Description, risk factors, signs, diagnosis, management, social work practice.
Three sections follow:
1. Background Material that provides the context for the topic
2. Suggestions for Practice
3. Reference
Feedback welcome!
The material that follows is drawn from the University of Tasmania Wicking Centre MOOC on Parkinson’s. https://mooc.utas.edu.au/course/20278/Parkinson_s_MOOC__2025.html
Background Material
What is Parkinson's?
Parkinson’s is the world’s fastest-growing neurological condition, with estimates of 8.5 - 10 million people living with Parkinson’s. These numbers are rapidly increasing, having doubled over the past 25 years. About 60% of people with Parkinson's are men, with 40% being women. Parkinson's occurs in adults of all ages, sexes and nationalities.
Parkinson's is a brain condition brought about by loss of dopamine-containing neurons in the brain. Dopamine is important for controlling movements, mood, thinking, sleep and motivation. In Parkinson's, these dopamine-containing neurons are very slowly lost over a number of years, resulting in a steady reduction in dopamine levels.
The main changes occurring with Parkinson’s include slower movements (such as slower walking), muscle stiffness and a tremor. There are non-movement symptoms too - including low mood, or depression, loss of sense of smell, disrupted sleep and constipation. Some symptoms, like loss of smell and sleep disturbances, can be present many years before a diagnosis. The combination of symptoms varies from one person to the next, which means that not everyone with Parkinson's will develop all the same symptoms.
Parkinson’s is a very slowly progressive condition caused by the gradual loss of dopaminergic neurons in the brain. Parkinson’s rate stays about the same over time. It does not rapidly progress over months and most people with Parkinson's will only notice a slight change from one year to the next.
Unfortunately Parkinson’s cannot be reversed. There is no medication to stop the loss of neurons. But there are many different medications that increase dopamine in the brain. Many people with Parkinson's who take these medications report minimal progression in their symptoms over the years. There is also emerging evidence from research that exercise may help slow - or even stop - the progression of Parkinson's.
Risk Factors for Parkinson’s
While the exact cause of Parkinson's is unknown, it is likely a combination of genetics, environment and changes in the brain. The strongest risk factor is ageing. Most Parkinson's diagnoses are made in those over the age of 60. Overall, approximately 1% of adults over 60 and 4-5% of those over 80 develop Parkinson's. But Parkinson's cases also occur in those under 50, so age is not the only factor at play.
Approximately 10 - 20% of Parkinson's cases are linked to genetic changes, genes that are passed down through families.
Some risk factors are environmental, including exposure throughout life to pollution or chemicals. Long-term exposure to pesticides – specifically Paraquat, used for weed control – is thought to increase the risk of Parkinson’s by 150%. Cleaning chemicals and degreasants that contain trichloroethylene (TCE) are linked to an even higher risk of Parkinson’s, with a 500% increase. Air pollution is an emerging risk factor.
Medical conditions can increase the risk of Parkinson’s: type 2 diabetes, stroke, chronic high blood pressure and high cholesterol.
Head injuries are another key risk factor for Parkinson’s.
Symptoms and Signs of Parkinson’s
For many years, Parkinson's was primarily classified as a movement disorder, due to its most noticeable symptoms: slowness, stiffness and shaking. However, scientists now know Parkinson's involves a range of non-movement symptoms, including sleep, mood and fatigue symptoms. This broader understanding has led to a more comprehensive approach to diagnosing and treating the condition.
Movement symptoms
Parkinson's can cause many different movement changes, but the key ones include:
Slowness of movement (also called 'bradykinesia'), e.g. slower and smaller steps when walking
Shaking (also called 'tremor')—people with Parkinson's with a tremor usually have a slower rate of progression than those without.
Muscle stiffness (also called 'rigidity'), e.g. bending a limb and finding resistance through the whole range of movement
Balance problems (also called 'postural instability')—occur later in Parkinson’s progression.
For a diagnosis of Parkinson's, a person must have bradykinesia, plus at least one of the three key movement features above. The graph shows how movement symptoms are linked to brain changes over time in Parkinson's.
Other movement symptoms include dystonia (muscle spasms or cramping), less spontaneous facial expression—'poker face’, and micrographia—small handwriting and freezing, I.e. a sudden inability to move that can develop in later stages.
The graph shows movement symptoms over time, as changes in the brain progress.
Non-movement symptoms
Non-movement symptoms are common in Parkinson's. Some studies have shown that non-movement symptoms can impact daily life more than movement symptoms – even early in the condition. These changes aren’t always as obvious to anyone around the person, and this means they may not be optimally treated. Common non-movement symptoms include disrupted sleep, urinary urgency and constipation, fatigue, anxiety and low mood, and lack of motivation (apathy).
The most common non-movement symptom is fatigue, experienced by around two-thirds of people with Parkinson's. About 1 in 3 people with Parkinson's will experience changes to thinking and memory, but these may improve with medications and regular physical and social activities.
