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Parkinson’s disease (PD) is a condition that affects the brain. PD causes a range of symptoms including:
Shaking of arms or legs when at rest
Stiffness of arms, legs or body
Slowness of movement and walking
Stability problems when walking or standing
Fatigue
Depression
Sleep disorders
PD is a progressive condition, meaning it gets worse over time. Although there is currently no cure, there is treatment to help control the symptoms.
Dr Lim Ee Wei, Consultant from the Department of Neurology at National Neuroscience Institute (NNI), a member of the SingHealth group, will be answering your questions on this topic in this month’s ‘Ask the Specialist’ Q&A forum.
This forum is open from 1 Apr to 27 Apr 2022.
To post your question, please log in as a member. If you are not a member, you can register for a FREE membership here.
If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
What are the causes of Parkinson Disease and what are the early sumptoms or signs to look out for?
Answered by Dr Lim Ee Wei, Consultant, Department of Neurology, National Neuroscience Institute (NN)
We do not know exactly what causes Parkinson’s Disease, but scientists believe a complex combination of environmental, genetic factors and lifestyle influences is the cause. The extent to which each factor is involved varies from person to person.
Early symptoms and signs to look for include:
My father has Pakinson diseases and has passed away.
Will I have a high chance to get it and how do I prevent it?
Most people with Parkinson’s have no known genetic link. Their children will likely never develop Parkinson’s. There are some known genetic variations that increase the risk of getting Parkinson’s, but most people with these variations do not get Parkinson’s. Like many other diseases, Parkinson’s is a result of a complex interaction between genes and environmental factors.
There is no strong evidence to suggest any one way to prevent PD. I will suggest to keep yourself active with regular exercise and eat a healthy balanced diet.
I am currently on 5 mg haloperidol for schizophrenia. Will this medicine cause Parkinson's symptoms in me as I age? I am in my 50s.
Haloperidol has the risk of causing drug-induced parkinsonism. Do discuss with your psychiatrist. They will monitor for symptoms and will refer you for further evaluation if needed.
Hi Dr Lim, May I know if PD is hereditary? My maternal grandfather might have suffered from this and my mother has also been diagnosed with it.
Is there a way to determine if my sibling and I may also suffer from this? We are currently in our 50s. Thank you.
Most people with PD have no known genetic link. Their children will likely never develop Parkinson’s. Like many other diseases, Parkinson’s is a result of a complex interaction between genes and environmental factors. In a small number of people, Parkinson’s is inherited and run in families as a result of faulty genes being passed to a child by their parents. But it is rare for the disease to be inherited this way.
We don’t routinely screen for genetic cause in people with PD in our daily practice. However, genetic testing can be done by sending a blood sample to the U.S. We generally would not recommend genetic testing in people without symptoms, but it can be done.
I suggest you speak with your mother’s treating doctor with regards to your concern. Nowadays, we have genetic counsellors. A genetic counsellor is a specialist who provides risk assessments and education about genetics and how to read test results. Genetic testing helps estimate the risk of developing Parkinson’s, but is not a diagnosis and cannot provide your probability of developing the disease.
I have been detected to have high brain pressure from unidentified causes.
Medication is making me sleep a lot. But I need to work to stay alive. What are my chances of getting brain issues like Parkinson's?
There is no evidence to show the association of Parkinson’s disease and high brain pressure from unidentified causes.
How do i know if i have PD? I do shake involuntary at times and my father had this disease.
I will suggest you to see a doctor at polyclinic for further evaluation. They will refer you to the neurology department accordingly.
Hello Dr Lim, my mother is 83 years old. She suffered and underwent surgery for trigeminal neuralgia in Nov 2020 at TTSH NNI. She is fully recovered. Ever since this traumatic episode, I noticed that she is exhibiting 3 of the symptoms that you've mentioned for PD, namely clowness of movement or walking, stability problem when walking / standing and fatigue. In fact I notice that her short term memory seems to have also deteriorated significantly. Prior to the episode with Trigeminal N, she had non of these weaknesses. I am not too sure if these symptoms could be purely due to her age after such a major surgery or could it be signs of PD. Is there anyway for this to be determined more accurately than simply looking out for these symptoms? Appreacite your expert advise. Thank you.
If your mother has an existing neurologist, do speak with her neurologist about this problem. If not, do ask your neurosurgeon or consult a doctor at a polyclinic to get a neurology referral for further evaluation.
