes into the brain and is converted to dopamine.

Levodopa is combined with carbidopa (Lodosyn), which protects levodopa from early conversion to dopamine outside the brain. This prevents or lessens side effects such as nausea.

Side effects may include nausea or lightheadedness when you stand, called orthostatic hypotension.

After years, as your disease progresses, the benefit from levodopa may lessen, with a tendency to wax and wane, also called "wearing off."

Also, you may experience involuntary movements known as dyskinesia after taking higher doses of levodopa. Your care team may lessen your dose or adjust the times of your doses to control these effects.

Unless told otherwise by your health care team, carbidopa-levodopa is best taken on an empty stomach if you have advanced Parkinson's disease.

Inhaled carbidopa-levodopa. Inbrija is a brand-name medicine delivering carbidopa-levodopa in an inhaled form. It may be helpful in managing symptoms that arise when medicines taken by mouth suddenly stop working during the day.

Carbidopa-levodopa infusion. Duopa is a brand-name medicine combining carbidopa and levodopa. However, it's administered through a feeding tube that delivers the medicine in a gel form directly to the small intestine.

Duopa is for patients with more-advanced Parkinson's who still respond to carbidopa-levodopa but who have a lot of fluctuations in their response. Because Duopa is continually infused, blood levels of the two medicines remain constant.

Placement of the tube requires a small surgical procedure. Risks associated with having the tube include the tube falling out or infections at the infusion site.

Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in the brain.

Dopamine agonists aren't as effective as levodopa in treating symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

Dopamine agonists include pramipexole (Mirapex ER) and rotigotine (Neupro), which is given as a patch. Apomorphine (Apokyn) is a short-acting dopamine agonist shot used for quick relief.

Some of the side effects of dopamine agonists are like the side effects of carbidopa-levodopa. But they also can include hallucinations, sleepiness and compulsive behaviors such as hypersexuality, gambling and eating. If you're taking these medicines and you behave in a way that's out of character for you, talk to your health care team.

Monoamine oxidase B (MAO B) inhibitors. These medicines include selegiline (Zelapar), rasagiline (Azilect) and safinamide (Xadago). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme breaks down brain dopamine. Selegiline given with levodopa may help prevent wearing off.

Side effects of MAO B inhibitors may include headaches, nausea or insomnia. When added to carbidopa-levodopa, these medicines increase the risk of hallucinations.

These medicines are not often used in combination with most antidepressants or certain pain medicines due to potentially serious but rare reactions. Check with your health care team before taking any additional medicines with an MAO B inhibitor.

Catechol O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) and opicapone (Ongentys) are the primary medicines from this class. This medicine mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Side effects, including an increased risk of involuntary movements called dyskinesia, mainly result from an enhanced levodopa effect. Other side effects include diarrhea, nausea or vomiting.

Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.

Anticholinergics. These medicines were used for many years to help control the tremor associated with Parkinson's disease. Several anticholinergic medicines are available, including benztropine (Cogentin) or trihexyphenidyl.

However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.

Amantadine. Health care professionals may prescribe amantadine (Gocovri) alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease. It also may be given with carbidopa-levodopa therapy during the later stages of Parkinson's disease to control involuntary movements called dyskinesia induced by carbidopa-levodopa.

Side effects may include a change in skin color, ankle swelling or hallucinations.

Adenosine receptor antagonists (A2A receptor antagonists). These drugs target areas in the brain that regulate the response to dopamine and allow more dopamine to be released. Istradefylline (Nourianz) is one of the A2A antagonist drugs.

Nuplazid (Pimavanserin). This drug is used to treat hallucinations and delusions that can occur with Parkinson's disease. Experts aren't sure how it works.

Surgical procedures

Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of the brain. The electrodes are connected to a generator implanted in the chest near the collarbone. The generator sends electrical pulses to the brain and may reduce Parkinson's disease symptoms.

Your health care team may adjust your settings as necessary to treat your condition. Surgery involves risks, including infections, stroke or brain hemorrhage. Some people experience problems with the DBS system or have complications due to stimulation. A member of your health care team may need to adjust or replace some parts of the system.

Deep brain stimulation is most often offered to people with advanced Parkinson's disease who have unstable responses to levodopa. DBS can stabilize medicine fluctuations, reduce or halt involuntary movements called dyskinesia, reduce tremor, reduce rigidity, and improve movements.

DBS is effective for controlling changing responses to levodopa or for controlling dyskinesia that doesn't improve with medicine adjustments.

However, DBS isn't helpful for problems that don't respond to levodopa therapy apart from tremor. Tremor may be controlled by DBS even if the tremor isn't very responsive to levodopa.

Although DBS may provide sustained benefit for Parkinson's symptoms, it doesn't keep Parkinson's disease from progressing.

Advanced treatments

MRI-guided focused ultrasound (MRgFUS) is a minimally invasive treatment that has helped some people with Parkinson's disease manage tremors. Ultrasound is guided by an MRI to the area in the brain where the tremors start. The ultrasound waves are at a very high temperature and burn areas that are contributing to the tremors.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

You'll need to work closely with your health care team to find a Parkinson's treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain medicines can make your symptoms worse, so please discuss with your care team any medicines you currently take.

Certain lifestyle changes also may help make living with Parkinson's disease easier.

Healthy eating

While no food or combination of foods has been proved to help in Parkinson's disease, some foods may help ease some of the symptoms. For example, eating foods high in fiber and drinking plenty of fluids can help prevent constipation that is common in Parkinson's disease.

A balanced diet also provides nutrients, such as omega-3 fatty acids, that might be beneficial for people with Parkinson's disease.

Exercise

Exercising may increase your muscle strength, flexibility and balance. Exercise also can improve your well-being and reduce depression or anxiety.

Your health care team may suggest that you work with a physical therapist to learn an exercise program that works for you. You also may try exercises such as walking, swimming, gardening, dancing, water aerobics or stretching.

Parkinson's disease can disturb your sense of balance, making it difficult to walk with your usual gait. Exercise may improve your balance. These suggestions also may help:

Try not to move too quickly.

Aim for your heel to strike the floor first when you're walking.

If you notice yourself shuffling, stop and check your posture. It's best to stand up straight.

Look in front of you, not directly down, while walking.

Avoiding falls

In the later stages of the disease, you may fall more easily. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:

Make a U-turn instead of pivoting your body over your feet.

Distribute your weight evenly between both feet, and don't lean.

Avoid carrying things while you walk.

Avoid walking backward.

Daily living activities

Daily living activities - such as dressing, eating, bathing and writing - can be difficult for people with Parkinson's disease. An occupational therapist can show you techniques that make daily life easier.

If you are having trouble talking, a speech therapist may be able to help. Many people with Parkinson's disease have speech difficulties such as a slow, weak voice, trouble with consonants, slurred speech, a low voice that has a monotone with little expression, and inappropriate silences. A speech therapist may be able to help with these problems.

Alternative medicine

Supportive therapies can help ease some of the symptoms and complications of Parkinson's disease, such as pain, fatigue and depression. When performed in combination with your treatments, these therapies might improve your quality of life:

Massage. Massage therapy can reduce muscle tension and promote relaxation. This therapy, however, is rarely covered by health insurance.

Tai chi. An ancient form of Chinese exercise, tai chi uses slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi also may help prevent falls. Several forms of tai chi are tailored for people of any age or physical condition.

A study showed that tai chi may improve the balance of people with mild to moderate Parkinson's disease more than stretching and resistance training do.

Yoga. In yoga, gentle stretching movements and poses may increase your flexibility and balance. You may modify most poses to fit your physical abilities.

Alexander technique. This technique - which focuses on muscle posture, balance and thinking about how you use muscles - may reduce muscle tension and pain.

Meditation. In meditation, you quietly reflect and focus your mind on an idea or image. Meditation may reduce stress and pain and improve your sense of well-being.

Pet therapy. Having a dog or cat may increase your flexibility and movement and improve your emotional health.

Relaxation techniques. These practices help lower your blood pressure, reduce your heart rate and improve muscle tone.

Coping and support

Living with any chronic illness can be difficult, and it's not uncommon to feel angry, depressed or discouraged at times. Parkinson's disease can be profoundly frustrating as walking, talking and even eating become more difficult and time-consuming.

Depression is common in people with Parkinson's disease. But antidepressant medicines can help ease the symptoms of depression, so talk with your health care team if you're feeling persistently sad or hopeless.

Although friends and family can be your best allies, the understanding of people who know what you're going through can be especially helpful. Support groups aren't for everyone. However, for many people with Parkinson's disease and their families, a support group can be a good resource for practical information about Parkinson's disease.

Also, groups offer a place for you to find people who are going through similar situations and can support you.

Trying to maintain some of your usual activities may be helpful. Aim to do as many things as possible that you could do before the onset of Parkinson's disease. Focus on the present and try to maintain a positive attitude.

To learn about support groups in your community, talk to your health care team, a Parkinson's disease social worker or a local public health nurse. Or contact the Parkinson's Foundation or the American Parkinson Disease Association.

You and your family also may benefit from talking to a mental health professional, such as a psychologist or social worker trained in working with people who have chronic conditions.

Preparing for your appointment

You're likely to first see a health care professional. You may then be referred to a doctor trained in nervous system disorders, called a neurologist.

Because there's often a lot to discuss, it's a good idea to prepare for your appointment. Here's some information to help you get ready for your appointment.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medicines, vitamins and supplements that you're taking.

Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.

Write down questions to ask during your appointment.

Your time with your care team is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For Parkinson's disease, some basic questions to ask include:

What's the most likely cause of my symptoms?

Are there other possible causes?

What kinds of tests do I need? Do these tests require any special preparation?

How does Parkinson's disease usually progress?

Will I eventually need long-term care?

What treatments are available, and which do you recommend for me?

What types of side effects can I expect from treatment?

If the treatment doesn't work or stops working, do I have additional options?

I have other health conditions. How can I best manage these conditions together?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your care team, don't hesitate to ask questions that occur to you during your appointment.

What to expect from your doctor

Your health care team is likely to ask you a several questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. You may be asked:

When did you first begin experiencing symptoms?

Do you have symptoms all the time, or do they come and go?

Does anything seem to improve your symptoms?

Does anything seem to make your symptoms worse?

# data[].attributes.attachment_link.description
There's no cure for this progressive movement disorder, but treatments can help significantly improve your symptoms.

# data[].attributes.body
Another common way of diagnosing Parkinson's Disease is through physical examinations. These types of tests can include blood & lab tests, imaging tests, etc.

Blood & lab tests: this is used to rule out any other conditions that may be causing your symptoms so that you can get a clear, definite, conclusion.

Imaging Tests: tests such as an MRI scan, brain ultrasound, PET scan, and dopamine transporter (DPT) scans. These can also help identify any other potential conditions to help rule out your symptoms to be diagnosed with Parkinson's Disease. A DPT scan is also helpful for identifying various types of tremors, but it is almost always not necessarily needed for diagnosis.

Source: https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062

# data[].attributes.attachment_link.readable_text
Diagnosis

Currently, there isn't a specific test to diagnose Parkinson's disease. A diagnosis is made by a doctor trained in nervous system conditions, known as a neurologist. A diagnosis of Parkinson's is based on your medical history, a review of your symptoms, and a neurological and physical exam.

A member of your health care team may suggest a specific single-photon emission computerized tomography (SPECT) scan called a dopamine transporter (DAT) scan. Although this can help support the suspicion that you have Parkinson's disease, it is your symptoms and results of a neurological exam that ultimately determine the correct diagnosis. Most people do not require a DAT scan.

Your care team may order lab tests, such as blood tests, to rule out other conditions that may be causing your symptoms.

Imaging tests - such as an MRI, ultrasound of the brain and PET scans - also may be used to help rule out other disorders. Imaging tests aren't particularly helpful for diagnosing Parkinson's disease.

In addition to examining you, a member of your health care team may give you carbidopa-levodopa (Rytary, Sinemet, others), a Parkinson's disease medicine. You must be given a sufficient dose to show the benefit, as getting low doses for a day or two isn't reliable. Significant improvement with this medicine will often confirm your diagnosis of Parkinson's disease.

Sometimes it takes time to diagnose Parkinson's disease. Health care professionals may recommend regular follow-up appointments with neurologists trained in movement disorders to evaluate your condition and symptoms over time and diagnose Parkinson's disease.

However, a new test may be on the horizon. Researchers are studying a Parkinson's test that can detect the disease before symptoms begin. The test is called an alpha-synuclein seed amplification assay. In a 2023 study, researchers tested the spinal fluid of more than 1,000 people to look for clumps of the protein alpha-synuclein. Alpha-synuclein is found in Lewy bodies. It forms clumps that the body can't break down. The clumps spread and damage brain cells.

Alpha-synuclein clumps are a hallmark sign of Parkinson's disease. The test accurately identified people with Parkinson's disease 87.7% of the time. The test also was highly sensitive for detecting people at risk of Parkinson's disease.

This study of the alpha-synuclein seed amplification assay was the largest so far. Some researchers say the study may be a game changer for Parkinson's disease diagnosis, research and treatment trials. But larger studies are needed. There's hope among researchers that in the future, the test could be done using blood samples rather than spinal fluid.

Treatment

Parkinson's disease can't be cured, but medicines can help control the symptoms, often dramatically. In some more advanced cases, surgery may be advised.

Your health care team also may recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching is important. A speech-language pathologist may help improve speech problems.

Medications

Medicines may help you manage problems with walking, movement and tremor. These medicines increase or substitute for dopamine.

People with Parkinson's disease have low levels of brain dopamine. However, dopamine can't be given directly because it can't enter the brain.

You may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of medicines frequently diminish or become less consistent. You can usually still control your symptoms well.

Medicines your care team may prescribe include:

Carbidopa-levodopa (Rytary, Sinemet, Duopa, others). Levodopa, the most effective Parkinson's disease medicine, is a natural chemical that passes into the brain and is converted to dopamine.

Levodopa is combined with carbidopa (Lodosyn), which protects levodopa from early conversion to dopamine outside the brain. This prevents or lessens side effects such as nausea.

Side effects may include nausea or lightheadedness when you stand, called orthostatic hypotension.

After years, as your disease progresses, the benefit from levodopa may lessen, with a tendency to wax and wane, also called "wearing off."

Also, you may experience involuntary movements known as dyskinesia after taking higher doses of levodopa. Your care team may lessen your dose or adjust the times of your doses to control these effects.

Unless told otherwise by your health care team, carbidopa-levodopa is best taken on an empty stomach if you have advanced Parkinson's disease.

Inhaled carbidopa-levodopa. Inbrija is a brand-name medicine delivering carbidopa-levodopa in an inhaled form. It may be helpful in managing symptoms that arise when medicines taken by mouth suddenly stop working during the day.

Carbidopa-levodopa infusion. Duopa is a brand-name medicine combining carbidopa and levodopa. However, it's administered through a feeding tube that delivers the medicine in a gel form directly to the small intestine.

Duopa is for patients with more-advanced Parkinson's who still respond to carbidopa-levodopa but who have a lot of fluctuations in their response. Because Duopa is continually infused, blood levels of the two medicines remain constant.

Placement of the tube requires a small surgical procedure. Risks associated with having the tube include the tube falling out or infections at the infusion site.

Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in the brain.

Dopamine agonists aren't as effective as levodopa in treating symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

Dopamine agonists include pramipexole (Mirapex ER) and rotigotine (Neupro), which is given as a patch. Apomorphine (Apokyn) is a short-acting dopamine agonist shot used for quick relief.

Some of the side effects of dopamine agonists are like the side effects of carbidopa-levodopa. But they also can include hallucinations, sleepiness and compulsive behaviors such as hypersexuality, gambling and eating. If you're taking these medicines and you behave in a way that's out of character for you, talk to your health care team.

Monoamine oxidase B (MAO B) inhibitors. These medicines include selegiline (Zelapar), rasagiline (Azilect) and safinamide (Xadago). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO B). This enzyme breaks down brain dopamine. Selegiline given with levodopa may help prevent wearing off.

Side effects of MAO B inhibitors may include headaches, nausea or insomnia. When added to carbidopa-levodopa, these medicines increase the risk of hallucinations.

These medicines are not often used in combination with most antidepressants or certain pain medicines due to potentially serious but rare reactions. Check with your health care team before taking any additional medicines with an MAO B inhibitor.

Catechol O-methyltransferase (COMT) inhibitors. Entacapone (Comtan) and opicapone (Ongentys) are the primary medicines from this class. This medicine mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Side effects, including an increased risk of involuntary movements called dyskinesia, mainly result from an enhanced levodopa effect. Other side effects include diarrhea, nausea or vomiting.

Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.

Anticholinergics. These medicines were used for many years to help control the tremor associated with Parkinson's disease. Several anticholinergic medicines are available, including benztropine (Cogentin) or trihexyphenidyl.

However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.

Amantadine. Health care professionals may prescribe amantadine (Gocovri) alone to provide short-term relief of symptoms of mild, early-stage Parkinson's disease. It also may be given with carbidopa-levodopa therapy during the later stages of Parkinson's disease to control involuntary movements called dyskinesia induced by carbidopa-levodopa.

Side effects may include a change in skin color, ankle swelling or hallucinations.

Adenosine receptor antagonists (A2A receptor antagonists). These drugs target areas in the brain that regulate the response to dopamine and allow more dopamine to be released. Istradefylline (Nourianz) is one of the A2A antagonist drugs.

Nuplazid (Pimavanserin). This drug is used to treat hallucinations and delusions that can occur with Parkinson's disease. Experts aren't sure how it works.

Surgical procedures

Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of the brain. The electrodes are connected to a generator implanted in the chest near the collarbone. The generator sends electrical pulses to the brain and may reduce Parkinson's disease symptoms.

Your health care team may adjust your settings as necessary to treat your condition. Surgery involves risks, including infections, stroke or brain hemorrhage. Some people experience problems with the DBS system or have complications due to stimulation. A member of your health care team may need to adjust or replace some parts of the system.

Deep brain stimulation is most often offered to people with advanced Parkinson's disease who have unstable responses to levodopa. DBS can stabilize medicine fluctuations, reduce or halt involuntary movements called dyskinesia, reduce tremor, reduce rigidity, and improve movements.

DBS is effective for controlling changing responses to levodopa or for controlling dyskinesia that doesn't improve with medicine adjustments.

However, DBS isn't helpful for problems that don't respond to levodopa therapy apart from tremor. Tremor may be controlled by DBS even if the tremor isn't very responsive to levodopa.

Although DBS may provide sustained benefit for Parkinson's symptoms, it doesn't keep Parkinson's disease from progressing.

Advanced treatments

MRI-guided focused ultrasound (MRgFUS) is a minimally invasive treatment that has helped some people with Parkinson's disease manage tremors. Ultrasound is guided by an MRI to the area in the brain where the tremors start. The ultrasound waves are at a very high temperature and burn areas that are contributing to the tremors.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

You'll need to work closely with your health care team to find a Parkinson's treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain medicines can make your symptoms worse, so please discuss with your care team any medicines you currently take.

Certain lifestyle changes also may help make living with Parkinson's disease easier.

Healthy eating

While no food or combination of foods has been proved to help in Parkinson's disease, some foods may help ease some of the symptoms. For example, eating foods high in fiber and drinking plenty of fluids can help prevent constipation that is common in Parkinson's disease.

A balanced diet also provides nutrients, such as omega-3 fatty acids, that might be beneficial for people with Parkinson's disease.

Exercise

Exercising may increase your muscle strength, flexibility and balance. Exercise also can improve your well-being and reduce depression or anxiety.