Some non-movement symptoms occur years before a Parkinson's diagnosis:
70 - 90% of people with Parkinson's will experience a loss of smell (called hyposmia).
Constipation can be present as early as 20 years before diagnosis.
Approximately 50% of people with Parkinson's will experience REM-sleep-behaviour disorder (RBD). This results in acting out dreams, such as moving limbs and shouting while asleep.
People with Parkinson's may experience some cognitive changes in their ability to think, remember and process information quickly. Sometimes these improve with medications.
Hyposmia, constipation and RBD are early markers of Parkinson's. This means that if a person without a Parkinson's diagnosis has these symptoms, there is a slightly higher risk of Parkinson's developing in the future.
The graph shows non-movement symptoms over time, as changes in the brain progress. Note just how early some of these can appear, but not everybody will develop all of these symptoms.
Diagnosis
The diagnosis of Parkinson's is 'a clinical diagnosis', i.e. it relies on a doctor finding specific clinical features rather than using any specialist tests. The doctor makes a diagnosis of Parkinson’s based on:
taking a history, which means asking a series of questions and,
performing a physical examination. This includes moving the arms and legs to feel for muscle stiffness and observing walking patterns to look for signs of slowness.
For a diagnosis of Parkinson's, a person must have bradykinesia, plus at least one of the three key movement signs (rigidity, tremor and postural changes).
Receiving a diagnosis can sometimes be a confronting and confusing experience. Clinicians can support people during the diagnostic process through listening and compassion. A Parkinson's diagnosis can trigger a range of different emotions. Each person's needs and circumstances will impact the emotional stages they go through; reactions to the diagnosis have been compared to the process followed when experiencing grief and loss.
Management
A multidisciplinary team may be involved in supporting and managing symptoms of Parkinson’s and this is beneficial right from the time of diagnosis. A multi-disciplinary team can include geriatrician, occupational therapist, dentist, neuropsychologist, speech pathologist, physiotherapist, Parkinson’s nurse, dietician, general practitioner, and neurologist.
Medications
Medical management encompasses education, collaboration, and shared decision-making to help manage symptoms, and improve the person’s overall psychological and physical well-being. Medical management isn't just about drugs or medical interventions and devices. It is about the therapeutic relationship: empathy, conversation and communication, as well as monitoring and tracking the condition, and supporting strategies for active wellness and self-management.
Parkinson's is a treatable condition. There are a variety of effective medications that usually work by increasing dopamine levels in the brain. Strong evidence from research studies shows that these medications improve Parkinson's symptoms and quality of life. The key dopaminergic medications are:
Levodopa: Remains the gold standard for treating motor symptoms. It increases dopamine levels in the brain.
Dopamine Agonists: Mimics dopamine effects in the brain and can be used in early stages or alongside levodopa.
MAO-B and COMT Inhibitors: Prevents the breakdown of dopamine in the brain.
Levodopa is a gold standard medication for Parkinson’s, used by millions of people around the world—approximately 90% of people with Parkinson's are treated with levodopa. Levodopa is converted to, and thereby replaces, the dopamine in the brain that has been lost. It improves both movement and non-movement symptoms, improving quality of life. Levodopa continues to work well throughout all stages of the condition. It does not stop being effective, even in the later stages of Parkinson's.
Dopamine agonists are a key treatment option for Parkinson’s, working by mimicking dopamine to stimulate the brain’s dopamine receptors. Unlike levodopa, they don’t need to be converted into dopamine, which means they provide a smoother, longer-lasting effect and can help delay the need for levodopa in early Parkinson’s. While they can be effective in managing symptoms like stiffness and tremors, they do also carry side-effects that doctors work to combat by carefully adjusting dosages. Dopamine agonists are often used alongside other medications to balance effectiveness and tolerability.
There are two types of inhibitors used to treat Parkinson’s: monoamine oxidase-B (MAO-B) inhibitors and catechol-O-methyltransferase (COMT) inhibitors. Inhibitors work to block the enzymes in the brain that break down dopamine so that more of the chemical can circulate in the brain.
People with Parkinson’s usually require multiple daily doses at precise times for medication to be effective. Strategies such as using diaries, alarms and smart devices are commonly used. A small delay can make a big difference to how someone feels throughout the day.
Exercise
Focusing on a healthy diet and lifestyle, with plenty of exercise is a great way to lower the risk of many conditions - including Parkinson's. Taking care of the body through exercise, eating healthy, and getting enough rest further strengthens the brain, helping it cope better with the challenges of Parkinson’s.
Exercise is one of the most important things a person can do to improve or slow the progression of symptoms. Exercise increases the release of dopamine in the brain and is beneficial for both movement and non-movement symptoms. New research shows exercise may slow the progression of Parkinson's symptoms - but this needs to be at least "moderate intensity" exercise (which means the person is sweating or slightly short of breath). Exercise boost mood and reduces anxiety, supports memory and thinking, improves fatigue, improves sleep, improves constipation, improves bone strength and reduces the risk of fall.