Dear Dr. Lim, my mother (67 yo) is a PD patient for about 15 years. She is taking Stalevo, Sinemet, Pramipexole and Amantadine; she tried other combinations before and these are the ones that work for her now. She started exercising about 2 years ago, 5 to 15 minutes each session, unable to proceed longer due to stiffness or dyskinesia. She does “word search”, P2 mathematics revision books, listens to songs and plays games on her mobile phone during her “on time”. However, her "on time" is relatively short (1 to 2 hours) and her "off time" is constantly bothering her and other family members. Her mood is affected particularly when she is unable to move. She also tends to have the urge of wanting to pass urine especially whenever she cannot move, and that is when she starts to groan/moan until she can go to the toilet or after regaining mobility. She said that the groaning is involuntary, but many times she managed to stop or not make the sound. The groan demoralises her and creates negative vibes around the house throughout the day. We suggested her to use breathing method to ease her negative emotions and with the hope to control her groaning but it didn’t work for her. She got angry that we didn't understand her suffering. Please share with us if there is any method to guide my mother not to groan whenever she cannot move.
Other than that, my mother hasn't slept well at night for more than 10 years. At times she talks and screams during sleep, these disrupt her sleep. Sometimes after a 1 to 2 hours sleep, she wakes up groaning as she cannot move. We suggested her to wear adult diaper so that there is no need to keep waking up to go toilet every 2 to 3 hours, but she said that she couldn’t pass urine with diaper on and insisted to go toilet. Others such as tremors and restless legs also disturb her sleep. She experienced hallucinations when she was prescribed sleeping pills and that caused her to stop taking it. These persistent sleep disturbances affect her emotions and overall well-being. Please share with us what other methods we can consider to help her with better sleep quality.
Recently (since circuit breaker), she repeatedly said that residents from a housing block around 150meters away peeping at her when she had dyskinesia. Sometimes she said that someone was peeping at her in the toilet through the frosted opaque window glass. We checked and we reassured her that no one can peep through, and residents from a distance away may just stand near the window and not particularly look into her room. Please share with us any specific test that we can do to find out what is happening to her.
Sometimes we are lost, helpless. Sometimes we are motivated when my mother is in a positive mood. With all that we are facing now, we do not know how to prepare ourselves to handle my mother for the coming years. We are constantly looking out for more ways to help my mother and to help ourselves. Thank you for your time in reading our case.
It must not be easy walking with your mum in her journey with Parkinson’s disease (PD). Generally, I would suggest you speak with the neurologist who has been taking care of your mum for many years. He/she knows your mum better and may have already tried some coping methods. I must admit that it is not easy to address all the problems you mentioned and your mum will feel the most. From your description, your mum seems to be experiencing several issues e.g., medication wearing off and non-motor symptoms fluctuation, restless leg syndrome, REM sleep behaviour disorder, hallucination and delusion in Parkinson’s disease and sleep disorder.
Dear Dr Lim,
My mum has Parkinson's for about 10 years and her condition has deteriorated as expected. How do we know which stage the patient is and are there any help to manage their worsening condition? My mum has been experiencing numbness stemming from her tongue to her feet which affects her quality of life. I'm lost trying to find a way to reduce her pain. Will TCM help?
There is no strong evidence to suggest that TCM will help.
With regards to what stage your mum is at, I suggest you to talk to the neurologist who manages your mum. We would need to physically examine patients to determine the stage.
Dear Dr Lim Ee Wei,
My dad was diagnosed with Vascular Parkinson in 2015 at age 80. In 2017, during one of his physiotherapy sessions, he was put onto a gait rehabilitation device, belt up and hanged onto the machine. After sharing concern, the gait rehabilitation session was stopped.
As I read, PD is a condition that affects the brain. PD causes a range of symptoms including:
-Shaking of arms or legs when at rest
-Stiffness of arms, legs or body
-Slowness of movement and walking
-Stability problems when walking or standing
-Fatigue
-Depression
-Sleep disorders
Is it safe for a Parkinson patient to undergo such a physiotherapy session? Can the stiffness of arms, legs or body got hurt as the machine stretched the stiffness of limbs during the session? Thank you, Dr Lim.
Hi, we work closely with physiotherapists who are specialists in exercise. The physiotherapist will tailor the exercise according to each individual. As far as I know, physiotherapists may use certain devices to help with the rehabilitation and this definitely depends on each individual situation. Do ask the physiotherapist for the purpose of using a certain device if you are in doubt. I am sure the physiotherapist will discuss with patients and family to reach a mutual agreement.