Your health care team may suggest that you work with a physical therapist to learn an exercise program that works for you. You also may try exercises such as walking, swimming, gardening, dancing, water aerobics or stretching.

Parkinson's disease can disturb your sense of balance, making it difficult to walk with your usual gait. Exercise may improve your balance. These suggestions also may help:

Try not to move too quickly.

Aim for your heel to strike the floor first when you're walking.

If you notice yourself shuffling, stop and check your posture. It's best to stand up straight.

Look in front of you, not directly down, while walking.

Avoiding falls

In the later stages of the disease, you may fall more easily. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:

Make a U-turn instead of pivoting your body over your feet.

Distribute your weight evenly between both feet, and don't lean.

Avoid carrying things while you walk.

Avoid walking backward.

Daily living activities

Daily living activities - such as dressing, eating, bathing and writing - can be difficult for people with Parkinson's disease. An occupational therapist can show you techniques that make daily life easier.

If you are having trouble talking, a speech therapist may be able to help. Many people with Parkinson's disease have speech difficulties such as a slow, weak voice, trouble with consonants, slurred speech, a low voice that has a monotone with little expression, and inappropriate silences. A speech therapist may be able to help with these problems.

Alternative medicine

Supportive therapies can help ease some of the symptoms and complications of Parkinson's disease, such as pain, fatigue and depression. When performed in combination with your treatments, these therapies might improve your quality of life:

Massage. Massage therapy can reduce muscle tension and promote relaxation. This therapy, however, is rarely covered by health insurance.

Tai chi. An ancient form of Chinese exercise, tai chi uses slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi also may help prevent falls. Several forms of tai chi are tailored for people of any age or physical condition.

A study showed that tai chi may improve the balance of people with mild to moderate Parkinson's disease more than stretching and resistance training do.

Yoga. In yoga, gentle stretching movements and poses may increase your flexibility and balance. You may modify most poses to fit your physical abilities.

Alexander technique. This technique - which focuses on muscle posture, balance and thinking about how you use muscles - may reduce muscle tension and pain.

Meditation. In meditation, you quietly reflect and focus your mind on an idea or image. Meditation may reduce stress and pain and improve your sense of well-being.

Pet therapy. Having a dog or cat may increase your flexibility and movement and improve your emotional health.

Relaxation techniques. These practices help lower your blood pressure, reduce your heart rate and improve muscle tone.

Coping and support

Living with any chronic illness can be difficult, and it's not uncommon to feel angry, depressed or discouraged at times. Parkinson's disease can be profoundly frustrating as walking, talking and even eating become more difficult and time-consuming.

Depression is common in people with Parkinson's disease. But antidepressant medicines can help ease the symptoms of depression, so talk with your health care team if you're feeling persistently sad or hopeless.

Although friends and family can be your best allies, the understanding of people who know what you're going through can be especially helpful. Support groups aren't for everyone. However, for many people with Parkinson's disease and their families, a support group can be a good resource for practical information about Parkinson's disease.

Also, groups offer a place for you to find people who are going through similar situations and can support you.

Trying to maintain some of your usual activities may be helpful. Aim to do as many things as possible that you could do before the onset of Parkinson's disease. Focus on the present and try to maintain a positive attitude.

To learn about support groups in your community, talk to your health care team, a Parkinson's disease social worker or a local public health nurse. Or contact the Parkinson's Foundation or the American Parkinson Disease Association.

You and your family also may benefit from talking to a mental health professional, such as a psychologist or social worker trained in working with people who have chronic conditions.

Preparing for your appointment

You're likely to first see a health care professional. You may then be referred to a doctor trained in nervous system disorders, called a neurologist.

Because there's often a lot to discuss, it's a good idea to prepare for your appointment. Here's some information to help you get ready for your appointment.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medicines, vitamins and supplements that you're taking.

Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.

Write down questions to ask during your appointment.

Your time with your care team is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For Parkinson's disease, some basic questions to ask include:

What's the most likely cause of my symptoms?

Are there other possible causes?

What kinds of tests do I need? Do these tests require any special preparation?

How does Parkinson's disease usually progress?

Will I eventually need long-term care?

What treatments are available, and which do you recommend for me?

What types of side effects can I expect from treatment?

If the treatment doesn't work or stops working, do I have additional options?

I have other health conditions. How can I best manage these conditions together?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your care team, don't hesitate to ask questions that occur to you during your appointment.

What to expect from your doctor

Your health care team is likely to ask you a several questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. You may be asked:

When did you first begin experiencing symptoms?

Do you have symptoms all the time, or do they come and go?

Does anything seem to improve your symptoms?

Does anything seem to make your symptoms worse?

# data[].attributes.attachment_link.description
There's no cure for this progressive movement disorder, but treatments can help significantly improve your symptoms.

# data[].attributes.body
The dopamine agonists as the principal treatment for Parkinson's disease (PD). The doctors started the research and this treatment could reduce the tremors and protect the brain from supposed injuries. They still need more information and studies about this treatment, because PD is a complex and hard problem so they don’t have a clear and absolute certainty with these studies. With precise evidence, they could start the treatment on Parkinson’s patience.

https://www.neurology.org/doi/abs/10.1212/01.WNL.0000052681.28286.52

# data[].attributes.body
Since Parkinson's Disease affects your cognitive functions, over time, as this disease progresses, it can lead to dementia. A specific type of dementia called Lewy Body Dementia can severely affect one's memory and thinking abilities in everyday life. This can be tough to face because we need memory and thinking abilities to survive in the world, so this is a difficult long-term consequence to face when someone has Parkinson's Disease.

Source: https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments#:~:text=Changes%20in%20cognition%20and%20Parkinson's,problems%20with%20thinking%20or%20memory.

# data[].attributes.body
One thing that Parkinson's can affect is the persons mental well-being. Over time parkinon's tends to cause depression. Not just sadness, or mourning the fact they have this disease. Depression is a part of Parkinson's itself. Parkinson's impacts areas of the brain that produce dopamine, norepinephrine and serotonin. These are chemicals involved in regulating mood, energy, motivation, appetite and sleep. So when parkinon's comes in and ruins these chemicals your emotions are going to be out of balance: causing this like depression.

https://www.parkinson.org/understanding-parkinsons/non-movement-symptoms/depression

# data[].attributes.attachment_link.readable_text
Major depressive disorder

Other names

Clinical depression, major depression, unipolar depression, unipolar disorder, recurrent depression

Sorrowing Old Man ('At Eternity's Gate')
by Vincent van Gogh (1890)

Specialty
Psychiatry
Clinical psychology

Symptoms

Low mood, low self-esteem, loss of interest in normally enjoyable activities, low energy, pain without a clear cause[1]

Complications

Self-harm, suicide[2]

Usual onset

20s-30s[3][4]

Duration

> 2 weeks[1]

Causes

Genetic, environmental, and psychological factors[1]

Risk factors

Family history, major life changes, certain medications, chronic health problems, substance abuse[1][3]

Differential diagnosis

Bipolar disorder, ADHD, sadness[3]

Treatment

Counseling, antidepressant medication, electroconvulsive therapy, exercise[5][1]

Frequency

163 million (2017)[6]

Major depressive disorder ( MDD), also known simply as depression, is a mental disorder characterized by at least two weeks of pervasive low mood. Low self-esteem, loss of interest in normally enjoyable activities, low energy, and pain without a clear cause are common symptoms. Those affected may also occasionally have delusions or hallucinations. Some people have periods of depression separated by years, while others nearly always have symptoms present. Major depression is more severe and lasts longer than sadness, which is a normal part of life.

The diagnosis of major depressive disorder is based on the person's reported experiences and a mental status examination. There is no laboratory test for the disorder, but testing may be done to rule out physical conditions that can cause similar symptoms. Those with major depressive disorder are typically treated with counseling and antidepressant medication. Medication appears to be effective, but the effect may only be significant in the most severely depressed. Types of counseling used include cognitive behavioral therapy (CBT) and interpersonal therapy, and electroconvulsive therapy (ECT) may be considered if other measures are not effective. Hospitalization may be necessary in cases with a risk of harm to self and may occasionally occur against a person's wishes.

The most common time of onset is in a person's 20s and 30s, with females affected about twice as often as males. Major depressive disorder affected approximately 163 million people (2% of the world's population) in 2017. The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. Lifetime rates are higher in the developed world (15%) compared to the developing world (11%). The disorder causes the second-most years lived with disability, after lower back pain.

The term major depressive disorder was introduced by a group of US clinicians in the mid-1970s. The cause of major depressive disorder is believed to be a combination of genetic, environmental, and psychological factors, with about 40% of the risk related to genetics. Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse. It can negatively affect a person's personal life, work life, or education as well as sleeping, eating habits, and general health. Those currently or previously affected with the disorder may be stigmatized.

Symptoms and signs

Major depression significantly affects a person's family and personal relationships, work or school life, sleeping and eating habits, and general health. Its impact on functioning and well-being has been compared to that of other chronic medical conditions, such as diabetes.

A person having a major depressive episode usually exhibits a low mood, which pervades all aspects of life, and an inability to experience pleasure in previously enjoyable activities. Depressed people may be preoccupied with-or ruminate over-thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness or hopelessness. In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant. Other symptoms of depression include poor concentration and memory (especially in those with melancholic or psychotic features), withdrawal from social situations and activities, reduced sex drive, irritability, and thoughts of death or suicide. Insomnia is common among the depressed. In the typical pattern, a person wakes very early and cannot get back to sleep. Hypersomnia, or oversleeping, can also happen. Some antidepressants may also cause insomnia due to their stimulating effect.

A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the World Health Organization's criteria for depression. Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. Family and friends may notice that the person's behavior is either agitated or lethargic. Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness, and a more noticeable slowing of movements.

Depressed children may often display an irritable mood rather than a depressed one, and show varying symptoms depending on age and situation. Most lose interest in school and show a decline in academic performance. They may be described as clingy, demanding, dependent, or insecure. Diagnosis may be delayed or missed when symptoms are interpreted as "normal moodiness."

Associated conditions

Major depression frequently co-occurs with other psychiatric problems. The 1990-92 National Comorbidity Survey (US) reports that half of those with major depression also have lifetime anxiety and its associated disorders such as generalized anxiety disorder. Anxiety symptoms can have a major impact on the course of a depressive illness, with delayed recovery, increased risk of relapse, greater disability and increased suicide attempts. There are increased rates of alcohol and drug abuse and particularly dependence, and around a third of individuals diagnosed with ADHD develop comorbid depression. Post-traumatic stress disorder and depression often co-occur. Depression may also coexist with attention deficit hyperactivity disorder (ADHD), complicating the diagnosis and treatment of both. Depression is also frequently comorbid with alcohol abuse and personality disorders. Depression can also be exacerbated during particular months (usually winter) for those with seasonal affective disorder. While overuse of digital media has been associated with depressive symptoms, digital media may also be utilised in some situations to improve mood.

Depression and pain often co-occur. One or more pain symptoms are present in 65% of depressed patients, and anywhere from 5 to 85% of patients with pain will be suffering from depression, depending on the setting; there is a lower prevalence in general practice, and higher in specialty clinics. The diagnosis of depression is often delayed or missed, and the outcome can worsen if the depression is noticed but completely misunderstood.

Depression is also associated with a 1.5- to 2-fold increased risk of cardiovascular disease, independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity. People with major depression are less likely to follow medical recommendations for treating and preventing cardiovascular disorders, which further increases their risk of medical complications. In addition, cardiologists may not recognize underlying depression that complicates a cardiovascular problem under their care.

Depression often coexists with physical disorders common among the elderly, such as stroke, other cardiovascular diseases, Parkinson's disease, and chronic obstructive pulmonary disease.

The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. The diathesis-stress model specifies that depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The preexisting vulnerability can be either genetic, implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.

Childhood abuse, either physical, sexual or psychological, are all risk factors for depression, among other psychiatric issues that co-occur such as anxiety and drug abuse. Childhood trauma also correlates with severity of depression, lack of response to treatment and length of illness. However, some are more susceptible to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility.

Family and twin studies find that nearly 40% of individual differences in risk for major depressive disorder can be explained by genetic factors. Like most psychiatric disorders, major depressive disorder is likely to be influenced by many individual genetic changes. In 2018, a genome-wide association study discovered 44 variants in the genome linked to risk for major depression. This was followed by a 2019 study that found 102 variants in the genome linked to depression.

The 5-HTTLPR, or serotonin transporter promoter gene's short allele has been associated with increased risk of depression. However, since the 1990s, results have been inconsistent, with three recent reviews finding an effect and two finding none. Other genes that have been linked to a gene-environment interaction include CRHR1, FKBP5 and BDNF, the first two of which are related to the stress reaction of the HPA axis, and the latter of which is involved in neurogenesis. There is no conclusive effects of candidate gene on depression, either alone or in combination with life stress. Research focusing on specific candidate genes has been criticized for its tendency to generate false positive findings. There are also other efforts to examine interactions between life stress and polygenic risk for depression.

Other health problems

Depression may also come secondary to a chronic or terminal medical condition, such as HIV/AIDS or asthma, and may be labeled "secondary depression." It is unknown whether the underlying diseases induce depression through effect on quality of life, of through shared etiologies (such as degeneration of the basal ganglia in Parkinson's disease or immune dysregulation in asthma). Depression may also be iatrogenic (the result of healthcare), such as drug-induced depression. Therapies associated with depression include interferons, beta-blockers, isotretinoin, contraceptives, cardiac agents, anticonvulsants, antimigraine drugs, antipsychotics, and hormonal agents such as gonadotropin-releasing hormone agonist. Drug abuse in early age is also associated with increased risk of developing depression later in life. Depression that occurs as a result of pregnancy is called postpartum depression, and is thought to be the result of hormonal changes associated with pregnancy. Seasonal affective disorder, a type of depression associated with seasonal changes in sunlight, is thought to be the result of decreased sunlight.

Pathophysiology

The pathophysiology of depression is not yet understood, but the current theories center around monoaminergic systems, the circadian rhythm, immunological dysfunction, HPA axis dysfunction and structural or functional abnormalities of emotional circuits.

The monoamine theory, derived from the efficacy of monoaminergic drugs in treating depression, was the dominant theory until recently[when? ]. The theory postulates that insufficient activity of monoamine neurotransmitters is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. Firstly, acute depletion of tryptophan, a necessary precursor of serotonin, a monoamine, can cause depression in those in remission or relatives of depressed patients; this suggests that decreased serotonergic neurotransmission is important in depression. Secondly, the correlation between depression risk and polymorphisms in the 5-HTTLPR gene, which codes for serotonin receptors, suggests a link. Third, decreased size of the locus coeruleus, decreased activity of tyrosine hydroxylase, increased density of alpha-2 adrenergic receptor, and evidence from rat models suggest decreased adrenergic neurotransmission in depression. Furthermore, decreased levels of homovanillic acid, altered response to dextroamphetamine, responses of depressive symptoms to dopamine receptor agonists, decreased dopamine receptor D1 binding in the striatum, and polymorphism of dopamine receptor genes implicate dopamine, another monoamine, in depression. Lastly, increased activity of monoamine oxidase, which degrades monoamines, has been associated with depression. However, this theory is inconsistent with the fact that serotonin depletion does not cause depression in healthy persons, the fact that antidepressants instantly increase levels of monoamines but take weeks to work, and the existence of atypical antidepressants which can be effective despite not targeting this pathway. One proposed explanation for the therapeutic lag, and further support for the deficiency of monoamines, is a desensitization of self-inhibition in raphe nuclei by the increased serotonin mediated by antidepressants. However, disinhibition of the dorsal raphe has been proposed to occur as a result of decreased serotonergic activity in tryptophan depletion, resulting in a depressed state mediated by increased serotonin. Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive than controls, the finding of increased jugular 5-HIAA in depressed patients that normalized with SSRI treatment, and the preference for carbohydrates in depressed patients. Already limited, the monoamine hypothesis has been further oversimplified when presented to the general public.

Immune system abnormalities have been observed, including increased levels of cytokines involved in generating sickness behavior (which shares overlap with depression). The effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) and cytokine inhibitors in treating depression, and normalization of cytokine levels after successful treatment further suggest immune system abnormalities in depression.

HPA axis abnormalities have been suggested in depression given the association of CRHR1 with depression and the increased frequency of dexamethasone test non-suppression in depressed patients. However, this abnormality is not adequate as a diagnosis tool, because its sensitivity is only 44%. These stress-related abnormalities have been hypothesized to be the cause of hippocampal volume reductions seen in depressed patients. Furthermore, a meta-analysis yielded decreased dexamethasone suppression, and increased response to psychological stressors. Further abnormal results have been obscured with the cortisol awakening response, with increased response being associated with depression.

Theories unifying neuroimaging findings have been proposed. The first model proposed is the "Limbic Cortical Model", which involves hyperactivity of the ventral paralimbic regions and hypoactivity of frontal regulatory regions in emotional processing. Another model, the "Corito-Striatal model", suggests that abnormalities of the prefrontal cortex in regulating striatal and subcortical structures results in depression. Another model proposes hyperactivity of salience structures in identifying negative stimuli, and hypoactivity of cortical regulatory structures resulting in a negative emotional bias and depression, consistent with emotional bias studies.

Clinical assessment

A diagnostic assessment may be conducted by a suitably trained general practitioner, or by a psychiatrist or psychologist, who records the person's current circumstances, biographical history, current symptoms, family history, and alcohol and drug use. The assessment also includes a mental state examination, which is an assessment of the person's current mood and thought content, in particular the presence of themes of hopelessness or pessimism, self-harm or suicide, and an absence of positive thoughts or plans. Specialist mental health services are rare in rural areas, and thus diagnosis and management is left largely to primary-care clinicians. This issue is even more marked in developing countries. Rating scales are not used to diagnose depression, but they provide an indication of the severity of symptoms for a time period, so a person who scores above a given cut-off point can be more thoroughly evaluated for a depressive disorder diagnosis. Several rating scales are used for this purpose; these include the Hamilton Rating Scale for Depression, the Beck Depression Inventory or the Suicide Behaviors Questionnaire-Revised.

Primary-care physicians and other non-psychiatrist physicians have more difficulty with underrecognition and undertreatment of depression compared to psychiatric physicians, in part because of the physical symptoms that often accompany depression, in addition to many potential patient, provider, and system barriers. A review found that non-psychiatrist physicians miss about two-thirds of cases, though this has improved somewhat in more recent studies.

Before diagnosing major depressive disorder, a doctor generally performs a medical examination and selected investigations to rule out other causes of symptoms. These include blood tests measuring TSH and thyroxine to exclude hypothyroidism; basic electrolytes and serum calcium to rule out a metabolic disturbance; and a full blood count including ESR to rule out a systemic infection or chronic disease. Adverse affective reactions to medications or alcohol misuse are often ruled out, as well. Testosterone levels may be evaluated to diagnose hypogonadism, a cause of depression in men. Vitamin D levels might be evaluated, as low levels of vitamin D have been associated with greater risk for depression.

Subjective cognitive complaints appear in older depressed people, but they can also be indicative of the onset of a dementing disorder, such as Alzheimer's disease. Cognitive testing and brain imaging can help distinguish depression from dementia. A CT scan can exclude brain pathology in those with psychotic, rapid-onset or otherwise unusual symptoms. No biological tests confirm major depression. In general, investigations are not repeated for a subsequent episode unless there is a medical indication.