Emotional and mental wellbeing
Active wellness is critical for Parkinson's management. Part of that is maintaining emotional and mental wellbeing through reducing stress. Stress can impact the person with Parkinson's as they face new challenges with the condition, but also their caregiver and loved ones.
Mindfulness, a type of meditation, is the practice of being fully present and engaged in the moment, with an open and non-judgemental awareness of thoughts, feelings, and surroundings. It involves focusing on the present rather than dwelling on the past or worrying about the future, often through techniques like breathing exercises, meditation, or body awareness. Mindfulness can be a strategy for addressing mood changes, such as anxiety, depression and apathy in Parkinson’s, helping people reconnect with the present moment and regain a sense of purpose.
Social connections and peer support
While medical treatments and therapies play a crucial role in managing the condition, social connection and peer support are equally important. They provide a sense of community and reduce feelings of isolation, as individuals can share experiences, challenges, and coping strategies that are specific to living with Parkinson’s. These connections also offer mental encouragement, reminding people that they are not alone in their journey.
When people lose connections with friends and loved ones, they are more likely to become isolated. This can contribute to mood changes, reduce motivation to stay engaged in medical management, increase stress and even impact cognitive function. But there are challenges to building and maintaining relationships when living with Parkinson's. Fatigue is a big factor when it comes to having the energy to spend time with people, as are changes like depression and apathy.
Cognitive reserve
Cognitive reserve is the ability of the brain to adapt and resist damage, which can help people maintain their thinking abilities as they age. Engaging multiple brain regions involved in memory, attention, language, and movement can help build cognitive reserve. Learning to play an instrument or actively listening to music strengthens connections between neurons, enhances neuroplasticity, and promotes new synapse formation, which can protect the brain in conditions like Parkinson’s. Additionally, music stimulates dopaminergic pathways, supporting mood, motivation, and cognitive flexibility, all of which contribute to maintaining brain health over time. Staying mentally, physically and socially active, eating a balanced diet, learning a new language and playing strategy games (e.g. chess) are ways to build cognitive reserve.
Suggestions for Practice
If required, join the multidisciplinary team that will be tasked with managing the person’s Parkinson’s.
Be aware of the risk factors for Parkinson’s.
Age over 60
Movement symptoms: slowness, stiffness and shaking
Environmental—pesticide exposure, cleaning chemicals, air pollution
Medical conditions—type 2 diabetes, stroke, chronic high blood pressure, high cholesterol
Head injuries
Non-movement symptoms, e.g. sleep disturbance, loss of smell, fatigue, apathy, depression
Where relevant, explore these factors as part of the initial BPSS assessment and encourage a GP consultation.
If risk factors exist, explore the existence of protective factors.
Diet
Exercise
Adequate rest
Coping with stress
Social connections
Activities to build cognitive reserve, e.g. type of hobbies, pastimes, recreational interests.
Where relevant, explore these factors as part of the initial BPSS assessment.
Support the person after a diagnosis of Parkinson’s.
Experiencing grief and loss emotions are common. Many people will initially feel a sense of shock, be upset or angry. Others will enter a period of denial or feel that there must be a mistake and seek further opinions. Yet some people express a sense of relief, finally having an explanation for what they are experiencing. How a person moves through those stages is completely individual
Exhibit hope and compassion while prioritising a person's perspective, experiences, and values.
Encourage the person to learn about Parkinson’s; provide resources.
Encourage the person to take an active role in their fitness and in social activities, e.g. join a Parkinson’s group, share their condition with friends and family, and try new hobbies.
Support the person in managing Parkinson’s: the medication regime, diet, exercise opportunities, coping with stress, continuing and enhancing social connections, engaging in activities to build cognitive reserve
Explain the roles of relevant allied health professionals and encourage the person to seek their assistance, e.g. physiotherapist, speech pathologist, occupational therapist and dietitian.
Assist carers to cope with what is involved in caring for someone with Parkinson’s. Strategies carers can use include:
Share feelings, concerns, and challenges with the person and with friends.
Create networks of friends and loved ones. Don't be afraid to share and seek reassurance as needed.
Consider respite care to have a break.
Join support groups and meet other carers. Share your experience with others facing similar challenges.
Maintain hobbies and healthy habits, using support services as needed to help with this.
Seek help with practical tasks like everyday chores.
Acknowledge the emotional and physical impacts of caring for a loved one thereby actioning strategies that help maintain overall wellbeing, ultimately improving care outcomes.
Reference
University of Tasmania Wicking Dementia Research and Education Centre. (2025). Parkinson’s MOOC. https://mooc.utas.edu.au/course/20278/Parkinson_s_MOOC__2025.html
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