Parkinson's Disease Overview

Parkinson's disease is a progressive neurological condition caused by the loss of dopamine-producing nerve cells in the brain. Around 153,000 people in the UK live with it, and roughly 18,000 are diagnosed each year. It is the fastest-growing neurological condition worldwide.

The condition develops gradually. Early symptoms can be easy to dismiss — a slight tremor, a stiff shoulder, handwriting that's getting smaller. Recognising these signs early matters because starting the right treatment at the right time makes a meaningful difference to quality of life.

Understanding the symptoms

Motor symptoms

The three hallmark motor features are tremor (usually starting in one hand at rest), rigidity (stiffness in the limbs and trunk), and bradykinesia (slowness of movement). Bradykinesia is the defining feature — without it, Parkinson's cannot be diagnosed.

As the condition progresses, postural instability (difficulty with balance) develops. Walking may become shuffling, with reduced arm swing. Turning can feel unsteady. Facial expression may become less animated, sometimes described as a "mask-like" face.

Non-motor symptoms

These are increasingly recognised as a major part of Parkinson's and can appear years before motor symptoms. They include loss of sense of smell, constipation, depression, anxiety, sleep disturbances (particularly acting out dreams — REM sleep behaviour disorder), and fatigue.

Later in the condition, cognitive changes, pain, urinary problems, and autonomic dysfunction (dizziness on standing, excessive sweating) can occur. Non-motor symptoms often have more impact on daily life than the tremor or stiffness.

Diagnosis

Parkinson's is a clinical diagnosis — there is no blood test that confirms it. A neurologist with expertise in movement disorders assesses the pattern of symptoms and their progression. The key diagnostic criteria are bradykinesia (slowness) plus either rest tremor, rigidity, or both.

NICE guidelines state that people with suspected Parkinson's should be referred quickly and untreated to a specialist. Starting medication before specialist assessment can mask symptoms and complicate diagnosis.

A DaTSCAN (dopamine transporter scan) may be used when the diagnosis is uncertain, for example to distinguish essential tremor from Parkinson's. MRI brain scans don't show Parkinson's itself but can exclude other structural causes of symptoms.

Treatment

Levodopa is the most effective medication for the motor symptoms of Parkinson's. It replaces the dopamine that the brain is no longer producing enough of. It is usually given in combination with a decarboxylase inhibitor (as co-beneldopa or co-careldopa) to reduce side effects.

Dopamine agonists (ropinirole, pramipexole, rotigotine patch) stimulate dopamine receptors directly and may be used as an alternative or addition to levodopa. MAO-B inhibitors (rasagiline, selegiline, safinamide) slow the breakdown of dopamine in the brain.

Treatment is not just medication. Physiotherapy helps maintain mobility and balance. Occupational therapy addresses practical difficulties with daily tasks. Speech and language therapy is important for voice and swallowing problems. Regular exercise — particularly activities involving balance and coordination — has strong evidence for slowing functional decline.

How we can help

If you're concerned about symptoms that could suggest Parkinson's, we can provide a prompt GP assessment and arrange a fast-track referral to a neurologist with specialist movement disorder expertise. NICE recommends that patients are seen by a specialist before any treatment is started.

For patients with an existing Parkinson's diagnosis, we offer ongoing GP support, medication reviews, and coordination with your neurology team. We can also arrange blood tests, bone density scans, and referrals to physiotherapy, occupational therapy, or speech therapy as needed.