DSM and ICD criteria

The most widely used criteria for diagnosing depressive conditions are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems which uses the name depressive episode for a single episode and recurrent depressive disorder for repeated episodes. The latter system is typically used in European countries, while the former is used in the US and many other non-European nations, and the authors of both have worked towards conforming one with the other.

Both DSM-5 and ICD-10 mark out typical (main) depressive symptoms. ICD-10 defines three typical depressive symptoms (depressed mood, anhedonia, and reduced energy), two of which should be present to determine the depressive disorder diagnosis. According to DSM-5, there are two main depressive symptoms- a depressed mood and loss of interest/pleasure in activities (anhedonia). These symptoms, as well as five out of the nine more specific symptoms listed, must frequently occur for more than two weeks (to the extent in which it impairs functioning) for the diagnosis.

Major depressive disorder is classified as a mood disorder in DSM-5. The diagnosis hinges on the presence of single or recurrent major depressive episodes. Further qualifiers are used to classify both the episode itself and the course of the disorder. The category Unspecified Depressive Disorder is diagnosed if the depressive episode's manifestation does not meet the criteria for a major depressive episode. The ICD-10 system does not use the term major depressive disorder but lists very similar criteria for the diagnosis of a depressive episode (mild, moderate or severe); the term recurrent may be added if there have been multiple episodes without mania.

Major depressive episode

A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks. Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning). An episode with psychotic features-commonly referred to as psychotic depression-is automatically rated as severe. If the patient has had an episode of mania or markedly elevated mood, a diagnosis of bipolar disorder is made instead. Depression without mania is sometimes referred to as unipolar because the mood remains at one emotional state or "pole".

DSM-IV-TR excludes cases where the symptoms are a result of bereavement, although it is possible for normal bereavement to evolve into a depressive episode if the mood persists and the characteristic features of a major depressive episode develop. The criteria were criticized because they do not take into account any other aspects of the personal and social context in which depression can occur. In addition, some studies have found little empirical support for the DSM-IV cut-off criteria, indicating they are a diagnostic convention imposed on a continuum of depressive symptoms of varying severity and duration. Bereavement is no longer an exclusion criterion in DSM-5, and it is now up to the clinician to distinguish between normal reactions to a loss and MDD. Excluded are a range of related diagnoses, including dysthymia, which involves a chronic but milder mood disturbance; recurrent brief depression, consisting of briefer depressive episodes; minor depressive disorder, whereby only some symptoms of major depression are present; and adjustment disorder with depressed mood, which denotes low mood resulting from a psychological response to an identifiable event or stressor. Three new depressive disorders were added to the DSM-5: disruptive mood dysregulation disorder, classified by significant childhood irritability and tantrums, premenstrual dysphoric disorder (PMDD), causing periods of anxiety, depression, or irritability in the week or two before a woman's menstruation, and persistent depressive disorder.

The DSM-5 recognizes six further subtypes of MDD, called specifiers, in addition to noting the length, severity and presence of psychotic features:

"Melancholic depression" is characterized by a loss of pleasure in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early-morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt.

"Atypical depression" is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite (comfort eating), excessive sleep or sleepiness (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.

"Catatonic depression" is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here, the person is mute and almost stuporous, and either remains immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in schizophrenia or in manic episodes, or may be caused by neuroleptic malignant syndrome.

"Depression with anxious distress" was added into the DSM-V as a means to emphasize the common co-occurrence between depression or mania and anxiety, as well as the risk of suicide of depressed individuals with anxiety. Specifying in such a way can also help with the prognosis of those diagnosed with a depressive or bipolar disorder.

"Depression with peri-partum onset" refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth or while a woman is pregnant. DSM-IV-TR used the classification "postpartum depression," but this was changed in order to not exclude cases of depressed woman during pregnancy. Depression with peripartum onset has an incidence rate of 10-15% among new mothers. The DSM-V mandates that, in order to qualify as depression with peripartum onset, onset occur during pregnancy or within one month of delivery. It has been said that postpartum depression can last as long as three months.

"Seasonal affective disorder" (SAD) is a form of depression in which depressive episodes come on in the autumn or winter, and resolve in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times, over a two-year period or longer.

Differential diagnoses

To confirm major depressive disorder as the most likely diagnosis, other potential diagnoses must be considered, including dysthymia, adjustment disorder with depressed mood, or bipolar disorder. Dysthymia is a chronic, milder mood disturbance in which a person reports a low mood almost daily over a span of at least two years. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression (sometimes referred to as double depression). Adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode. Bipolar disorder, also known as manic-depressive disorder, is a condition in which depressive phases alternate with periods of mania or hypomania. Although depression is currently categorized as a separate disorder, there is ongoing debate because individuals diagnosed with major depression often experience some hypomanic symptoms, indicating a mood disorder continuum. Further differential diagnoses involve chronic fatigue syndrome.

Other disorders need to be ruled out before diagnosing major depressive disorder. They include depressions due to physical illness, medications, and substance abuse. Depression due to physical illness is diagnosed as a mood disorder due to a general medical condition. This condition is determined based on history, laboratory findings, or physical examination. When the depression is caused by a medication, drug of abuse, or exposure to a toxin, it is then diagnosed as a specific mood disorder (previously called substance-induced mood disorder in the DSM-IV-TR).

Screening and prevention

Since 2016, the United States Preventive Services Task Force (USPSTF) has recommended screening for depression among those over the age 12; a 2005 Cochrane review found that the routine use of screening questionnaires has little effect on detection or treatment.

Preventive efforts may result in decreases in rates of the condition of between 22 and 38%. Eating large amounts of fish may also reduce the risk.

Behavioral interventions, such as interpersonal therapy and cognitive-behavioral therapy, are effective at preventing new onset depression. Because such interventions appear to be most effective when delivered to individuals or small groups, it has been suggested that they may be able to reach their large target audience most efficiently through the Internet.

However, an earlier meta-analysis found preventive programs with a competence-enhancing component to be superior to behavior-oriented programs overall, and found behavioral programs to be particularly unhelpful for older people, for whom social support programs were uniquely beneficial. In addition, the programs that best prevented depression comprised more than eight sessions, each lasting between 60 and 90 minutes, were provided by a combination of lay and professional workers, had a high-quality research design, reported attrition rates, and had a well-defined intervention.

The Netherlands mental health care system provides preventive interventions, such as the "Coping with Depression" course (CWD) for people with sub-threshold depression. The course is claimed to be the most successful of psychoeducational interventions for the treatment and prevention of depression (both for its adaptability to various populations and its results), with a risk reduction of 38% in major depression and an efficacy as a treatment comparing favorably to other psychotherapies.

Management

The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Psychotherapy is the treatment of choice (over medication) for people under 18. The UK National Institute for Health and Care Excellence (NICE) 2004 guidelines indicate that antidepressants should not be used for the initial treatment of mild depression because the risk-benefit ratio is poor. The guidelines recommend that antidepressants treatment in combination with psychosocial interventions should be considered for:

People with a history of moderate or severe depression

Those with mild depression that has been present for a long period

As a second line treatment for mild depression that persists after other interventions

As a first line treatment for moderate or severe depression.

The guidelines further note that antidepressant treatment should be continued for at least six months to reduce the risk of relapse, and that SSRIs are better tolerated than tricyclic antidepressants.

American Psychiatric Association treatment guidelines recommend that initial treatment should be individually tailored based on factors including severity of symptoms, co-existing disorders, prior treatment experience, and patient preference. Options may include pharmacotherapy, psychotherapy, exercise, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) or light therapy. Antidepressant medication is recommended as an initial treatment choice in people with mild, moderate, or severe major depression, and should be given to all patients with severe depression unless ECT is planned. There is evidence that collaborative care by a team of health care practitioners produces better results than routine single-practitioner care.

Treatment options are much more limited in developing countries, where access to mental health staff, medication, and psychotherapy is often difficult. Development of mental health services is minimal in many countries; depression is viewed as a phenomenon of the developed world despite evidence to the contrary, and not as an inherently life-threatening condition. A 2014 Cochrane review found insufficient evidence to determine the effectiveness of psychological versus medical therapy in children.

Physical exercise is recommended for management of mild depression, and has a moderate effect on symptoms. Exercise has also been found to be effective for (unipolar) major depression. It is equivalent to the use of medications or psychological therapies in most people. In older people it does appear to decrease depression. Exercise may be recommended to people who are willing, motivated, and physically healthy enough to participate in an exercise program as treatment.

There is a small amount of evidence that skipping a night's sleep may improve depressive symptoms, with the effects usually showing up within a day. This effect is usually temporary. Besides sleepiness, this method can cause a side effect of mania or hypomania.

In observational studies, smoking cessation has benefits in depression as large as or larger than those of medications.

Besides exercise, sleep and diet may play a role in depression, and interventions in these areas may be an effective add-on to conventional methods.

Talking therapies

Talking therapy (psychotherapy) can be delivered to individuals, groups, or families by mental health professionals. A 2017 review found that cognitive behavioral therapy appears to be similar to antidepressant medication in terms of effect. A 2012 review found psychotherapy to be better than no treatment but not other treatments. With more complex and chronic forms of depression, a combination of medication and psychotherapy may be used. A 2014 Cochrane review found that work-directed interventions combined with clinical interventions helped to reduce sick days taken by people with depression. There is moderate-quality evidence that psychological therapies are a useful addition to standard antidepressant treatment of treatment-resistant depression in the short term.

Psychotherapy has been shown to be effective in older people. Successful psychotherapy appears to reduce the recurrence of depression even after it has been stopped or replaced by occasional booster sessions.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) currently has the most research evidence for the treatment of depression in children and adolescents, and CBT and interpersonal psychotherapy (IPT) are preferred therapies for adolescent depression. In people under 18, according to the National Institute for Health and Clinical Excellence, medication should be offered only in conjunction with a psychological therapy, such as CBT, interpersonal therapy, or family therapy. Cognitive behavioral therapy has also been shown to reduce the number of sick days taken by people with depression, when used in conjunction with primary care.

The most-studied form of psychotherapy for depression is CBT, which teaches clients to challenge self-defeating, but enduring ways of thinking (cognitions) and change counter-productive behaviors. Research beginning in the mid-1990s suggested that CBT could perform as well as or better than antidepressants in patients with moderate to severe depression. CBT may be effective in depressed adolescents, although its effects on severe episodes are not definitively known. Several variables predict success for cognitive behavioral therapy in adolescents: higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions. CBT is particularly beneficial in preventing relapse.

Cognitive behavioral therapy and occupational programs (including modification of work activities and assistance) have been shown to be effective in reducing sick days taken by workers with depression.

Several variants of cognitive behavior therapy have been used in those with depression, the most notable being rational emotive behavior therapy, and mindfulness-based cognitive therapy. Mindfulness-based stress reduction programs may reduce depression symptoms. Mindfulness programs also appear to be a promising intervention in youth.

Psychoanalysis

Psychoanalysis is a school of thought, founded by Sigmund Freud, which emphasizes the resolution of unconscious mental conflicts. Psychoanalytic techniques are used by some practitioners to treat clients presenting with major depression. A more widely practiced therapy, called psychodynamic psychotherapy, is in the tradition of psychoanalysis but less intensive, meeting once or twice a week. It also tends to focus more on the person's immediate problems, and has an additional social and interpersonal focus. In a meta-analysis of three controlled trials of Short Psychodynamic Supportive Psychotherapy, this modification was found to be as effective as medication for mild to moderate depression.

Antidepressants

Conflicting results have arisen from studies that look at the effectiveness of antidepressants in people with acute, mild to moderate depression. Stronger evidence supports the usefulness of antidepressants in the treatment of depression that is chronic ( dysthymia) or severe.

While small benefits were found, researchers Irving Kirsch and Thomas Moore state they may be due to issues with the trials rather than a true effect of the medication. In a later publication, Kirsch concluded that the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance. Similar results were obtained in a meta-analysis by Fornier.

A review commissioned by the National Institute for Health and Care Excellence (UK) concluded that there is strong evidence that selective serotonin reuptake inhibitors (SSRIs), such as escitalopram, paroxetine, and sertraline, have greater efficacy than placebo on achieving a 50% reduction in depression scores in moderate and severe major depression, and that there is some evidence for a similar effect in mild depression. Similarly, a Cochrane systematic review of clinical trials of the generic tricyclic antidepressant amitriptyline concluded that there is strong evidence that its efficacy is superior to placebo.

In 2014 the U.S. Food and Drug Administration published a systematic review of all antidepressant maintenance trials submitted to the agency between 1985 and 2012. The authors concluded that maintenance treatment reduced the risk of relapse by 52% compared to placebo, and that this effect was primarily due to recurrent depression in the placebo group rather than a drug withdrawal effect.

To find the most effective antidepressant medication with minimal side-effects, the dosages can be adjusted, and if necessary, combinations of different classes of antidepressants can be tried. Response rates to the first antidepressant administered range from 50 to 75%, and it can take at least six to eight weeks from the start of medication to improvement. Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation is recommended. People with chronic depression may need to take medication indefinitely to avoid relapse.

SSRIs are the primary medications prescribed, owing to their relatively mild side-effects, and because they are less toxic in overdose than other antidepressants. People who do not respond to one SSRI can be switched to another antidepressant, and this results in improvement in almost 50% of cases. Another option is to switch to the atypical antidepressant bupropion. Venlafaxine, an antidepressant with a different mechanism of action, may be modestly more effective than SSRIs. However, venlafaxine is not recommended in the UK as a first-line treatment because of evidence suggesting its risks may outweigh benefits, and it is specifically discouraged in children and adolescents.

For children, some research has supported the use of the SSRI antidepressant fluoxetine. The benefit however appears to be slight in children, while other antidepressants have not been shown to be effective. Medications are not recommended in children with mild disease. There is also insufficient evidence to determine effectiveness in those with depression complicated by dementia. Any antidepressant can cause low blood sodium levels; nevertheless, it has been reported more often with SSRIs. It is not uncommon for SSRIs to cause or worsen insomnia; the sedating atypical antidepressant mirtazapine can be used in such cases.

Irreversible monoamine oxidase inhibitors, an older class of antidepressants, have been plagued by potentially life-threatening dietary and drug interactions. They are still used only rarely, although newer and better-tolerated agents of this class have been developed. The safety profile is different with reversible monoamine oxidase inhibitors, such as moclobemide, where the risk of serious dietary interactions is negligible and dietary restrictions are less strict.

It is unclear whether antidepressants affect a person's risk of suicide. For children, adolescents, and probably young adults between 18 and 24 years old, there is a higher risk of both suicidal ideations and suicidal behavior in those treated with SSRIs. For adults, it is unclear whether SSRIs affect the risk of suicidality. One review found no connection; another an increased risk; and a third no risk in those 25-65 years old and a decreased risk in those more than 65. A black box warning was introduced in the United States in 2007 on SSRIs and other antidepressant medications due to the increased risk of suicide in patients younger than 24 years old. Similar precautionary notice revisions were implemented by the Japanese Ministry of Health.

Other medications

There is some evidence that omega-3 fatty acids fish oil supplements containing high levels of eicosapentaenoic acid (EPA) to docosahexaenoic acid (DHA) are effective in the treatment of, but not the prevention of major depression. However, a Cochrane review determined there was insufficient high quality evidence to suggest omega-3 fatty acids were effective in depression. There is limited evidence that vitamin D supplementation is of value in alleviating the symptoms of depression in individuals who are vitamin D-deficient. There is some preliminary evidence that COX-2 inhibitors, such as celecoxib, have a beneficial effect on major depression. Lithium appears effective at lowering the risk of suicide in those with bipolar disorder and unipolar depression to nearly the same levels as the general population. There is a narrow range of effective and safe dosages of lithium thus close monitoring may be needed. Low-dose thyroid hormone may be added to existing antidepressants to treat persistent depression symptoms in people who have tried multiple courses of medication. Limited evidence suggests stimulants, such as amphetamine and modafinil, may be effective in the short term, or as adjuvant therapy. Also, it is suggested that folate supplements may have a role in depression management. There is tentative evidence for benefit from testosterone in males.

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a standard psychiatric treatment in which seizures are electrically induced in patients to provide relief from psychiatric illnesses. ECT is used with informed consent as a last line of intervention for major depressive disorder.

Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment, the most common adverse effects are confusion and memory loss. ECT is considered one of the least harmful treatment options available for severely depressed pregnant women.

A usual course of ECT involves multiple administrations, typically given two or three times per week, until the patient is no longer suffering symptoms. ECT is administered under anesthesia with a muscle relaxant. Electroconvulsive therapy can differ in its application in three ways: electrode placement, frequency of treatments, and the electrical waveform of the stimulus. These three forms of application have significant differences in both adverse side effects and symptom remission. After treatment, drug therapy is usually continued, and some patients receive maintenance ECT.

ECT appears to work in the short term via an anticonvulsant effect mostly in the frontal lobes, and longer term via neurotrophic effects primarily in the medial temporal lobe.

Transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) or deep transcranial magnetic stimulation is a noninvasive method used to stimulate small regions of the brain. TMS was approved by the FDA for treatment-resistant major depressive disorder (trMDD) in 2008 and as of 2014 evidence supports that it is probably effective. The American Psychiatric Association the Canadian Network for Mood and Anxiety Disorders, and the Royal Australia and New Zealand College of Psychiatrists have endorsed TMS for trMDD.

Transcranial direct current stimulation

Light therapy

Bright light therapy reduces depression symptom severity, with benefit for both seasonal affective disorder and for nonseasonal depression, and an effect similar to those for conventional antidepressants. For nonseasonal depression, adding light therapy to the standard antidepressant treatment was not effective. For nonseasonal depression, where light was used mostly in combination with antidepressants or wake therapy, a moderate effect was found, with response better than control treatment in high-quality studies, in studies that applied morning light treatment, and with people who respond to total or partial sleep deprivation. Both analyses noted poor quality, short duration, and small size of most of the reviewed studies.

There is insufficient evidence for Reiki and dance movement therapy in depression. As of 2019 cannabis is specifically not recommended as a treatment.

Major depressive episodes often resolve over time whether or not they are treated. Outpatients on a waiting list show a 10-15% reduction in symptoms within a few months, with approximately 20% no longer meeting the full criteria for a depressive disorder. The median duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months.

Studies have shown that 80% of those suffering from their first major depressive episode will have at least one more depression during their life, with a lifetime average of 4 episodes. Other general population studies indicate that around half those who have an episode recover (whether treated or not) and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence. Studies recruiting from selective inpatient sources suggest lower recovery and higher chronicity, while studies of mostly outpatients show that nearly all recover, with a median episode duration of 11 months. Around 90% of those with severe or psychotic depression, most of whom also meet criteria for other mental disorders, experience recurrence.

A high proportion of people who experience full symptomatic remission still have at least one not fully resolved symptom after treatment. Recurrence or chronicity is more likely if symptoms have not fully resolved with treatment. Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. Evidence from many randomized controlled trials indicate continuing antidepressant medications after recovery can reduce the chance of relapse by 70% (41% on placebo vs. 18% on antidepressant). The preventive effect probably lasts for at least the first 36 months of use.

People experiencing repeated episodes of depression require ongoing treatment in order to prevent more severe, long-term depression. In some cases, people must take medications for the rest of their lives.

Cases when outcome is poor are associated with inappropriate treatment, severe initial symptoms including psychosis, early age of onset, previous episodes, incomplete recovery after one year of treatment, pre-existing severe mental or medical disorder, and family dysfunction.

