Common patient questions

Shaking hands for no reason can be caused by:

• an overactive thyroid
• anxiety
• caffeine or other stimulants
• essential tremor
• low blood sugar
• medication side effects
• Parkinson's disease.

Hand tremors associated with Parkinson's disease are typically classified as 'resting tremors', meaning they are most noticeable when the hand is relaxed and still, and may improve with deliberate movement. Tremor alone doesn't diagnose Parkinson's disease; the overall pattern of symptoms matter.

Early signs of Parkinson's disease can include subtle changes in movement and non-movement functions.

• Early movement symptoms may include a mild resting tremor, stiffness or reduced arm swing when walking. These changes typically develop gradually and often begin on one side of the body.
• Early non-movement symptoms such as constipation, loss of smell and sleep disturbance, including REM sleep behaviour disorder, can sometimes begin years before the appearance of any movement symptoms and might allow earlier targeted treatment.

Rapid eye movement (REM) sleep behaviour disorder involves acting out dreams during sleep – talking, shouting, punching, kicking or physically moving – because the normal muscle paralysis that occurs during dream sleep doesn't happen properly.

It is one of the earliest known markers of Parkinson's disease, sometimes appearing years or even decades before movement symptoms. If you or a bed partner has noticed this pattern, it's worth mentioning to your doctor, particularly alongside any other early signs of Parkinson's disease like losing your sense of smell.

Parkinson's disease is often described using a staging scale (such as the Hoehn and Yahr scale), which broadly tracks progression of physical symptoms over time: from mild, one-sided symptoms in the earliest stage, through to more advanced stages involving bilateral symptoms, balance difficulty and greater dependence on others for daily activities.

Staging can help communication and planning, but it is imperfect because non-motor symptoms (sleep, mood, cognition, autonomic symptoms) can be highly impactful and do not map neatly onto a single stage.

Progression rates and impact on day-to-day activities vary considerably, so patients require personalised care to help them manage the difficulties they experience.

Parkinson's disease is progressive, but the rate and pattern of progression vary considerably between individuals. Many people who are treated remain able to live for years without serious disability.

You should seek assessment if:

• a tremor is present, particularly at rest
• balance is worsening or falls are occurring
• changes are impacting safety, independence or daily activities
• family members notice changes in movement, posture or facial expression
• if your sense of smell is deteriorating
• if you start acting out your dreams
• movement is becoming slower, stiffer or less coordinated.

For sudden or rapidly worsening symptoms, call Emergency 000.

No, Parkinson's disease is not a normal or inevitable part of ageing. Age increases risk but most people do not develop Parkinson's.

Parkinson's disease is more common in people over 50, with an estimated one per cent of people over 60 affected.

Parkinson's disease can occur before the age of 50; this is sometimes referred to as young-onset Parkinson's disease. Whilst less common, it is not rare, with five per cent of all patients diagnosed under the age of 40.

Normal ageing may include:

• occasional stiffness
• reduced flexibility
• slower movement.

Parkinson's disease involves changes that:

• typically begin on one side of the body
• progressively worsen over time
• include a combination of slowness (bradykinesia) with tremor and/or stiffness
• often include non-motor symptoms such as constipation, loss of smell, or sleep changes.

The key differences are progression, asymmetry, functional impact and the combination of hallmark signs rather than any single symptom.

Parkinsonism (or being parkinsonian) is an umbrella term used to describe patients who experience the common symptoms of Parkinson’s disease (tremor, slowness, stiffness, balance difficulty), regardless of their underlying cause.

Parkinson's disease (often called idiopathic Parkinson’s) is the most common specific cause of parkinsonism.

Other parkinsonian conditions include:

• atypical parkinsonism
  • corticobasal degeneration (CBD)
  • multiple system atrophy (MSA)
  • progressive supranuclear palsy (PSP)
• drug-induced parkinsonism
• vascular parkinsonism.

These conditions can differ in prognosis, medication response and supportive care needs.

Parkinson's disease is caused by the progressive loss of dopamine-producing nerve cells in a brain region called the substantia nigra. The exact trigger for this cell loss is not known in most cases.

A small proportion of cases, particularly those with an earlier age of onset, are linked to specific genetic factors. Still, most cases are thought to result from a complex combination of genetic and environmental influences.

Most cases of Parkinson’s disease are not inherited. Some genetic factors can increase risk, particularly in young-onset dementia cases or with a strong family history. Even when genetic factors are present, they do not always guarantee someone will develop Parkinson’s.

Not by scan alone. Parkinson's diagnosis is clinical, based on a person's history and neurological examination. Scans are not usually required to make the diagnosis but may sometimes be used to support it or rule out other causes of similar symptoms.

For example, a DaTscan using radioactive labels can indirectly measure dopamine transporter density in the brain, which may help support the diagnosis in certain situations.

GPs are crucial for early recognition and ongoing care, but confirming Parkinson’s disease and distinguishing it from parkinsonism symptoms due to other causes such as medications, vascular disease or atypical parkinsonism, often benefits from specialist assessment.

A Parkinson’s-trained neurologist is a movement disorder specialist who can improve diagnostic accuracy, tailor medication choices (and timing) and anticipate complications (for example falls, swallowing issues, cognitive changes).

Shared care is common: specialist input for diagnosis and strategy, with GP support for monitoring, prescriptions, comorbidities and coordination.

There is currently no treatment that stops or reverses Parkinson's disease. Treatment focuses on managing individual symptoms and maintaining function and quality of life, often through a multidisciplinary approach.

Levodopa, usually combined with carbidopa (which helps reduce side effects and allows more levodopa to reach the brain), remains the most effective medication for movement symptoms such as tremor, stiffness and slow movements (bradykinesia).

Learn about other symptom management approaches, including medication classes, specialised ‘Smart’ therapies and non-medication support.

There is currently no proven way to prevent Parkinson's disease. Research into modifiable risk factors and disease-modifying treatments is ongoing, including through clinical trials.

Parkinson's disease cannot currently be cured, and there is no treatment proven to slow the underlying loss of dopamine-producing nerve cells, although we are conducting clinical trials.

Medications and allied health support can help manage symptoms. As symptoms progress, the level of support needed will increase, and medications may need to be adjusted, or additional medicines added to existing regimens.

Some conditions can mimic Parkinson's disease and are more directly treatable (for example, drug-induced parkinsonism), so it's important to see a doctor for an assessment.