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Parkinson's Disease

Parkinson’s disease is a slow-progressing nervous system disorder caused by the damage of dopaminergic neurons. Although it is known as a disorder of old people, it is remarkable to note that it can be observed in 30s nowadays. It is more prevalent in males. Four important symptoms of this disease are involuntary tremors, muscle stiffness, slow movements and loss of balance.

Tremors are the most common symptom of this disease. It is observed in 70% of the patients. While most prevalent initial symptom is asymmetric tremors, first symptom observed in the one fifth of the patients is the difficulties in using one hand.

Typically, tremor starts in one hand, and is observed more frequently while resting. When the person starts a movement to do something intentionally or pays attention to the trembling hand, the tremors may reduce and disappear. However, it appears again while walking. The tremor severity increases over time and moves to the other side of the body.

One of the important symptoms is the slowing down in the movement. With the loss of facial expressions (fixed and mask-like expressions), the patient’s face turns into a masked face. The voice may get hoarse and monotonous. Routine chores such as buttoning up and combing may become challenging for the patient. Hand-writing of the patient gets smaller and its shape may be distorted. The patient gets tired quickly. People with Parkinson’s disease may walk slowly with their chest bent forward, with short fast shuffling steps, and with less arm and body movement.

In the later periods, saliva may outpour from the mouth, and may have difficulties with swallowing. Taste sensation may change due to the loss of sense of smell. Depression and dementia may emerge. Frequency and urgency in urinating, sweating abnormalities and sleeping disorders may also be observed.

Stages of the Parkinson’s disease is made as follows based on the Hoehn and Yahr scale:




No symptoms


Symptoms of unilateral involvement (tremor, rigidity or bradykinesia)


Bilateral tremors, rigidity or bradykinesia.

No difficulties with walking.


Bilateral symptoms.

Mild level of walking difficulties.


Bilateral symptoms.

Moderate level of walking difficulties.

The patient needs assistance for survival.


Bilateral symptoms.

The patient cannot walk, and is wheelchair bound or bedridden.


Since the Parkinson’s disease is a progressive disorder, treatment is adjusted based on the symptoms and the level of functional disorders. With the improvements in diagnosis and treatment, the lifespan of the Parkinson’s disease patients approached to those of general population. Patients can maintain their regular lifestyle and occupation for a long time with the accurate treatment, health diet, and authentic physiotherapy