Depressed individuals have a shorter life expectancy than those without depression, in part because depressed patients are at risk of dying of suicide. They also have a higher rate of dying from other causes, being more susceptible to medical conditions such as heart disease. Up to 60% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and borderline personality disorder. About 2-8% of adults with major depression die by suicide, and about 50% of people who die by suicide had depression or another mood disorder. The lifetime risk of suicide associated with a diagnosis of major depression in the US is estimated at 3.4%, which averages two highly disparate figures of almost 7% for men and 1% for women (although suicide attempts are more frequent in women). The estimate is substantially lower than a previously accepted figure of 15%, which had been derived from older studies of hospitalized patients.

Major depression is currently the leading cause of disease burden in North America and other high-income countries, and the fourth-leading cause worldwide. In the year 2030, it is predicted to be the second-leading cause of disease burden worldwide after HIV, according to the WHO. Delay or failure in seeking treatment after relapse and the failure of health professionals to provide treatment are two barriers to reducing disability.

Epidemiology

Major depressive disorder affected approximately 163 million people in 2017 (2% of the global population). The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France. In most countries the number of people who have depression during their lives falls within an 8-18% range. In North America, the probability of having a major depressive episode within a year-long period is 3-5% for males and 8-10% for females. Major depression is about twice as common in women as in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this. The relative increase in occurrence is related to pubertal development rather than chronological age, reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors. Depression is a major cause of disability worldwide.

People are most likely to develop their first depressive episode between the ages of 30 and 40, and there is a second, smaller peak of incidence between ages 50 and 60. The risk of major depression is increased with neurological conditions such as stroke, Parkinson's disease, or multiple sclerosis, and during the first year after childbirth. It is also more common after cardiovascular illnesses, and is related more to those with a poor cardiac disease outcome than to a better one. Studies conflict on the prevalence of depression in the elderly, but most data suggest there is a reduction in this age group. Depressive disorders are more common in urban populations than in rural ones and the prevalence is increased in groups with poorer socioeconomic factors, e.g., homelessness.

The term depression itself was derived from the Latin verb deprimere, "to press down". From the 14th century, "to depress" meant to subjugate or to bring down in spirits. It was used in 1665 in English author Richard Baker's Chronicle to refer to someone having "a great depression of spirit", and by English author Samuel Johnson in a similar sense in 1753. The term also came into use in physiology and economics. An early usage referring to a psychiatric symptom was by French psychiatrist Louis Delasiauve in 1856, and by the 1860s it was appearing in medical dictionaries to refer to a physiological and metaphorical lowering of emotional function. Since Aristotle, melancholia had been associated with men of learning and intellectual brilliance, a hazard of contemplation and creativity. The newer concept abandoned these associations and through the 19th century, became more associated with women.

Although melancholia remained the dominant diagnostic term, depression gained increasing currency in medical treatises and was a synonym by the end of the century; German psychiatrist Emil Kraepelin may have been the first to use it as the overarching term, referring to different kinds of melancholia as depressive states.

Sigmund Freud likened the state of melancholia to mourning in his 1917 paper Mourning and Melancholia. He theorized that objective loss, such as the loss of a valued relationship through death or a romantic break-up, results in subjective loss as well; the depressed individual has identified with the object of affection through an unconscious, narcissistic process called the libidinal cathexis of the ego. Such loss results in severe melancholic symptoms more profound than mourning; not only is the outside world viewed negatively but the ego itself is compromised. The patient's decline of self-perception is revealed in his belief of his own blame, inferiority, and unworthiness. He also emphasized early life experiences as a predisposing factor. Adolf Meyer put forward a mixed social and biological framework emphasizing reactions in the context of an individual's life, and argued that the term depression should be used instead of melancholia. The first version of the DSM (DSM-I, 1952) contained depressive reaction and the DSM-II (1968) depressive neurosis, defined as an excessive reaction to internal conflict or an identifiable event, and also included a depressive type of manic-depressive psychosis within Major affective disorders.

In the mid-20th century, researchers theorized that depression was caused by a chemical imbalance in neurotransmitters in the brain, a theory based on observations made in the 1950s of the effects of reserpine and isoniazid in altering monoamine neurotransmitter levels and affecting depressive symptoms. The chemical imbalance theory has never been proven.

The term unipolar (along with the related term ) was coined by the neurologist and psychiatrist Karl Kleist, and subsequently used by his disciples Edda Neele and Karl Leonhard.

The term Major depressive disorder was introduced by a group of US clinicians in the mid-1970s as part of proposals for diagnostic criteria based on patterns of symptoms (called the "Research Diagnostic Criteria", building on earlier Feighner Criteria), and was incorporated into the DSM-III in 1980. The American Psychiatric Association added "major depressive disorder" to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), as a split of the previous depressive neurosis in the DSM-II, which also encompassed the conditions now known as dysthymia and adjustment disorder with depressed mood. To maintain consistency the ICD-10 used the same criteria, with only minor alterations, but using the DSM diagnostic threshold to mark a mild depressive episode, adding higher threshold categories for moderate and severe episodes. The ancient idea of melancholia still survives in the notion of a melancholic subtype.

The new definitions of depression were widely accepted, albeit with some conflicting findings and views. There have been some continued empirically based arguments for a return to the diagnosis of melancholia. There has been some criticism of the expansion of coverage of the diagnosis, related to the development and promotion of antidepressants and the biological model since the late 1950s.

Society and culture

Terminology

The term "depression" is used in a number of different ways. It is often used to mean this syndrome but may refer to other mood disorders or simply to a low mood. People's conceptualizations of depression vary widely, both within and among cultures. "Because of the lack of scientific certainty," one commentator has observed, "the debate over depression turns on questions of language. What we call it-'disease,' 'disorder,' 'state of mind'-affects how we view, diagnose, and treat it." There are cultural differences in the extent to which serious depression is considered an illness requiring personal professional treatment, or is an indicator of something else, such as the need to address social or moral problems, the result of biological imbalances, or a reflection of individual differences in the understanding of distress that may reinforce feelings of powerlessness, and emotional struggle.

The diagnosis is less common in some countries, such as China. It has been argued that the Chinese traditionally deny or somatize emotional depression (although since the early 1980s, the Chinese denial of depression may have modified). Alternatively, it may be that Western cultures reframe and elevate some expressions of human distress to disorder status. Australian professor Gordon Parker and others have argued that the Western concept of depression "medicalizes" sadness or misery. Similarly, Hungarian-American psychiatrist Thomas Szasz and others argue that depression is a metaphorical illness that is inappropriately regarded as an actual disease. There has also been concern that the DSM, as well as the field of descriptive psychiatry that employs it, tends to reify abstract phenomena such as depression, which may in fact be social constructs. American archetypal psychologist James Hillman writes that depression can be healthy for the soul, insofar as "it brings refuge, limitation, focus, gravity, weight, and humble powerlessness." Hillman argues that therapeutic attempts to eliminate depression echo the Christian theme of resurrection, but have the unfortunate effect of demonizing a soulful state of being.

Historical figures were often reluctant to discuss or seek treatment for depression due to social stigma about the condition, or due to ignorance of diagnosis or treatments. Nevertheless, analysis or interpretation of letters, journals, artwork, writings, or statements of family and friends of some historical personalities has led to the presumption that they may have had some form of depression. People who may have had depression include English author Mary Shelley, American-British writer Henry James, and American president Abraham Lincoln. Some well-known contemporary people with possible depression include Canadian songwriter Leonard Cohen and American playwright and novelist Tennessee Williams. Some pioneering psychologists, such as Americans William James and John B. Watson, dealt with their own depression.

There has been a continuing discussion of whether neurological disorders and mood disorders may be linked to creativity, a discussion that goes back to Aristotelian times. British literature gives many examples of reflections on depression. English philosopher John Stuart Mill experienced a several-months-long period of what he called "a dull state of nerves", when one is "unsusceptible to enjoyment or pleasurable excitement; one of those moods when what is pleasure at other times, becomes insipid or indifferent". He quoted English poet Samuel Taylor Coleridge's "Dejection" as a perfect description of his case: "A grief without a pang, void, dark and drear, / A drowsy, stifled, unimpassioned grief, / Which finds no natural outlet or relief / In word, or sigh, or tear." English writer Samuel Johnson used the term "the black dog" in the 1780s to describe his own depression, and it was subsequently popularized by depression sufferer former British Prime Minister Sir Winston Churchill.

Social stigma of major depression is widespread, and contact with mental health services reduces this only slightly. Public opinions on treatment differ markedly to those of health professionals; alternative treatments are held to be more helpful than pharmacological ones, which are viewed poorly. In the UK, the Royal College of Psychiatrists and the Royal College of General Practitioners conducted a joint Five-year Defeat Depression campaign to educate and reduce stigma from 1992 to 1996; a MORI study conducted afterwards showed a small positive change in public attitudes to depression and treatment.

Depression is especially common among those over 65 years of age and increases in frequency beyond this age. In addition, the risk of depression increases in relation to the frailty of the individual. Depression is one of the most important factors which negatively impact quality of life in adults, as well as the elderly. Both symptoms and treatment among the elderly differ from those of the rest of the population.

As with many other diseases, it is common among the elderly not to present with classical depressive symptoms. Diagnosis and treatment is further complicated in that the elderly are often simultaneously treated with a number of other drugs, and often have other concurrent diseases. Treatment differs in that studies of SSRIs have shown lesser and often inadequate effects among the elderly, while other drugs, such as duloxetine (a serotonin-norepinephrine reuptake inhibitor), with more clear effects have adverse effects, such as dizziness, dryness of the mouth, diarrhea and constipation, which can be especially difficult to handle among the elderly.

Problem solving therapy was, as of 2015, the only psychological therapy with proven effect, and can be likened to a simpler form of cognitive behavioral therapy. However, elderly with depression are seldom offered any psychological treatment, and the evidence proving other treatments effective is incomplete. ECT has been used in the elderly, and register-studies suggest it is effective, although less so as compared to the rest of the population. The risks involved with treatment of depression among the elderly as opposed to benefits are not entirely clear.

MRI scans of patients with depression have revealed a number of differences in brain structure compared to those who are not depressed. Meta-analyses of neuroimaging studies in major depression reported that, compared to controls, depressed patients had increased volume of the lateral ventricles and adrenal gland and smaller volumes of the basal ganglia, thalamus, hippocampus, and frontal lobe (including the orbitofrontal cortex and gyrus rectus). Hyperintensities have been associated with patients with a late age of onset, and have led to the development of the theory of vascular depression.

Trials are looking at the effects of botulinum toxins on depression. The idea is that the drug is used to make the person look less frowning and that this stops the negative facial feedback from the face. In 2015 results showed, however, that the partly positive effects that had been observed until then could have been due to placebo effects.

In 2018-2019, the US Food and Drug Administration (FDA) granted Breakthrough therapy designation to Compass Pathways and, separately, Usona Institute. Compass is a for-profit company studying psilocybin for treatment-resistant depression; Usona is a non-profit organization studying psilocybin for major depressive disorder more broadly.

Animals models

Models of depression in animals for the purpose of study include iatrogenic depression models (such as drug-induced), forced swim tests, tail suspension test, and learned helplessness models. Criteria frequently used to assess depression in animals include expression of despair, neurovegetative changes, and anhedonia, as many other criteria for depression are untestable in animals, such as guilt and suicidality.

References

Cited works

# data[].attributes.attachment_link.description
Major depressive disorder Other names Clinical depression, major depression, unipolar depression, unipolar disorder, recurrent depression Sorrowing Old Man ('At Eternity's Gate') by Vincent van Gogh (1890) Specialty Psychiatry Clinical psychology Symptoms Low mood, low self-esteem, loss of interest in normally enjoyable activities, low energy, pain without a clear cause[1] Complications

# data[].attributes.body
Occupational therapy may be necessary for treatment if someone suffers from one or more of these symptoms of Parkinson's Disease.

Motor Symptoms: tremors, rigidity, bradykinesia, postural instability, hypomimia, etc.

Cognitive Changes: memory, attention, making decisions, etc.

Speech and Swallowing difficulties

Occupational therapy is a great treatment option for those who need help getting back into doing their daily everyday activities caused by Parkinson's Disease. This can be done by using assistive devices to aid in tasks such as writing, eating, walking, talking, etc. This can also be done by doing exercises to practice things that they are unable to do. This rehabilitation treatment is delivered by occupational therapists.

Source(s):

1. https://www.parkinson.org/understanding-parkinsons/movement-symptoms

2. https://www.parkinson.org/library/fact-sheets/occupational-therapy#:~:text=An%20occupational%20therapist%20can%20help%20evaluate%20and%20make%20recommendations%20to,writing%20tools%20with%20larger%20handles

# data[].attributes.attachment_link.description
Know the movement symptoms Parkinson’s can cause such as tremors, postural instability, rigidity and others.

# data[].attributes.body
Parkinson's problems with speech are real and so constant. They have difficulty with speaking and swallowing. And both can be severely problematic in their routines.

Speech-language pathologists can help people with Parkinson's disease maintain as many communication skills as possible. They also teach techniques that conserve energy, including non-verbal communication skills.

Recommend appropriate communication technologies that will help with daily activities.

Treat all types of speech, language, and communication problems.

Evaluate swallowing function and recommend changes as necessary.

Treatment can cost around $75 to $200 per session depending on the location, provider, and intensity of the program.

https://www.webmd.com/parkinsons-disease/parkinsons-speech-therapy

# data[].attributes.attachment_link.readable_text
Dysarthria (difficulty speaking) and dysphagia (difficulty swallowing) can be severely limiting symptoms of Parkinson's disease. Both can be helped by seeing a speech pathologist or speech therapist.

In particular, the Lee Silverman Voice Therapy Program has demonstrated significant value for people with Parkinson's. Ask your doctor about a referral to a speech pathologist experienced in administering the Lee Silverman Voice Therapy program.

Nonverbal communication, also called augmentative and alternative communication (AAC), is a method of communicating without spoken words.

When communication needs cannot be met through speech, the following techniques can help:

Make the best use out of what speaking ability is left.

Use expressions and gestures to communicate.

Non-verbal communication can help people with speech difficulties actually speak better by:

Reducing the frustration and stress of being unable to communicate.

Alleviating the pressure to speak.

Allowing the person to be more relaxed and come across in a more understandable manner.

Here's a sample of the devices that are available to help people with Parkinson's disease communicate more clearly.

Palatal lift. A dental apparatus that is similar to a retainer. It lifts the soft palate and stops air from escaping out of the nose during speech.

Amplification. A personal amplifier can be used to increase the volume of the voice. The amplifier also decreases voice fatigue.

TTY telephone relay system. A telephone equipped with a keyboard so speech can be typed and read by a relay operator to the listener. Either the whole message can be typed or just the words that are not understood can be typed.

Low technology devices. Notebooks and language boards can be used as alternative communication techniques.

High technology electronic speech enhancers, communication devices. Computers with voice synthesizers and dedicated communication devices are available.

Your speech therapist can help you choose the best device.

Use an intercom system or baby monitor to alert others that there is an emergency.

Use bells or buzzers if you are not able to speak. Use "codes" that signify urgency. For example, a tinkling bell may mean, "I'd like company" while an air-horn means there's an emergency.

Carry a portable phone that is equipped with pre-programmed numbers.

Pre-program all of your telephones so they can automatically dial the necessary emergency number(s).

Consider a "life call" button if you spend time alone.

Speech-language pathologists can help people with Parkinson's disease maintain as many communication skills as possible. They also teach techniques that conserve energy, including non-verbal communication skills. Speech-language pathologists are also available to:

Recommend appropriate communication technologies that will help with daily activities.

Treat all types of speech, language, and communication problems.

Evaluate swallowing function and recommend changes as necessary.

1. Choose an environment with reduced noise. It can be tiring to try to "talk over" the television or radio.

2. Speak slowly.

3. Be certain your listener can see your face. Look at the person while you are talking. A well-lit room enhances face-to-face conversation, increasing understanding.

4. Use short phrases. Say one or two words or syllables per breath.

5. Over-articulate your speech by prolonging the vowels and exaggerating the consonants.

6. Choose a comfortable posture and position that provide support during long and stressful conversations.

7. Be aware that exercises intended to strengthen weakening muscles may be counter-productive. Always ask your speech therapist which exercises are right for you.

8. Plan periods of vocal rest before planned conversations or phone calls. Know that fatigue significantly affects your speaking ability. Techniques that work in the morning may not work later in the day.

9. If you are soft spoken and your voice has become low, consider using an amplifier.

10. If some people have difficulty understanding you, the following strategies may help:

If you are able to write without difficulty, always carry a paper and pen as a backup so you can write down what you are trying to say.

If writing is difficult, use an alphabet board to point or scan to the first letter of the words that are spoken.

Spell words out loud or on an alphabet board if they are not understood.

Establish the topic before speaking.

Use telegraphic speech. Leave out unnecessary words to communicate the meaning of the topic.

# data[].attributes.attachment_link.description
WebMD explains speech therapy for Parkinson's disease and devices that may make it easier to communicate.

# data[].attributes.body
One medication that many people with Parkinson's Disease is called Levodopa. This medication works by increasing the dopamine in your brain to manage body movements/coordination affected by Parkinson's symptoms. The expected cost of this medication ranges from around $13 to $25 for a 30-day supply or around $162 to $540 annually. This price may also vary due to different dosage amounts per person. This medication is covered by most if not all, types of insurance. If a person does not seek levodopa medication for treatment, they will experience the symptoms of Parkinson's Disease since this medication is for alleviating and managing one's symptoms.

Sources:

1. https://www.drugs.com/price-guide/carbidopa-levodopa#:~:text=Carbidopa/levodopa%20Prices%2C%20Coupons%2C%20Copay%20Cards%20&%20Patient%20Assistance,-Prices&text=Carbidopa/levodopa%20is%20a%20member,accepted%20at%20most%20U.S.%20pharmacies.

2. https://www.goodrx.com/carbidopa-levodopa/medicare-coverage#:~:text=Yes.,Copay%20Range

3. https://www.parkinsons.org.uk/information-and-support/your-magazine/experts/qa-importance-getting-parkinsons-medication-time#:~:text=Without%20enough%20dopamine%2C%20the%20symptoms,to%20manage%20day%20to%20day.

4. https://my.clevelandclinic.org/health/drugs/20349-carbidopa-levodopa-tablets

# data[].attributes.attachment_link.readable_text
Carbidopa/levodopa is a member of the dopaminergic antiparkinsonism agents drug class and is commonly used for GTP-CH Deficiency, Neuroleptic Malignant Syndrome, Parkinson's Disease, and others.

Brand names for carbidopa/levodopa include Sinemet, and Dhivy.

The cost for carbidopa/levodopa (25 mg-100 mg) oral tablet is around $13 for a supply of 30 tablets, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies.

Carbidopa/levodopa prices

Oral Tablet

Oral Tablet, Disintegrating

Important: When there is a range of pricing, consumers should normally expect to pay the lower price. However, due to stock shortages and other unknown variables we cannot provide any guarantee.

Oral Tablet, Extended Release

Important: When there is a range of pricing, consumers should normally expect to pay the lower price. However, due to stock shortages and other unknown variables we cannot provide any guarantee.

Drugs.com Printable Discount Card

The free Drugs.com Discount Card works like a coupon and can save you up to 80% or more off the cost of prescription medicines, over-the-counter drugs and pet prescriptions.

Print Free Discount Card

Note: This is a drug discount program, not an insurance plan. Valid at all major chains including Walgreens, CVS Pharmacy, Target, WalMart Pharmacy, Duane Reade and 65,000 pharmacies nationwide.

Carbidopa/levodopa Coupons, Copay Cards and Rebates

Carbidopa/levodopa offers may take the form of printable coupons, rebates, savings or copay cards, trial offers, or free samples. Certain offers may be printable from a website while others may require registration, completing a questionnaire, or obtaining a sample from a medical professional.

No manufacturer promotions could be found for this medication.

Patient Assistance & Copay Programs for Carbidopa/levodopa

Patient assistance programs (PAPs) are typically sponsored by pharmaceutical companies and offer cost-free or discounted medicines, as well as copay programs, to individuals with low income or those who are uninsured/under-insured and meet specific criteria. Eligibility requirements for each program may vary.

No Patient Assistance Programs were found for this medication. However, your healthcare provider may have more information concerning specific programs available in your area.

Disclaimer: Medication pricing is sourced from a variety of providers. Pricing may vary significantly due to several factors including brand or generic status, insurance coverage, pharmacy choice, location, and manufacturer pricing policies. Prices are subject to change. For the most accurate and up-to-date information, always consult directly with your pharmacy or healthcare provider.

Drug Status

# data[].attributes.attachment_link.title
Carbidopa/levodopa Prices, Coupons, Copay Cards & Patient Assistance - Drugs.com

# data[].attributes.attachment_link.description
Compare carbidopa/levodopa prices, print discount coupons, find manufacturer promotions, copay cards and patient assistance programs.

# data[].attributes.body
Deep brain stimulation or DBS is a neurosurgical procedure, or surgery on the nervous system, that uses electrical stimulations by implanting wires or "leads" into the brain. This isn't a one time process. they do this for a week or two until they see a difference in side affects.

The cost of DBS fluctuates to the way you go about it. DBS is around $39,152 ± $5340. Asleep or under general anesthesia. While being awake cost around $40,052 ± $6604. You would also have to pay for your MRI and physical fees.

Most public and private health insurances do help cover deep brain stimulation surgery's.

Some long term consequence's of DBS is a risk of stroke, depression, seizures, or numbness.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/deep-brain-stimulation#:~:text=Deep%20brain%20stimulation%20(DBS)%20is,dystonia%20and%20other%20neurological%20conditions.

# data[].attributes.attachment_link.readable_text
How does deep brain stimulation work?

Movement-related symptoms of Parkinson's disease and other neurological conditions are caused by disorganized electrical signals in the areas of the brain that control movement. When successful, DBS interrupts the irregular signals that cause tremors and other movement symptoms.

After a series of tests that determines the optimal placement, neurosurgeons implant one or more wires, called "leads," inside the brain. The leads are connected with an insulated wire extension to a very small neurostimulator (electrical generator) implanted under the person's collarbone, similar to a heart pacemaker. Continuous pulses of electric current from the neurostimulator pass through the leads and into the brain.

A few weeks after the neurostimulator has been in place, the doctor programs it to deliver an electrical signal. This programming process may take more than one visit over a period of weeks or months to ensure the current is properly adjusted and providing effective results. In adjusting the device, the doctor seeks an optimal balance between improving symptom control and limiting side effects.

Who is a candidate for deep brain stimulation?

DBS is more than just a surgical procedure. It involves a series of evaluations, procedures, and consultations before and after the actual operation, so people interested in being treated with DBS should be prepared to commit time to the process.

For example, those who do not live close to a medical center that offers DBS surgery may need to spend significant time traveling back and forth to appointments.

The procedure, as well as the pre-operative evaluation and post-operative follow-up, can be expensive depending on the person's insurance coverage. DBS surgery is an FDA-approved treatment for Parkinson's disease, and Medicare and most private insurers cover the procedure, but the extent of coverage will depend on each person's individual policy.

Prospective patients should have realistic expectations about DBS results. Although DBS can improve movement symptoms of Parkinson's disease and greatly improve quality of life in properly selected patients, it is not likely to return anyone to perfect health.

Parkinson's Disease

Three types of PD patients typically benefit from DBS:

1. Patients with uncontrollable tremor for whom medications have not been effective.

2. Patients with symptoms that respond well to medications but who, when the drugs wear off, experience severe motor fluctuations and dyskinesias, despite medication adjustments.

3. Patients whose movement symptoms might respond to higher or more frequent medication doses, but who are limited to do so because of side effects.

Essential Tremor

Essential tremor is the most common movement disorder, and DBS can be an effective therapy, particularly in severe cases where the shaking can be disabling, limiting everyday tasks such as dressing, shaving, eating or drinking. Since tremor is the only symptom in essential tremor, DBS can improve life for people with the condition and help them function normally.

Dystonia

Dystonia is a relatively uncommon movement disorder, but its symptoms - abnormal postures and twisting movements - can respond to DBS when medications fail to provide adequate relief. An individual's response to DBS depends on the underlying cause of the dystonia - genetic, drug-induced, or other factor. If the cause isn't known, the doctor is likely to perform more tests as part of the DBS workup.

Psychiatric Conditions

Some recent studies have suggested that people living with depression, obsessive-compulsive disorder (OCD) or Tourette disorder may benefit from DBS surgery. More research is needed to determine if DBS is effective in treating psychiatric disorders and if any benefits outweigh risks and side effects.

Choosing Deep Brain Stimulation Surgery

DBS surgery is not recommended for all people living with Parkinson's disease or other movement disorders. Talking with a neurologist who specializes in movement disorders can determine if an individual is a good candidate for DBS.

Why a Doctor May (or May Not) Choose Deep Brain Stimulation

According to the National Parkinson Foundation, the ideal Parkinson's disease candidate for DBS surgery has:

PD symptoms that interfere with activities of daily living.

Fluctuations in mobility due to PD medications ("on-off" phenomenon) with or without dyskinesia (involuntary jerking motions, especially in the arms and head).

Continued good response to PD medications, even if the medication effects may wear off sooner than they have in the past.

A history of several different combinations of PD medications while under the supervision of a neurologist specializing in movement disorders.

These factors* may make a person a less than ideal candidate for DBS surgery:

Difficulty with balance, walking, or "freezing" as the main disabling symptom.

A primary symptom of speech difficulty.

Continuous confusion and problems with memory and thinking.

A psychiatric condition such as depression or anxiety that has not improved or stabilized with other treatment.

Another condition that increases the risk for surgery complications.

*Some of these factors may be treatable. Having one or more does not disqualify a person for future DBS surgery, but the doctor may recommend more aggressive therapy focused on these issues before surgery takes place.

Testing Before Deep Brain Stimulation

For patients with Parkinson's disease, the doctor must confirm that the PD is levodopa-responsive and determine which symptoms are most likely to respond to DBS and discuss these with the patient.

To accomplish these two objectives, the movement disorders neurologist will examine the patient in the absence of his or her PD medications, then again after having taken them. Seeing the effect of PD medications on the movement and non-motor symptoms helps the physician and patient identify good target symptoms for DBS.

A cognitive assessment can help determine a person's ability to participate in the procedure, which involves providing feedback to the doctor during surgery and throughout the neurostimulator adjustment process. This assessment also informs the team of the risk of having worsened confusion or cognitive problems following the procedure.

Some hospitals also perform an occupational therapy review or speech, language and swallowing assessment. A psychiatrist may examine the person to determine if a condition such as depression or anxiety requires treatment before the DBS procedure.

The Deep Brain Stimulation Procedure

In some cases the surgeon will insert both the lead and the neurostimulator; in other instances the two surgeries may be performed separately, with the neurostimulator implanted days or weeks after the lead is placed.

Stereotactic DBS vs. Interventional Image-Guided DBS

Stereotactic DBS surgery requires the patient to be off their medication. During the procedure, a frame stabilizes the head and provides coordinates to help the surgeons guide the lead to the correct location in the brain. The patient gets local anesthesia (numbing medicine) to keep them comfortable throughout each step along with a mild sedative to help them relax.

During image-guided DBS surgery, such as with interventional MRI (iMRI) or CT scan, the patient is often asleep under general anesthesia while the surgeon uses images of the brain to guide the lead to its target.

Some advanced centers offer both the stereotactic and iMRI-guided options for DBS surgery. In this case, the doctor and patient will discuss which procedure is better based on a number of factors.

For instance, the doctor may recommend an image-guided procedure for children, patients who have extreme symptoms, those who are especially anxious or fearful or those whose leads are going into certain parts of the brain.

Generally, DBS surgery follows this process:

Lead Implantation

The person removes clothing, jewelry or other objects that may interfere with the procedure.

After shaving a small amount of hair behind the hairline, the surgery team injects local anesthesia (numbing medication) into the scalp for placement of the head frame.

The head frame (or "halo") will be attached to the skull with screws, and remains in place during the entire procedure to keep the head in the proper position.

Next, the team uses CT or MRI to pinpoint the target site in the brain where the lead will go.

After more numbing medication, the neurosurgeon drills a small hole in the skull to insert the lead.

The team records the process as the lead moves through the brain tissue to ensure accurate placement of the lead. The person may be asked to move the face, arm or leg at certain times while the recordings are being taken.

Once the lead is in position it is attached to an external neurostimulator. Electrical stimulation administered through the lead for a short period helps the doctors see if symptoms improve or if side effects (such as muscle contractions or visual phenomena) appear.

An extension wire is attached to the lead and placed under the scalp, connecting the lead to the neurostimulator.

The opening in the skull is closed with a plastic cap and stitches.

Microelectrode Recording

Microelectrode recording (MER) uses electrical current (5-100uA) at a very high frequency (300Hz) to precisely identify the surgical site for implantation of the deep brain stimulator (DBS). This technique was pioneered at Johns Hopkins, and is endorsed by the Task Force on Surgery for Parkinson's Disease of the American Academy of Neurology Therapeutic and Technology Assessment Committee.

Because the structure of each person's brain varies, the information obtained from MER gives an accurate target for final DBS placement. The microelectrode allows the surgical team to visualize and hear the neuronal activity from different areas of the brain to identify specific structures based on the unique patterns of neuronal activity. The patient needs to be awake (not under general anesthesia) in order for MER to yield high quality information.

Placement of the Neurostimulator

This procedure takes place under general anesthesia so that the person is asleep. The surgical team inserts the neurostimulator under the outer layers of skin, usually just under the collarbone, but sometimes in the chest or abdomen. The extension wire from the lead is attached to the neurostimulator.

After Deep Brain Stimulation Surgery

In the Hospital

In general, the hospital stay after DBS surgery is 24 hours but it may be longer depending on how quickly the patient recovers and is ready to go home. The doctor will visit, ensure the person is ready to leave and provide instructions for home care.

At Home

At home, it is important to keep the incisions clean and dry. The doctor will provide the patient with specifics on how to bathe while the surgical site heals. If there are stitches, these will be removed during a follow-up office visit. Adhesive strips, if present, should be kept dry and generally will fall off within a few days.

The patient will be given a magnet that can be used to turn the neurostimulator on or off under conditions prescribed by their doctor.

Programming the Neurostimulator

After the DBS lead(s) and neurostimulator are in place, the patient will return to the doctor to have the neurostimulator programmed for optimal electrical stimulation. Programming generally begins a few weeks after the DBS procedure, although some doctors activate the neurostimulator before the patient is discharged from the hospital after surgery.

Programming takes time, and may require several appointments for adjusting the neurostimulator settings. At the same time, the doctors will address the patient's medications and dosages so that the medicines work effectively with the electrical stimulation to control symptoms.

Even after adjustment, the patient will need to return periodically for checkups. The doctor determines the frequency of follow-up appointments depending on each patient's particular situation.

The neurostimulator runs on a battery that generally lasts three to five years. When the battery begins to wear out, doctors can replace the neurostimulator in an outpatient procedure. There are also rechargeable neurostimulators that last longer, but require regular recharging.

Long-Term Effects of Deep Brain Stimulation

DBS surgery can help people with Parkinson's disease improve their symptoms of tremors, stiffness, slowness, and dyskinesias. It can also decrease the dose of medication the patient needs to manage their PD.

Researchers who have followed patients after DBS have found that many patients continue to have improvements in their symptoms for several years after the procedure and are able to eat, use the bathroom and feed themselves. Patients being treated with DBS for movement disorders may or may not experience changes in memory, thinking or mood.

At this time, Parkinson's disease is a progressive disorder that cannot be halted entirely. Even while DBS continues to work on tremor, stiffness and slowness, other symptoms such as poor posture, speech impairment, gait freezing, balance problems and dementia may still appear.

Special Precautions After Deep Brain Stimulation

In general, people who have had DBS surgery should:

Always carry an ID card that states they have a DBS neurostimulator. In addition, they may want to wear a medical identification bracelet indicating this information.

People with a neurostimulator should let airport security screeners know before going through the airport detectors. Many airport detectors are safe for pacemakers, but the small amount of metal in the neurostimulator may set off the alarm. Patients selected for additional screening by hand-held detector devices should politely remind the screeners that the detector wand should not be held over the neurostimulator for longer than a few seconds, since these devices contain magnets that may affect the function or programming of the neurostimulator.

Patients with leads and neurostimulators may not have certain MRI procedures. Patients should always check with their physician before any type of MRI, though DBS can be compatible with MRI under certain circumstances. They should avoid places with large magnetic fields, such as power generators and automobile junkyards that use large magnets.

Patients who have had DBS surgery should avoid using heat in physical therapy to treat muscles.

They should also avoid high-voltage or radar machinery, such as radio or television transmitters, electric arc welders, high-tension wires, radar installations or smelting furnaces.

If patients are scheduled for a surgical procedure, they should tell their surgeon that they have a neurostimulator well in advance. It is important to ask for advice on special precautions before and during the surgery since equipment such as the electrocautery device that controls bleeding may interfere with the neurostimulator.

When participating in a physical, recreational or sporting activity, patients should protect the neurostimulator area from trauma. A blow to the chest near the pacemaker can affect its functioning and warrants a trip to the doctor.

# data[].attributes.attachment_link.description
Deep brain stimulation (DBS) is a type of therapy that uses electrical stimulation to treat Parkinson's disease, essential tremor, multiple sclerosis, and certain other neurological conditions.

# data[].attributes.headline
Long-term consequences - Health problems 

# data[].attributes.subject
Long-term consequences - Health problems 

# data[].attributes.body
Parkinson’s disease is a progressive neurological disorder, the first appearance of the symptoms is the rigidity of your body movements and tremors, some patients have a specific side of their body who have this fragility. Then with the passage of time, some long-term consequences start to manifest in your body. Freezing of gait is an example, these consequences change the sensibility with your feet, they can feel a freezing of their feet on the floor. Some problems with constipation are very common. With the progress of Parkinson’s disease with time, symptoms associated with the problem become worse typically and many new problems emerge. Despite patients receiving benefits with the intake of anti-Parkinson medication; the benefit fails to last for a long time even when they intake it frequently.

https://www.epainassist.com/parkinsons-disease/what-are-the-long-term-effects-of-parkinsons-disease

# data[].attributes.attachment_link.title
What Are The Long-Term Effects Of Parkinson’s Disease? - Epainassist - Useful Information for Better Health

# data[].attributes.attachment_link.description
Parkinson’s disease is a type of progressive neurological disorder, which erodes the control of any person over their speech and body movements. With the passage of time, Parkinson’s patients deal with rigidity and stiffness in their legs and arms, lack of movement, slowness and walking difficulties, along with tremors in their legs, arms, hands face […]

# data[].attributes.body
Cognitive behavioral therapy is a form of psychological treatment that is effective for depression, anxiety, eating disorders, and other sever mental illness. CBT treatment is about changing ones thinking patterns, by learning whats creating the current problem, getting an understanding, coping with the situation, and changing the behavioral patterns.

A long term consequence of parkinson's that CBT could treat is depression. By Learning to calm one’s mind and relax one’s body. A short term consequence of parkinson's that CBT would also be depression.

The type of professional that would offer Cognitive behavioral therapy would be a psychologist, Counselors, and social workers.

https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

# data[].attributes.attachment_link.title
What is cognitive behavioral therapy? - Harvard Health

# data[].attributes.attachment_link.description
Cognitive behavioral therapy, or CBT, teaches people to challenge negative thought patterns and change their responses to unsettling situations. It is an effective therapy for many mental health co…

# data[].attributes.body
People with Parkinson's Disease may experience coughing, choking, or throat clearing problems that occur when eating, drinking, or talking. Treatment for this can include Parkinson's medication and/or swallowing therapy. Parkinson's medication may help ease in swallowing but usually won't fix the problem entirely. On the other hand, swallowing therapy can be a great treatment addition to the medication. This type of therapy will encourage exercises that helps strenghthen swallowing muscles, diet modification, or thickening liquids. This is performed by a swallowing therapist to manage these long-term effects.

Source: https://www.michaeljfox.org/symptoms/speech-swallowing-problems#:~:text=Speech%20Problems&text=Many%20people%20with%20PD%20speak,rapidly%2C%20even%20stuttering%20or%20stammering.

# data[].attributes.attachment_link.provider_name
The Michael J. Fox Foundation for Parkinson's Research | Parkinson's Disease

# data[].attributes.attachment_link.description
Parkinson’s disease (PD) can affect speech in several ways. Many people with PD speak quietly and in one tone; they don’t convey much emotion. Sometimes speech sounds breathy or hoarse. People with Parkinson’s might slur words, mumble or trail off at the end of a sentence. Most people talk slowly, but some speak rapidly, even stuttering or stammering.

# data[].attributes.body
Cognitive rehabilitation is a form of rehabilitation where they give the person a guid-line to follow over a timeline in hopes that they see a change in behavioral and mental well being.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8157874/

# data[].attributes.attachment_link.title
Cognitive Rehabilitation | Center for NeuroWellness

# data[].attributes.attachment_link.description
Cognitive Rehabilitation is designed to help individuals develop skills and learn compensatory strategies to improve overall functioning.

# data[].attributes.body
Treatment options for hearing loss with Parkinson's disease include:

Wearing hearing aids to treat age-related hearing loss.

Screening for hearing loss and appropriate use of hearing aids may reduce the incidence of PD.

Auditory processing disorder can also be linked to Parkinson's, and resources and therapies are available for it.

The risk of developing Parkinson disease (PD) after objective hearing loss is unknown. PD studies using self-reported hearing loss are insensitive, and objective data are lacking.

The use of hearing aids to treat people who suffer with hearing loss, their age can affect as well.

A new study suggests a possible connection between hearing loss and Parkinson's disease, and veterans fitted with a hearing aid within two years of hearing loss appear to lower the risk of developing Parkinson's. Acoustic stimulation may also improve motor symptoms in PD.

Hearing loss appears to be an independent risk factor for later development of PD. Hearing aids attenuate this risk, and therefore widespread screening for hearing loss and appropriate use of hearing aids may reduce the incidence of PD.

Additional studies are needed to examine the mechanisms underlying the association between hearing loss and PD.

https://pubmed.ncbi.nlm.nih.gov/39432289/

# data[].attributes.attachment_link.title
Hearing Loss, Incident Parkinson Disease, and Treatment With Hearing Aids - PubMed

# data[].attributes.attachment_link.description
Hearing loss appears to be an independent risk factor for later development of PD. Hearing aids attenuate this risk, and therefore widespread screening for hearing loss and appropriate use of hearing aids may reduce the incidence of PD. Additional studies are needed to examine the mechanisms underly …

# data[].attributes.body
Diet and nutrition in Parkinson disease.

A patient that has a Parkinson's problem, for the patient is very important, has a balanced diet to help in the treatment.

Studies show that making targeted nutrition the mainstay of your meals may slow Parkinson's disease (PD) advancement. Eating a whole-food, plant-based diet has many benefits.

While there is no prescription for a PD-specific diet, one that includes a variety of whole grains, vegetables, fruits and protein-rich foods can improve health. Also consider including nuts, olive oil, fish and eggs to your diet, for their beneficial fats.

Eating a variety of foods will help you get the energy, protein, vitamins, minerals and fiber you need for good health

The right foods will also optimize your medications, keep your bones strong, fight constipation and weight loss and maintain general health and fitness.

Diet and Parkinson’s medications can impact each other. Carbidopa/levodopa medications work best on an empty stomach. However, some people experience nausea as a side effect of these medications, and taking them on an empty stomach may not be their best option.

https://www.parkinson.org/living-with-parkinsons/management/diet-nutrition

# data[].attributes.attachment_link.readable_text
Studies show that making targeted nutrition the mainstay of your meals may slow Parkinson's disease (PD) advancement. Eating a whole-food, plant-based diet has many benefits.

While there is no prescription for a PD-specific diet, one that includes a variety of whole grains, vegetables, fruits and protein-rich foods can improve health. Also consider including nuts, olive oil, fish and eggs to your diet, for their beneficial fats.

Maintain Health

Avoid "fad" diets. Eat food from all food groups, following guidelines of the U.S. Department of Agriculture MyPlate program. Eating a variety of foods will help you get the energy, protein, vitamins, minerals and fiber you need for good health.

Tips

Choose a diet with plenty of whole grains, vegetables and fruits, which provide vitamins, minerals, fiber and complex carbohydrates and can help you lower your intake of fat.

Limit sugar intake. A diet with lots of sugar can have too many calories and too few nutrients. It can also contribute to tooth decay.

Reduce salt and sodium intake to help decrease your risk of high blood pressure.

Incorporate foods high in antioxidants (which are important for overall brain health) into your diet. These include brightly colored and dark fruits and vegetables.

Balance the food you eat with physical activity.

Choose a diet low in saturated fat and cholesterol to reduce your risk of heart attack and certain types of cancer.

Maintain a healthy weight to reduce chances of high blood pressure, heart disease, stroke, certain cancers and common types of diabetes. Your doctor can help you determine what a healthy weight means for you.

Drink alcoholic beverages in moderation, as they have empty calories and few (or no) nutrients. Drinking alcohol can cause many health problems and accidents. It may not be advisable to mix certain medications with alcohol. Check with your doctor.

Ease PD Symptoms

The right foods will also optimize your medications, keep your bones strong, fight constipation and weight loss and maintain general health and fitness.

Ease PD Symptoms

Drink enough water (6-8 glasses a day) and eat fiber-rich foods, including brown rice, whole grains (breads with 3 grams or more of dietary fiber per slice), fruit and beans to ease digestive difficulties and constipation.

Take your medications with a full glass of water. It may help your body break down the medication more efficiently.

Limit sugar intake, alcohol and caffeine particularly before bed, as they may interrupt sleep.

Talk to your doctor about whether you should increase your Vitamin D intake. Vitamin D helps maintain bone health. It can be found in fortified milk and milk products, egg yolks and fatty fish - like tuna, mackerel and salmon - and there are oral supplements available over the counter.

Snack on small quantities of walnuts, cashews and other nuts to promote brain health. Also try to incorporate berries, which contain beneficial antioxidants, and foods that may have anti-inflammatory effects in the brain, like salmon, tuna and dark, leafy green vegetables.

Challenges

Diet and Parkinson's medications can impact each other. Carbidopa/levodopa medications work best on an empty stomach. However, some people experience nausea as a side effect of these medications, and taking them on an empty stomach may not be their best option.

For some, taking certain PD medications close to a protein-rich meal - like meat, fish, eggs, dairy products, nuts and beans - may interfere with the absorption of the drug in the blood, causing it to work more slowly or less effectively. Talk to your doctor about the right option for you, such as taking the drug on an empty stomach or with a small snack, such as crackers or applesauce.

Tips

People with PD may eat less and lose weight because of difficulty swallowing, nausea from medications or movement symptoms that make it difficult to eat, or from feeling full after a small meal. Be sure to address these issues with your doctor.

Also consider adding foods with healthy fats - nuts, nut butters and avocado - to your diet. Try bitter greens or spicy foods to stimulate your appetite. Exercise to increase hunger.

PD symptoms such as tremor, stiffness or difficulty swallowing may make eating certain foods challenging. Try eating foods that are easy to swallow. Put dishes on rubber mats to prevent them from slipping.

Staying hydrated is important, try eating foods with high water content in addition to beverages to maintain hydration, such as celery, butternut squash, grapefruit, strawberries and watermelon.

Tips for Getting Started

Changing your diet can be difficult. Try making one change at a time, like eating a handful of nuts a few times a week or avoiding white bread. Small changes can add up to big benefits.

Consult with a registered dietician, who can help you plan menus and make shopping lists for preparing nutritious meals that you like and that account for your individual needs and the timing of your medications.

An occupational therapist can help you explore assistive devicesto make eating and drinking easier.

If you experience anxiety or depression, talk to your doctor. These symptoms can suppress appetite.

If swallowing issues are causing problems eating, a speech-language pathologist may be able to help.

MY PD STORY: Paul Rohrlich

I believe that exercise and weight training remain the most essential self-help one can practice, in addition to diet.

Involve your team

Seek reliable information about diet and nutrition from your medical team and local resources. Contact the Parkinson's Foundation Helpline at 1-800-4PD-INFO (1-800-473-4636) for help finding a nutritionist.
Page reviewed by Dr. Bhavana Patel, Movement Disorders Neurologist at the University of Florida, a Parkinson's Foundation Center of Excellence.

Related Materials

Related Blog Posts

PD Health @ Home

Join us for new, weekly virtual wellness programs! Take part in one or all of our events that cover: mindfulness, interviews with experts and guided exercise.

Studies show that making targeted nutrition the mainstay of your meals may slow Parkinson's disease (PD) advancement. Eating a whole-food, plant-based diet has many benefits.

While there is no prescription for a PD-specific diet, one that includes a variety of whole grains, vegetables, fruits and protein-rich foods can improve health. Also consider including nuts, olive oil, fish and eggs to your diet, for their beneficial fats.

Maintain Health

Avoid "fad" diets. Eat food from all food groups, following guidelines of the U.S. Department of Agriculture MyPlate program. Eating a variety of foods will help you get the energy, protein, vitamins, minerals and fiber you need for good health.

Tips

Choose a diet with plenty of whole grains, vegetables and fruits, which provide vitamins, minerals, fiber and complex carbohydrates and can help you lower your intake of fat.

Limit sugar intake. A diet with lots of sugar can have too many calories and too few nutrients. It can also contribute to tooth decay.

Reduce salt and sodium intake to help decrease your risk of high blood pressure.

Incorporate foods high in antioxidants (which are important for overall brain health) into your diet. These include brightly colored and dark fruits and vegetables.

Balance the food you eat with physical activity.

Choose a diet low in saturated fat and cholesterol to reduce your risk of heart attack and certain types of cancer.

Maintain a healthy weight to reduce chances of high blood pressure, heart disease, stroke, certain cancers and common types of diabetes. Your doctor can help you determine what a healthy weight means for you.

Drink alcoholic beverages in moderation, as they have empty calories and few (or no) nutrients. Drinking alcohol can cause many health problems and accidents. It may not be advisable to mix certain medications with alcohol. Check with your doctor.

Ease PD Symptoms

The right foods will also optimize your medications, keep your bones strong, fight constipation and weight loss and maintain general health and fitness.

Ease PD Symptoms

Drink enough water (6-8 glasses a day) and eat fiber-rich foods, including brown rice, whole grains (breads with 3 grams or more of dietary fiber per slice), fruit and beans to ease digestive difficulties and constipation.

Take your medications with a full glass of water. It may help your body break down the medication more efficiently.

Limit sugar intake, alcohol and caffeine particularly before bed, as they may interrupt sleep.

Talk to your doctor about whether you should increase your Vitamin D intake. Vitamin D helps maintain bone health. It can be found in fortified milk and milk products, egg yolks and fatty fish - like tuna, mackerel and salmon - and there are oral supplements available over the counter.

Snack on small quantities of walnuts, cashews and other nuts to promote brain health. Also try to incorporate berries, which contain beneficial antioxidants, and foods that may have anti-inflammatory effects in the brain, like salmon, tuna and dark, leafy green vegetables.

Challenges

Diet and Parkinson's medications can impact each other. Carbidopa/levodopa medications work best on an empty stomach. However, some people experience nausea as a side effect of these medications, and taking them on an empty stomach may not be their best option.

For some, taking certain PD medications close to a protein-rich meal - like meat, fish, eggs, dairy products, nuts and beans - may interfere with the absorption of the drug in the blood, causing it to work more slowly or less effectively. Talk to your doctor about the right option for you, such as taking the drug on an empty stomach or with a small snack, such as crackers or applesauce.

Tips

People with PD may eat less and lose weight because of difficulty swallowing, nausea from medications or movement symptoms that make it difficult to eat, or from feeling full after a small meal. Be sure to address these issues with your doctor.

Also consider adding foods with healthy fats - nuts, nut butters and avocado - to your diet. Try bitter greens or spicy foods to stimulate your appetite. Exercise to increase hunger.

PD symptoms such as tremor, stiffness or difficulty swallowing may make eating certain foods challenging. Try eating foods that are easy to swallow. Put dishes on rubber mats to prevent them from slipping.

Staying hydrated is important, try eating foods with high water content in addition to beverages to maintain hydration, such as celery, butternut squash, grapefruit, strawberries and watermelon.

Tips for Getting Started

Changing your diet can be difficult. Try making one change at a time, like eating a handful of nuts a few times a week or avoiding white bread. Small changes can add up to big benefits.

Consult with a registered dietician, who can help you plan menus and make shopping lists for preparing nutritious meals that you like and that account for your individual needs and the timing of your medications.

An occupational therapist can help you explore assistive devicesto make eating and drinking easier.

If you experience anxiety or depression, talk to your doctor. These symptoms can suppress appetite.

If swallowing issues are causing problems eating, a speech-language pathologist may be able to help.

MY PD STORY: Paul Rohrlich

I believe that exercise and weight training remain the most essential self-help one can practice, in addition to diet.

Involve your team

Seek reliable information about diet and nutrition from your medical team and local resources. Contact the Parkinson's Foundation Helpline at 1-800-4PD-INFO (1-800-473-4636) for help finding a nutritionist.
Page reviewed by Dr. Bhavana Patel, Movement Disorders Neurologist at the University of Florida, a Parkinson's Foundation Center of Excellence.

Related Materials

Related Blog Posts

PD Health @ Home

Join us for new, weekly virtual wellness programs! Take part in one or all of our events that cover: mindfulness, interviews with experts and guided exercise.

Tips

Choose a diet with plenty of whole grains, vegetables and fruits, which provide vitamins, minerals, fiber and complex carbohydrates and can help you lower your intake of fat.

Limit sugar intake. A diet with lots of sugar can have too many calories and too few nutrients. It can also contribute to tooth decay.

Reduce salt and sodium intake to help decrease your risk of high blood pressure.

Incorporate foods high in antioxidants (which are important for overall brain health) into your diet. These include brightly colored and dark fruits and vegetables.

Balance the food you eat with physical activity.

Choose a diet low in saturated fat and cholesterol to reduce your risk of heart attack and certain types of cancer.

Maintain a healthy weight to reduce chances of high blood pressure, heart disease, stroke, certain cancers and common types of diabetes. Your doctor can help you determine what a healthy weight means for you.

Drink alcoholic beverages in moderation, as they have empty calories and few (or no) nutrients. Drinking alcohol can cause many health problems and accidents. It may not be advisable to mix certain medications with alcohol. Check with your doctor.

Ease PD Symptoms

The right foods will also optimize your medications, keep your bones strong, fight constipation and weight loss and maintain general health and fitness.

Ease PD Symptoms

Drink enough water (6-8 glasses a day) and eat fiber-rich foods, including brown rice, whole grains (breads with 3 grams or more of dietary fiber per slice), fruit and beans to ease digestive difficulties and constipation.

Take your medications with a full glass of water. It may help your body break down the medication more efficiently.

Limit sugar intake, alcohol and caffeine particularly before bed, as they may interrupt sleep.

Talk to your doctor about whether you should increase your Vitamin D intake. Vitamin D helps maintain bone health. It can be found in fortified milk and milk products, egg yolks and fatty fish - like tuna, mackerel and salmon - and there are oral supplements available over the counter.

Snack on small quantities of walnuts, cashews and other nuts to promote brain health. Also try to incorporate berries, which contain beneficial antioxidants, and foods that may have anti-inflammatory effects in the brain, like salmon, tuna and dark, leafy green vegetables.

Tips

People with PD may eat less and lose weight because of difficulty swallowing, nausea from medications or movement symptoms that make it difficult to eat, or from feeling full after a small meal. Be sure to address these issues with your doctor.

Also consider adding foods with healthy fats - nuts, nut butters and avocado - to your diet. Try bitter greens or spicy foods to stimulate your appetite. Exercise to increase hunger.

PD symptoms such as tremor, stiffness or difficulty swallowing may make eating certain foods challenging. Try eating foods that are easy to swallow. Put dishes on rubber mats to prevent them from slipping.

Staying hydrated is important, try eating foods with high water content in addition to beverages to maintain hydration, such as celery, butternut squash, grapefruit, strawberries and watermelon.

MY PD STORY: Paul Rohrlich

I believe that exercise and weight training remain the most essential self-help one can practice, in addition to diet.

Related Materials

Related Blog Posts

# data[].attributes.attachment_link.description
Improve your overall health with these diet & nutrition tips to live better with Parkinson's disease.

# data[].attributes.body
To reduce the risk of Parkinson's disease, a preventative measure is regular exercise. Regular exercises can improve brain health and promote better motor function. This can also help keep their heart strong & healthy and get the blood pumping to help the brain tissue build up as a preventative measure. Challenges of this can include physical limitations that don't allow one to move as well or at all.

Source: https://www.umms.org/bwmc/news/2021/the-two-best-ways-to-prevent-parkinsons-disease

# data[].attributes.body
For a Parkinson patient, making healthy food choices and practicing good hygiene are two forms of preventive measures consequently reducing the risk of Parkinson disease.

Creating a diet with a nutrition that is specialist in healthy foods and how it can help you to improve your health, making good choices and preventing the growing up of parkinson. Practicing good hygiene is so interesting to parkinson people because any bacteria in your house or outhome that you can prevent before it affects your disease is important, so being a hygiene person is very good for preventing measures in Parkinson.

Trying to enact these preventive measures, motor impairments, cognitive decline, taste changes, fatigue or support needs can consequently happen with the parkinson patient.

https://foodsafety.institute/fqs-principles-mgt/guide-good-hygiene-food-production/

# data[].attributes.attachment_link.title
Comprehensive Guide to Good Hygiene Practices in Food Production • Food Safety Institute

# data[].attributes.attachment_link.description
Good Hygiene Practices (GHP) are vital for maintaining food safety throughout the food chain, from primary production to final consumption. GHP aims to prevent foodborne illness, injury, and spoilage by emphasizing the importance of hygiene control. Key principles include managing primary production to ensure food safety, hygienic handling, storage, and transport of food, proper cleaning and maintenance, and ensuring personnel hygiene. The Codex Alimentarius Commission provides guidelines to implement these practices effectively, safeguarding public health and maintaining confidence in food safety.

# data[].attributes.body
Special populations like older adults (especially men) are more likely to be affected by Parkinson's Disease. The reason why older men are more likely to get Parkinson's Disease is that as they get older, the dopamine-producing neurons in the brain naturally decline over time. People may face medical care challenges because they may get a delayed diagnosis, which may be mistaken for aging, or it may completely take over them without them being able to get a diagnosis or treatment.

Source: https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments#:~:text=One%20clear%20risk%20is%20age,to%20specific%20alterations%20in%20genes.

# data[].attributes.body
Parkinsons Disease is most common in men over the age of 60. However, women can still develop PD. Aging increases the risk due to natural neurodegeneration. Although women also develop Parkinsons Disease it is less likely to occur than in men. there experience throughout PD is also different than men.

https://parkinsonsdisease.net/special-populations

# data[].attributes.body
When it comes to woman with PD. Women are less likely to develop Parkinson than men. They also experience PD differently than men. Like different symptoms and they tend to experience drug side effects more often. Unfortunately, in many cases, women with PD are not treated as effectively by doctors.

Levodopa is the best treatment we currently have to trear the movement symptoms of Parkinson. It is a molecule that the body convert into dopamine to make up for the dopamine it cannot make.

Some studies have shown that this drug stops working earlier for women than for men. Women also report side effects of levodopa more often. The most common side effcet women report is Dyskinesia.

No medicine can stop the destruction of the dopamine- producing areas of the brain. Because of that, levodopa can be less effective the longer someone has Parkinson.

https://parkinsonsdisease.net/special-populations

# data[].attributes.headline
Wearable Sensors for Monitoring Motor Symptoms

# data[].attributes.subject
Wearable Sensors for Monitoring Motor Symptoms

# data[].attributes.body
Description:
Wearable sensors, such as accelerometers, gyroscopes, and surface electromyography (sEMG), are utilized to continuously monitor motor symptoms like tremors, bradykinesia (slowness of movement), and dyskinesia (involuntary movements). These devices provide real-time, objective data on motor fluctuations, offering insights into symptom progression and treatment efficacy.​

Assistance:
These sensors aid in the diagnosis by detecting motor impairments and assist in treatment by monitoring the effectiveness of interventions.​

Negative aspect:

Short battery life, they can stretch or deform, can be complex and difficult to implement.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5014594/

# data[].attributes.body
As Parkinson’s disease (PD) progresses, some tasks may become more difficult. Adaptive tools and assistive technology — innovative devices designed to improve daily living — can enhance function and wellbeing and foster continued independence. Mobility Aids. Rollator walkers, canes, and other assistive devices can enhance safety and mobility, especially for individuals with gait difficulties.

Assistive technology devices include:

Mobility aids- Tools that can help enhance safety, mobility, and balance, such as a rollator walker or cane.

Bathing & Grooming aids- Tools that help simplify self-care tasks, such as an electric toothbrush or razor, or shower chair.

Dressing aids- Tools that make getting dressed easier including magnetic fasteners and a shoehorn.

Meal Preparation and Feeding aids- Tools that can make dining easier, including adaptive utensils.

Home safety aids- Tools such as personal medical alert systems and smart home technology devices that can ease health and home management. Devices include voice-activated lights and speakers.

Speech and Communication aids- Tools that can help you speak, including voice amplifiers, communication applications, and alphabet and picture boards.

Memory and Visual aids- Such as reminder signage, calendar, alarms and electronic notifications.

Recreation and Leisure aids- Tools that can help you continue doing the activities you enjoy. Examples include audiobooks, cardholders and adaptive gaming.

https://www.parkinson.org/living-with-parkinsons/management/activities-daily-living/assistive-tech-devices

# data[].attributes.body
Mobility aids is a type of treatment that can help alleviate symptoms that impact motor functions like walking. There are different types of mobility aids that can be used for different purposes and/or severities - these include canes, walkers, and wheelchairs. Each of these can help alleviate symptoms with balance, posture, stability, or movement. Negative aspects of these can include the bulkiness of having to take it or carry it around anywhere you go.

Source: https://www.parkinson.org/living-with-parkinsons/management/activities-daily-living/assistive-tech-devices

# data[].attributes.attachment_link.readable_text
As Parkinson's disease (PD) progresses, some tasks may become more difficult. Adaptive tools and assistive technology - innovative devices designed to improve daily living - can enhance function and wellbeing and foster continued independence.

Wide-ranging assistive devices empower people experiencing Parkinson's-related changes, supporting you in your home and career. These tools can help you continue to participate in the activities that bring you joy and the ones that keep you moving.

Types of Assistive Technology and Devices

Hearing aids, medication organizers and an adaptive computer mouse, are all examples of assistive technology. These tools can help simplify daily living tasks, while some are engineered to ease Parkinson's symptoms that impact motor, speech, balance and thinking.

Allowing enough time for tasks and creating a safe home environment is essential when living with Parkinson's or caring for someone who does. Among the many assistive devices to improve living with Parkinson's are those that facilitate staying active (such as a wearable, step counter or pedometer) - exercise is vital for people with Parkinson's.

Assistive technology devices include:

Mobility aids- Tools that can help enhance safety, mobility, and balance, such as a rollator walker or cane.

Bathing & Grooming aids- Tools that help simplify self-care tasks, such as an electric toothbrush or razor, or shower chair.

Dressing aids- Tools that make getting dressed easier including magnetic fasteners and a shoehorn.

Meal Preparation and Feeding aids- Tools that can make dining easier, including adaptive utensils.

Home safety aids- Tools such as personal medical alert systems and smart home technology devices that can ease health and home management. Devices include voice-activated lights and speakers.

Speech and Communication aids- Tools that can help you speak, including voice amplifiers, communication applications, and alphabet and picture boards.

Memory and Visual aids- Such as reminder signage, calendar, alarms and electronic notifications.

Recreation and Leisure aids- Tools that can help you continue doing the activities you enjoy. Examples include audiobooks, cardholders and adaptive gaming.

Can I benefit from assistive technology?

Answer the following questions to see if assistive technology may help you:

Can I communicate effectively and be understood by others?

Can I use my computer to read or type as effectively as in the past?

Do tremors impact my ability to type?

Do I have difficulty using a touch screen?

Am I having more difficulty remembering passwords?

Am I able to effectively control electronics within the home environment?

Have I experienced falls or loss of balance?

Finding a Specialist

Incorporating the right aids at the right time can preserve independence and increase quality of life. It's important to work with a healthcare expert who is knowledgeable in Parkinson's disease. Your doctor can refer you to a therapist trained to meet your assistive device needs.

Occupational therapists, physical therapists, and speech-language pathologists can evaluate your needs, teach you new techniques to compensate for your challenges, and offer tailored assistive device recommendations. Their experience can ensure you receive the right equipment and the appropriate fit. They will also help you learn how to properly use these devices and customize them to fit your needs.

Assistive Technology Specialists

Exerts who help match your personal strengths with exercises and strategies to help keep you doing the activities you enjoy.

Experts in movement and balance that help you keep active and safe at all PD stages, focusing on helping you thrive.

Experts trained to evaluate and help you manage speech, voice, language, thinking skills, memory and swallowing problems.

Assistive Technology and Device Tips

As you explore assistive technology, keep these tips in mind:

Many assistive devices are commercially available through major retailers and online.

Talk to your care team before using or purchasing medical-related equipment.

A written prescription may be needed for items such as a lift chair, walker, or wheelchair to be covered by your insurance provider. Your care team can help you navigate insurance reimbursement when applicable.

For more detailed information, utilize this online list of assistive and adaptive daily living aids developed by Chicago's Shirley Ryan AbilityLab, an innovative, research-driven rehabilitation institution affiliated with Northwestern University, a Parkinson's Foundation Center of Excellence.

We can help you locate a nearby expert therapist.

Related Materials

Related Blog Posts

Connect with Others

Explore our PD Conversations discussion groups to find answers or talk to others going through similar experiences.

As Parkinson's disease (PD) progresses, some tasks may become more difficult. Adaptive tools and assistive technology - innovative devices designed to improve daily living - can enhance function and wellbeing and foster continued independence.

Wide-ranging assistive devices empower people experiencing Parkinson's-related changes, supporting you in your home and career. These tools can help you continue to participate in the activities that bring you joy and the ones that keep you moving.

Types of Assistive Technology and Devices

Hearing aids, medication organizers and an adaptive computer mouse, are all examples of assistive technology. These tools can help simplify daily living tasks, while some are engineered to ease Parkinson's symptoms that impact motor, speech, balance and thinking.

Allowing enough time for tasks and creating a safe home environment is essential when living with Parkinson's or caring for someone who does. Among the many assistive devices to improve living with Parkinson's are those that facilitate staying active (such as a wearable, step counter or pedometer) - exercise is vital for people with Parkinson's.

Assistive technology devices include:

Mobility aids- Tools that can help enhance safety, mobility, and balance, such as a rollator walker or cane.

Bathing & Grooming aids- Tools that help simplify self-care tasks, such as an electric toothbrush or razor, or shower chair.

Dressing aids- Tools that make getting dressed easier including magnetic fasteners and a shoehorn.

Meal Preparation and Feeding aids- Tools that can make dining easier, including adaptive utensils.

Home safety aids- Tools such as personal medical alert systems and smart home technology devices that can ease health and home management. Devices include voice-activated lights and speakers.

Speech and Communication aids- Tools that can help you speak, including voice amplifiers, communication applications, and alphabet and picture boards.

Memory and Visual aids- Such as reminder signage, calendar, alarms and electronic notifications.

Recreation and Leisure aids- Tools that can help you continue doing the activities you enjoy. Examples include audiobooks, cardholders and adaptive gaming.

Can I benefit from assistive technology?

Answer the following questions to see if assistive technology may help you:

Can I communicate effectively and be understood by others?

Can I use my computer to read or type as effectively as in the past?

Do tremors impact my ability to type?

Do I have difficulty using a touch screen?

Am I having more difficulty remembering passwords?

Am I able to effectively control electronics within the home environment?

Have I experienced falls or loss of balance?

Finding a Specialist

Incorporating the right aids at the right time can preserve independence and increase quality of life. It's important to work with a healthcare expert who is knowledgeable in Parkinson's disease. Your doctor can refer you to a therapist trained to meet your assistive device needs.

Occupational therapists, physical therapists, and speech-language pathologists can evaluate your needs, teach you new techniques to compensate for your challenges, and offer tailored assistive device recommendations. Their experience can ensure you receive the right equipment and the appropriate fit. They will also help you learn how to properly use these devices and customize them to fit your needs.

Assistive Technology Specialists

Exerts who help match your personal strengths with exercises and strategies to help keep you doing the activities you enjoy.

Experts in movement and balance that help you keep active and safe at all PD stages, focusing on helping you thrive.

Experts trained to evaluate and help you manage speech, voice, language, thinking skills, memory and swallowing problems.

Assistive Technology and Device Tips

As you explore assistive technology, keep these tips in mind:

Many assistive devices are commercially available through major retailers and online.

Talk to your care team before using or purchasing medical-related equipment.

A written prescription may be needed for items such as a lift chair, walker, or wheelchair to be covered by your insurance provider. Your care team can help you navigate insurance reimbursement when applicable.

For more detailed information, utilize this online list of assistive and adaptive daily living aids developed by Chicago's Shirley Ryan AbilityLab, an innovative, research-driven rehabilitation institution affiliated with Northwestern University, a Parkinson's Foundation Center of Excellence.

We can help you locate a nearby expert therapist.

Related Materials

Related Blog Posts

Connect with Others

Explore our PD Conversations discussion groups to find answers or talk to others going through similar experiences.

Mobility aids- Tools that can help enhance safety, mobility, and balance, such as a rollator walker or cane.

Bathing & Grooming aids- Tools that help simplify self-care tasks, such as an electric toothbrush or razor, or shower chair.

Dressing aids- Tools that make getting dressed easier including magnetic fasteners and a shoehorn.

Meal Preparation and Feeding aids- Tools that can make dining easier, including adaptive utensils.

Home safety aids- Tools such as personal medical alert systems and smart home technology devices that can ease health and home management. Devices include voice-activated lights and speakers.

Speech and Communication aids- Tools that can help you speak, including voice amplifiers, communication applications, and alphabet and picture boards.

Memory and Visual aids- Such as reminder signage, calendar, alarms and electronic notifications.

Recreation and Leisure aids- Tools that can help you continue doing the activities you enjoy. Examples include audiobooks, cardholders and adaptive gaming.

Answer the following questions to see if assistive technology may help you:

Can I communicate effectively and be understood by others?

Can I use my computer to read or type as effectively as in the past?

Do tremors impact my ability to type?

Do I have difficulty using a touch screen?

Am I having more difficulty remembering passwords?

Am I able to effectively control electronics within the home environment?

Have I experienced falls or loss of balance?

Assistive Technology Specialists

Exerts who help match your personal strengths with exercises and strategies to help keep you doing the activities you enjoy.

Experts in movement and balance that help you keep active and safe at all PD stages, focusing on helping you thrive.

Experts trained to evaluate and help you manage speech, voice, language, thinking skills, memory and swallowing problems.

As you explore assistive technology, keep these tips in mind:

Many assistive devices are commercially available through major retailers and online.

Talk to your care team before using or purchasing medical-related equipment.

A written prescription may be needed for items such as a lift chair, walker, or wheelchair to be covered by your insurance provider. Your care team can help you navigate insurance reimbursement when applicable.

We can help you locate a nearby expert therapist.

Related Materials

Related Blog Posts

# data[].attributes.attachment_link.description
As Parkinson's disease (PD) progresses, some tasks may become more difficult. Adaptive tools and assistive technology - innovative devices designed to improve daily living - can enhance function and wellbeing and foster continued independence. Wide-ranging assistive devices empower people experiencing Parkinson's-related changes, supporting you in your home and career.

# data[].attributes.body
Spreading awareness and research are two types of public health measures that have been taken to prevent and control Parkinson's Disease. Spreading awareness is great because it helps spread the word about Parkinson's and teaches people what it is and how they can avoid and/or prevent it by getting a diagnosis. Research is also significant because, since there are not many treatment options for Parkinson's, research can be done to find more treatments that can work better or more efficiently. Possible challenges that can occur with these include people not wanting to learn about Parkinson's & how it affects people, and difficulty recruiting participants for research.

Source: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(22)00312-X/fulltext#:~:text=The%20specific%20actions%20include%20reducing,promote%20awareness%20and%20reduce%20discrimination.

# data[].attributes.headline
Promotion of Physical Activity Programs for Older Adults

# data[].attributes.subject
Promotion of Physical Activity Programs for Older Adults

# data[].attributes.body
Exercise is already such important part of healthy living for everyone. For those with Parkinson’s disease (PD), exercise is a vital component to maintaining balance, mobility and activities of daily living. Research shows that exercise and physical activity can not only maintain and improve mobility, flexibility and balance but also ease non-motor Parkinsons symptoms such.

Doing things such as

Aerobic Activity

Strength Training

Balance, Agility & Multitasking

Flexibility

Doing these things could help you prevent Parkinons. And for those who have it, this will help you prevent the symptoms of it.

https://www.parkinson.org/living-with-parkinsons/treatment/exercise#:~:text=Research%20has%20shown%20that%20exercise,with%20Tai%20Chi%20and%20yoga.

# data[].attributes.attachment_link.readable_text
Exercise is an important part of healthy living for everyone. For those with Parkinson's disease (PD), exercise is more than healthy - it is a vital component to maintaining balance, mobility and activities of daily living. Research shows that exercise and physical activity can not only maintain and improve mobility, flexibility and balance but also ease non-motor PD symptoms such as depression or constipation.

The Parkinson's Outcomes Project showed that people with PD who start exercising earlier in their disease course for a minimum of 2.5 hours per week experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is essential to overall disease management.

What type of exercise should I do?

To help manage the symptoms of PD, your exercise program should include these key components:

1. Aerobic Activity

2. Strength Training

3. Balance, Agility & Multitasking

4. Flexibility

The Parkinson's Foundation, in collaboration with the American College of Sports Medicine, created new Parkinson's disease exercise recommendations to provide people with PD safe and effective exercise programs and instruction.

The exercise guidelines include recommended frequency, intensity, time, type, volume and progression of exercises that are safe and effective for people with PD. Each recommendation is paired with specific types of activity and special safety considerations for people with PD.
Exercise Recommendations Recommendations are available in multiple languages.
The four elements of exercises are included in many types of exercise. Biking, running, Tai Chi, yoga, Pilates, dance, weight training, non-contact boxing, qi gong and more are included - all have positive effects on PD symptoms.

What kinds of exercise programs are available?

Many programs can help focus on improvements in functional capacity and mobility. These programs vary according to different aspects of physical training. Examples of PD exercise programs include:

Intensive sports training (non-contact boxing classes)

Treadmill training with body weight support

Resistance training

Aerobic exercise

Alternative forms of exercise (yoga)

Home-based exercise (YouTube videos or PD Health @ Home Fitness Fridays)

Stretching

There is no "exercise prescription" that is right for every person with PD. The type of exercise you do depends on your symptoms and challenges. For those who may be more sedentary, starting with low intensity exercise, such as walking, is beneficial. This can be increased to regular, more vigorous activity as tolerated.

The most important thing is to do the exercise regularly. We suggest finding an exercise you enjoy and can stick with!

How To Get Started

First, be safe. Before starting an exercise program, see a physical therapist specializing in PD for full functional evaluation and recommendations.

Use a pedometer (step-counter) and figure out how many steps you take on average each day, then build up from there. Many smartphones or smartwatches have a built-in pedometer feature or an application that can be downloaded.

Exercise indoors and outdoors. Change your routine to stay interested and motivated.

Most importantly, pick an exercise you enjoy.

Find Local PD Exercise Classes

Across the country, dance classes and boxing groups designed specifically for people with PD are growing in popularity. Contact our Helpline at 1-800-4PD-INFO (1-800-473-4636) or Helpline@parkinson.org to find one near you.

Working Out with a Partner

Many people find that they achieve the most success when exercising with a partner. Depending on the stage of the disease, it may be best for people with PD to train in an environment where others who could offer help are available if needed.

A workout partners can help motivate and engage one another in their exercise. People new to exercise programs may benefit with training with an individual or group leader. A physical therapist may be helpful in starting a program for people whose mobility is significantly affected by PD.

Exercise Tips

The best way to see benefits is to exercise on a consistent basis. People with PD enrolled in exercise programs with durations longer than six months, regardless of exercise intensity, showed significant gains in functional balance and mobility as compared to two-week or 10-week programs.

When it comes to exercise and PD, greater intensity may have greater benefits. Experts recommend that people with PD, particularly young-onset or those in the early stages, exercise with intensity for as long as possible as often as possible. The more you do, the more you benefit.

Intense exercise is exercise that raises your heart rate and makes you breathe heavily. Studies have focused on running and bicycle riding, but experts feel that other intense exercise such as swimming should provide the same benefit.

Regardless of your condition, always stretch, warm up and cool down properly.

Exercise in a way that is safe for you. Know your limits.

Many support groups, therapists and exercise programs can help with PD-safe exercises or help you set up your own program.

Challenges to Exercising

People in the early stages of PD tend to be just as strong and physically fit as healthy individuals of the same age. As Parkinson's progresses, it can lead to the following physical changes:

Loss of joint flexibility, which can affect balance.

Decreased muscle strength or deconditioning which can affect walking and the ability to stand up from sitting.

Decline in cardiovascular conditioning, which affects endurance.

The Parkinson's Outcomes Project study showed that 2.5 hours of weekly exercise, along with medication, can significantly improve quality of life for people living with Parkinson's.

Exercise & Parkinson's Research

Exercise is good for the heart and the muscles, but exercise can actually change the brain. Establishing early exercise habits is an essential part of overall disease management, which is why neurologists now recommend exercise as part of most PD treatment plans.

People with Parkinson's who engaged in at least 2.5 hours of exercise a week had a better quality of life than those who didn't exercise at all or started exercising later.
Research finding from the Parkinson's Outcomes Project, one of the largest clinical studies of Parkinson's

At Rhodes University in Memphis, TN, Dr. Gerecke and team report that exercise may be neuroprotective and have shown that exercise reduces the loss of dopamine-producing neurons after MPTP exposure. MPTP is a neurotoxin that causes loss of the dopamine-producing neurons in the same brain region that degenerates in human Parkinson's disease. Therefore, MPTP is used to generate an animal model for PD. Dr. Gerecke showed that three months of exercise provided complete protection against MPTP-induced neurotoxicity in mice. If running was limited to one to two months, or if the amount of running daily was decreased, the protective effects of exercise ended. In short, daily, sustained exercise was necessary for full protection.

Dr. Gerecke also found that three months of exercise induced changes in proteins related to energy regulation, cellular metabolism, cytoskeleton dynamics and intracellular signaling events. These changes might be responsible for the neuroprotection.

Other research findings include:

Out of 14 studies on treadmill training, three show an immediate effect of increased walking speed, longer stride length and improved balance as early as after one treadmill session. Eleven longer-term trials demonstrated safety and positive benefits in gait speed, strike length and related quality of life even several weeks later.

At the Cleveland Clinic, Dr. Alberts and team found that when people with PD pedaled on a stationary bike 30 percent faster than their preferred rate, they gained in aerobic fitness and showed improvement in motor function and coordination as well as manual dexterity. This improvement was retained for weeks after exercise stopped.

Evidence in animal models with PD have shown that intensive exercise can alter the way the brain works and promote recovery.

Mice models have shown that exercise improves that efficiency by modifying some of the areas of the brain where dopamine signals are received (ie, the substantia nigra and basal ganglia).

Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination. Exercise such as treadmill training and biking have all been shown to benefit, along with Tai Chi and yoga.

Studies have shown that:

Engaging in any level of physical activity is beneficial for movement symptoms.

For people with mild to moderate PD, targeted exercises can address specific symptoms. For example: aerobic exercise improves fitness, walking exercises assist in gait, and resistance training strengthens muscles.

One study showed that twice-a-week tango dancing classes helped people with PD improve motor symptoms, balance and walking speed.

Exercise may also improve cognition, depression and fatigue. Research is ongoing in these areas.

People who exercise vigorously, for example running or cycling, have fewer changes in their brains caused by aging.

Many physicians and physical therapists believe that exercise improves mobility, thinking, memory and reduces the risk of falls. In avoiding complications from falls, you can prevent further injuries and emergency hospitalizations.

Neurologists within the Parkinson's Foundation Center of Excellence network recommend that their patients with Parkinson's follow a regimented exercise program, along with anyone who may be at a higher risk of developing Parkinson's.

More and more researchers are dedicating studies to proving that exercise is an essential part of managing Parkinson's. Ongoing exercise-related studies are also looking to discover therapies that will change the course of the disease. Through our research grants, the Parkinson's Foundation supports research dedicated to better understanding how exercise can achieve the best quality of life for people with PD.

More research is needed to understand which aspects of exercise are most important, whether the benefits are long-lasting and whether drug and other therapies influence its effects. In studying the underlying molecular mechanisms, scientists may find new targets for drug therapies.In the meantime, intensive exercise helps people with PD walk and move better. Research is beginning to reveal how it reconditions the underlying brain circuits.

Neuroprotective Benefits of Exercise

Neuroprotection is when your brain works to prevent the death of neurons, or brain cells. For people with PD, exercise is not only vital to maintaining balance, mobility and daily living activities, but it has the potential to have a neuroprotective effect.

The Parkinson's Foundation studied exercise through our Parkinson's Outcomes Project study. Our Center of Excellence network believes that exercise is important to good outcomes in PD, and data support that. Exercising enhances the sense of well-being, even across different disease stages and severities.

We know that in PD, neurons that produce the chemical transmitter dopamine are damaged and lost. There is a period of time between when the loss of neurons begins and when PD movement symptoms start to show. By the time most people are diagnosed, nearly 80 percent of their dopamine neurons are already gone.

During this period, the brain changes, compensating for the loss of dopamine neurons which occurs during the process of neurodegeneration. Scientists call this ability to change and compensate exercise-dependent neuroplasticity . This same process occurs throughout life in response to experience. As children learn motor skills, for example, their brain cells make new connections. This process continues through adulthood.

Exercise may affect the brain by driving this compensation, or plasticity. People with PD who exercise regularly can move more normally than those who do not. We believe that exercise may be contributing to neuroplasticity - helping the brain maintain old connections, form new ones and restore lost ones. This may outweigh the effects of neurodegeneration.

What happens in the brain to produce these benefits? A study conducted by Beth Fisher and her team at the University of Southern California found that on a day-to-day basis, people with PD who exercised moved more normally than those who did not.

The study also found that in looking at mice that had exercised under conditions parallel to a human treadmill:

Exercising did not affect the amount of dopamine in the brain, but the mice that exercised the brain cells were using dopamine more efficiently and their dopamine signals lasted longer.

Exercise improves efficiency by modifying the areas of the brain where dopamine signals are received - the substantia nigra and basal ganglia.

Based on these findings, the research team believes exercise may help the brain maintain old connections, form new ones and restore lost ones. In certain situations, the neuroplasticity created from exercise in people with PD may outweigh the effects of neurodegeneration.

Monday - Friday from 9 a.m. to 7 p.m. ET. in English and Spanish

Page reviewed by Dr. Chauncey Spears, Clinical Assistant Professor at the University of Michigan.

Related Materials

Related Blog Posts

Fitness Fridays

Get moving with our PD-tailored fitness videos that feature a different focus every week, from balance to coordination and more.

Exercise is an important part of healthy living for everyone. For those with Parkinson's disease (PD), exercise is more than healthy - it is a vital component to maintaining balance, mobility and activities of daily living. Research shows that exercise and physical activity can not only maintain and improve mobility, flexibility and balance but also ease non-motor PD symptoms such as depression or constipation.

The Parkinson's Outcomes Project showed that people with PD who start exercising earlier in their disease course for a minimum of 2.5 hours per week experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is essential to overall disease management.

What type of exercise should I do?

To help manage the symptoms of PD, your exercise program should include these key components:

1. Aerobic Activity

2. Strength Training

3. Balance, Agility & Multitasking

4. Flexibility

The Parkinson's Foundation, in collaboration with the American College of Sports Medicine, created new Parkinson's disease exercise recommendations to provide people with PD safe and effective exercise programs and instruction.

The exercise guidelines include recommended frequency, intensity, time, type, volume and progression of exercises that are safe and effective for people with PD. Each recommendation is paired with specific types of activity and special safety considerations for people with PD.
Exercise Recommendations Recommendations are available in multiple languages.
The four elements of exercises are included in many types of exercise. Biking, running, Tai Chi, yoga, Pilates, dance, weight training, non-contact boxing, qi gong and more are included - all have positive effects on PD symptoms.

What kinds of exercise programs are available?

Many programs can help focus on improvements in functional capacity and mobility. These programs vary according to different aspects of physical training. Examples of PD exercise programs include:

Intensive sports training (non-contact boxing classes)

Treadmill training with body weight support

Resistance training

Aerobic exercise

Alternative forms of exercise (yoga)

Home-based exercise (YouTube videos or PD Health @ Home Fitness Fridays)

Stretching

There is no "exercise prescription" that is right for every person with PD. The type of exercise you do depends on your symptoms and challenges. For those who may be more sedentary, starting with low intensity exercise, such as walking, is beneficial. This can be increased to regular, more vigorous activity as tolerated.

The most important thing is to do the exercise regularly. We suggest finding an exercise you enjoy and can stick with!

How To Get Started

First, be safe. Before starting an exercise program, see a physical therapist specializing in PD for full functional evaluation and recommendations.

Use a pedometer (step-counter) and figure out how many steps you take on average each day, then build up from there. Many smartphones or smartwatches have a built-in pedometer feature or an application that can be downloaded.

Exercise indoors and outdoors. Change your routine to stay interested and motivated.

Most importantly, pick an exercise you enjoy.

Find Local PD Exercise Classes

Across the country, dance classes and boxing groups designed specifically for people with PD are growing in popularity. Contact our Helpline at 1-800-4PD-INFO (1-800-473-4636) or Helpline@parkinson.org to find one near you.

Working Out with a Partner

Many people find that they achieve the most success when exercising with a partner. Depending on the stage of the disease, it may be best for people with PD to train in an environment where others who could offer help are available if needed.

A workout partners can help motivate and engage one another in their exercise. People new to exercise programs may benefit with training with an individual or group leader. A physical therapist may be helpful in starting a program for people whose mobility is significantly affected by PD.

Exercise Tips

The best way to see benefits is to exercise on a consistent basis. People with PD enrolled in exercise programs with durations longer than six months, regardless of exercise intensity, showed significant gains in functional balance and mobility as compared to two-week or 10-week programs.

When it comes to exercise and PD, greater intensity may have greater benefits. Experts recommend that people with PD, particularly young-onset or those in the early stages, exercise with intensity for as long as possible as often as possible. The more you do, the more you benefit.

Intense exercise is exercise that raises your heart rate and makes you breathe heavily. Studies have focused on running and bicycle riding, but experts feel that other intense exercise such as swimming should provide the same benefit.

Regardless of your condition, always stretch, warm up and cool down properly.

Exercise in a way that is safe for you. Know your limits.

Many support groups, therapists and exercise programs can help with PD-safe exercises or help you set up your own program.

Challenges to Exercising

People in the early stages of PD tend to be just as strong and physically fit as healthy individuals of the same age. As Parkinson's progresses, it can lead to the following physical changes:

Loss of joint flexibility, which can affect balance.

Decreased muscle strength or deconditioning which can affect walking and the ability to stand up from sitting.

Decline in cardiovascular conditioning, which affects endurance.

The Parkinson's Outcomes Project study showed that 2.5 hours of weekly exercise, along with medication, can significantly improve quality of life for people living with Parkinson's.

Exercise & Parkinson's Research

Exercise is good for the heart and the muscles, but exercise can actually change the brain. Establishing early exercise habits is an essential part of overall disease management, which is why neurologists now recommend exercise as part of most PD treatment plans.

People with Parkinson's who engaged in at least 2.5 hours of exercise a week had a better quality of life than those who didn't exercise at all or started exercising later.
Research finding from the Parkinson's Outcomes Project, one of the largest clinical studies of Parkinson's

At Rhodes University in Memphis, TN, Dr. Gerecke and team report that exercise may be neuroprotective and have shown that exercise reduces the loss of dopamine-producing neurons after MPTP exposure. MPTP is a neurotoxin that causes loss of the dopamine-producing neurons in the same brain region that degenerates in human Parkinson's disease. Therefore, MPTP is used to generate an animal model for PD. Dr. Gerecke showed that three months of exercise provided complete protection against MPTP-induced neurotoxicity in mice. If running was limited to one to two months, or if the amount of running daily was decreased, the protective effects of exercise ended. In short, daily, sustained exercise was necessary for full protection.

Dr. Gerecke also found that three months of exercise induced changes in proteins related to energy regulation, cellular metabolism, cytoskeleton dynamics and intracellular signaling events. These changes might be responsible for the neuroprotection.

Other research findings include:

Out of 14 studies on treadmill training, three show an immediate effect of increased walking speed, longer stride length and improved balance as early as after one treadmill session. Eleven longer-term trials demonstrated safety and positive benefits in gait speed, strike length and related quality of life even several weeks later.

At the Cleveland Clinic, Dr. Alberts and team found that when people with PD pedaled on a stationary bike 30 percent faster than their preferred rate, they gained in aerobic fitness and showed improvement in motor function and coordination as well as manual dexterity. This improvement was retained for weeks after exercise stopped.

Evidence in animal models with PD have shown that intensive exercise can alter the way the brain works and promote recovery.

Mice models have shown that exercise improves that efficiency by modifying some of the areas of the brain where dopamine signals are received (ie, the substantia nigra and basal ganglia).

Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination. Exercise such as treadmill training and biking have all been shown to benefit, along with Tai Chi and yoga.

Studies have shown that:

Engaging in any level of physical activity is beneficial for movement symptoms.

For people with mild to moderate PD, targeted exercises can address specific symptoms. For example: aerobic exercise improves fitness, walking exercises assist in gait, and resistance training strengthens muscles.

One study showed that twice-a-week tango dancing classes helped people with PD improve motor symptoms, balance and walking speed.

Exercise may also improve cognition, depression and fatigue. Research is ongoing in these areas.

People who exercise vigorously, for example running or cycling, have fewer changes in their brains caused by aging.

Many physicians and physical therapists believe that exercise improves mobility, thinking, memory and reduces the risk of falls. In avoiding complications from falls, you can prevent further injuries and emergency hospitalizations.

Neurologists within the Parkinson's Foundation Center of Excellence network recommend that their patients with Parkinson's follow a regimented exercise program, along with anyone who may be at a higher risk of developing Parkinson's.

More and more researchers are dedicating studies to proving that exercise is an essential part of managing Parkinson's. Ongoing exercise-related studies are also looking to discover therapies that will change the course of the disease. Through our research grants, the Parkinson's Foundation supports research dedicated to better understanding how exercise can achieve the best quality of life for people with PD.

More research is needed to understand which aspects of exercise are most important, whether the benefits are long-lasting and whether drug and other therapies influence its effects. In studying the underlying molecular mechanisms, scientists may find new targets for drug therapies.In the meantime, intensive exercise helps people with PD walk and move better. Research is beginning to reveal how it reconditions the underlying brain circuits.

Neuroprotective Benefits of Exercise

Neuroprotection is when your brain works to prevent the death of neurons, or brain cells. For people with PD, exercise is not only vital to maintaining balance, mobility and daily living activities, but it has the potential to have a neuroprotective effect.

The Parkinson's Foundation studied exercise through our Parkinson's Outcomes Project study. Our Center of Excellence network believes that exercise is important to good outcomes in PD, and data support that. Exercising enhances the sense of well-being, even across different disease stages and severities.

We know that in PD, neurons that produce the chemical transmitter dopamine are damaged and lost. There is a period of time between when the loss of neurons begins and when PD movement symptoms start to show. By the time most people are diagnosed, nearly 80 percent of their dopamine neurons are already gone.

During this period, the brain changes, compensating for the loss of dopamine neurons which occurs during the process of neurodegeneration. Scientists call this ability to change and compensate exercise-dependent neuroplasticity . This same process occurs throughout life in response to experience. As children learn motor skills, for example, their brain cells make new connections. This process continues through adulthood.

Exercise may affect the brain by driving this compensation, or plasticity. People with PD who exercise regularly can move more normally than those who do not. We believe that exercise may be contributing to neuroplasticity - helping the brain maintain old connections, form new ones and restore lost ones. This may outweigh the effects of neurodegeneration.

What happens in the brain to produce these benefits? A study conducted by Beth Fisher and her team at the University of Southern California found that on a day-to-day basis, people with PD who exercised moved more normally than those who did not.

The study also found that in looking at mice that had exercised under conditions parallel to a human treadmill:

Exercising did not affect the amount of dopamine in the brain, but the mice that exercised the brain cells were using dopamine more efficiently and their dopamine signals lasted longer.

Exercise improves efficiency by modifying the areas of the brain where dopamine signals are received - the substantia nigra and basal ganglia.

Based on these findings, the research team believes exercise may help the brain maintain old connections, form new ones and restore lost ones. In certain situations, the neuroplasticity created from exercise in people with PD may outweigh the effects of neurodegeneration.

Monday - Friday from 9 a.m. to 7 p.m. ET. in English and Spanish

Exercise Recommendations

First, be safe. Before starting an exercise program, see a physical therapist specializing in PD for full functional evaluation and recommendations.

Use a pedometer (step-counter) and figure out how many steps you take on average each day, then build up from there. Many smartphones or smartwatches have a built-in pedometer feature or an application that can be downloaded.

Exercise indoors and outdoors. Change your routine to stay interested and motivated.

Most importantly, pick an exercise you enjoy.

The best way to see benefits is to exercise on a consistent basis. People with PD enrolled in exercise programs with durations longer than six months, regardless of exercise intensity, showed significant gains in functional balance and mobility as compared to two-week or 10-week programs.

When it comes to exercise and PD, greater intensity may have greater benefits. Experts recommend that people with PD, particularly young-onset or those in the early stages, exercise with intensity for as long as possible as often as possible. The more you do, the more you benefit.

Intense exercise is exercise that raises your heart rate and makes you breathe heavily. Studies have focused on running and bicycle riding, but experts feel that other intense exercise such as swimming should provide the same benefit.

Regardless of your condition, always stretch, warm up and cool down properly.

Exercise in a way that is safe for you. Know your limits.

Many support groups, therapists and exercise programs can help with PD-safe exercises or help you set up your own program.

Loss of joint flexibility, which can affect balance.

Decreased muscle strength or deconditioning which can affect walking and the ability to stand up from sitting.

Decline in cardiovascular conditioning, which affects endurance.

The Parkinson's Outcomes Project study showed that 2.5 hours of weekly exercise, along with medication, can significantly improve quality of life for people living with Parkinson's.

Research finding from the Parkinson's Outcomes Project, one of the largest clinical studies of Parkinson's

At Rhodes University in Memphis, TN, Dr. Gerecke and team report that exercise may be neuroprotective and have shown that exercise reduces the loss of dopamine-producing neurons after MPTP exposure. MPTP is a neurotoxin that causes loss of the dopamine-producing neurons in the same brain region that degenerates in human Parkinson's disease. Therefore, MPTP is used to generate an animal model for PD. Dr. Gerecke showed that three months of exercise provided complete protection against MPTP-induced neurotoxicity in mice. If running was limited to one to two months, or if the amount of running daily was decreased, the protective effects of exercise ended. In short, daily, sustained exercise was necessary for full protection.

Dr. Gerecke also found that three months of exercise induced changes in proteins related to energy regulation, cellular metabolism, cytoskeleton dynamics and intracellular signaling events. These changes might be responsible for the neuroprotection.

Other research findings include:

Out of 14 studies on treadmill training, three show an immediate effect of increased walking speed, longer stride length and improved balance as early as after one treadmill session. Eleven longer-term trials demonstrated safety and positive benefits in gait speed, strike length and related quality of life even several weeks later.

At the Cleveland Clinic, Dr. Alberts and team found that when people with PD pedaled on a stationary bike 30 percent faster than their preferred rate, they gained in aerobic fitness and showed improvement in motor function and coordination as well as manual dexterity. This improvement was retained for weeks after exercise stopped.

Evidence in animal models with PD have shown that intensive exercise can alter the way the brain works and promote recovery.

Mice models have shown that exercise improves that efficiency by modifying some of the areas of the brain where dopamine signals are received (ie, the substantia nigra and basal ganglia).

Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination. Exercise such as treadmill training and biking have all been shown to benefit, along with Tai Chi and yoga.

Studies have shown that:

Engaging in any level of physical activity is beneficial for movement symptoms.

For people with mild to moderate PD, targeted exercises can address specific symptoms. For example: aerobic exercise improves fitness, walking exercises assist in gait, and resistance training strengthens muscles.

One study showed that twice-a-week tango dancing classes helped people with PD improve motor symptoms, balance and walking speed.

Exercise may also improve cognition, depression and fatigue. Research is ongoing in these areas.

People who exercise vigorously, for example running or cycling, have fewer changes in their brains caused by aging.

Many physicians and physical therapists believe that exercise improves mobility, thinking, memory and reduces the risk of falls. In avoiding complications from falls, you can prevent further injuries and emergency hospitalizations.

Neurologists within the Parkinson's Foundation Center of Excellence network recommend that their patients with Parkinson's follow a regimented exercise program, along with anyone who may be at a higher risk of developing Parkinson's.

More and more researchers are dedicating studies to proving that exercise is an essential part of managing Parkinson's. Ongoing exercise-related studies are also looking to discover therapies that will change the course of the disease. Through our research grants, the Parkinson's Foundation supports research dedicated to better understanding how exercise can achieve the best quality of life for people with PD.

More research is needed to understand which aspects of exercise are most important, whether the benefits are long-lasting and whether drug and other therapies influence its effects. In studying the underlying molecular mechanisms, scientists may find new targets for drug therapies.In the meantime, intensive exercise helps people with PD walk and move better. Research is beginning to reveal how it reconditions the underlying brain circuits.

We know that in PD, neurons that produce the chemical transmitter dopamine are damaged and lost. There is a period of time between when the loss of neurons begins and when PD movement symptoms start to show. By the time most people are diagnosed, nearly 80 percent of their dopamine neurons are already gone.

During this period, the brain changes, compensating for the loss of dopamine neurons which occurs during the process of neurodegeneration. Scientists call this ability to change and compensate exercise-dependent neuroplasticity . This same process occurs throughout life in response to experience. As children learn motor skills, for example, their brain cells make new connections. This process continues through adulthood.

Exercise may affect the brain by driving this compensation, or plasticity. People with PD who exercise regularly can move more normally than those who do not. We believe that exercise may be contributing to neuroplasticity - helping the brain maintain old connections, form new ones and restore lost ones. This may outweigh the effects of neurodegeneration.

What happens in the brain to produce these benefits? A study conducted by Beth Fisher and her team at the University of Southern California found that on a day-to-day basis, people with PD who exercised moved more normally than those who did not.

The study also found that in looking at mice that had exercised under conditions parallel to a human treadmill:

Exercising did not affect the amount of dopamine in the brain, but the mice that exercised the brain cells were using dopamine more efficiently and their dopamine signals lasted longer.

Exercise improves efficiency by modifying the areas of the brain where dopamine signals are received - the substantia nigra and basal ganglia.

Based on these findings, the research team believes exercise may help the brain maintain old connections, form new ones and restore lost ones. In certain situations, the neuroplasticity created from exercise in people with PD may outweigh the effects of neurodegeneration.

Related Materials

Related Blog Posts

# data[].attributes.attachment_link.description
Exercise is a vital component to maintaining balance, mobility and activities of daily living.

# data[].attributes.headline
Occupational Safety Standards for High-Risk Jobs

# data[].attributes.subject
Occupational Safety Standards for High-Risk Jobs

# data[].attributes.body
there have been studies shown that there are occupations (agriculture, education, health care, welding, and mining) and toxicant exposures (solvents and pesticides) putatively associated with parkinsonism.

https://jamanetwork.com/journals/jamaneurology/fullarticle/797977

# data[].attributes.body
Lifestyle interventions offer a promising avenue for preventing progression from prodromal to manifest PD.

We illustrate this primarily for 1 specific lifestyle intervention:

namely aerobic exercise because the case for the other main lifestyle factor (dietary interventions) to modify the course of prodromal PD is currently less persuasive.

2 large trials in persons with manifest PD indicate that exercise can help to stabilize motor parkinsonism, although this could also reflect a symptomatic effect.

Advances in digital technology can be used to deliver the exercise intervention in the participant's own living environment and also to measure the outcomes remotely, which will help to further boost long-term compliance.

https://www.neurology.org/doi/10.1212/WNL.0000000000200787