Question posted by MV
Hi Dr Lim,
I have been diagnosed with early stage of PD. Currently I am taking Seligeline at 8am and 2pm. I would be visiting my son in Texas. The time difference is 13 hours. How should I take the medication when I am in US? Thank you.
When you reach Texas, follow the 8am and 2pm of Texas. During the transition, make sure no more than 2 doses in 24 hours. The main reason for taking the second dose of selegiline at 2pm is to prevent insomnia that may occur if selegiline is taken too late in the day.
Question posted by Foo CC
Hi Dr Lim Ee Wei,
I am male aged 84 years old. Can you please advise me how avoid or slow down this disease by way of:
Thank you
There is currently no way to prevent or cure PD, but treatments are available to help relieve symptoms and maintain the quality of life. So it is important to do what you can to stay physically and mentally healthy.
You can:
Question posted by Ronny
As one of the symptoms of PD is Sleep Disorder, I would like to know if my mother’s sleeping pattern is a cause for concern.
My mom is 73. For a few years now, she has been having very vivid and violent dreams or nightmares. She could be heard shouting or seen fighting. It’s almost a nightly affair. Anyone sharing the same bed with her risks being hit and usually would experience "rude awakening". However, when she is awake, she has no recollection of her dream.
Her sleeping hours are different. She would fall asleep early evening and wake up around 2am… she has been trying to sleep "normal" timing but she just couldn’t.
Who can we turn to for help?
I would suggest you bring your mother to seek medical attention at a polyclinic. The doctor there will evaluate her and will refer her to a sleep clinic if needed.
Question posted by Jenny
Hi Doctor,
Does consuming too much alcohol cause Parkinson’s disease? If yes, how can it be reversed. Thank you.
There is no evidence showing that consuming too much alcohol can cause Parkinson’s disease. However, it is advisable not to take excessive alcohol. If you are concerned you are drinking too much you can consider seeking help from National Addictions Management service (NAMS).
Question posted by Handson F
Hi Dr, are there any tests to determine on set of PD?
There is no "one way" to diagnose PD. The diagnosis of PD is based on clinical examination (history taking from patient and physical examination of patient). Tests that are performed are mostly supportive and to rule out other causes. The doctor will decide which tests to perform, based on the symptoms and signs, which can include blood investigations and brain imaging.
I'm takng Madopar 125mg 5 times daily on 3 hour interval. Is it necessaary to have food intake each time after taking the medi? Any food/fruits to recommend/avoid?
A diet high in protein affects the absorption of madopar. Therefore, it is advisable to take madopar on an empty stomach (30-40 min before food) or 2 hours after food. With regard to diet, we would advise a healthy balanced diet with proper fluid and fibre intake.
I have been diagnosed with OSA (AHI = 24.6/HR). I suspect the test conducted was not accurate (disturbed by noises and room temperature). Nevertheless, I started using CPAP and my AHI seldoms exceed 5/hr. I am surprised to learn that sleep disorder is a sympton of Parkinson.
Lately, I suspect I might be having stability problem (especially after getting up from bed). Beside this observation, I used to have vertigo (come and go) but not lately.
I read from the Q&A that nothing much can be done to prevent Parkinson from advancing.
I was told Gabapentin is prescribed for nerve problem. My question: does Gabapentin helps to delay Parkinson.
Gabapentin does not delay Parkinson’s.
Question posted by Katherine W
Hi Dr,
My neck tends to shake forward slightly and at times only. Is this an indication of early Parkinson's?
There are several causes of shaking involving the neck. I suggest you seek evaluation at a polyclinic or GP. The doctor will evaluate and refer you accordingly.
Question posted by Shirley T
Dear Dr Lim
My dad is diagnosed with PD. Below are some questions on PD that we hope you could enlighten us.
Question posted by Lilian W
I refer to the latest SingHealth HealthXchange and was glad to read about the forthcoming Forum on Parkinson and invited questions.
Last year, CNA carried an article on NTU researchers' development of a slow release Levodopa.
It is of great interest to me as I am 71 years old and a PD sufferer for over 12 years. My off time is getting longer and although I take my Levodopa religiously on time, sometimes I have to adjust my Levodopa dosage according to my activities. It has been touch and go, as we all know for PD sufferers sometimes no two days are alike. My gait is a problem and I can run better than I can walk.
The CNA article said that they were going to seek approval to go on trials at the end of 2021. I was wondering if trials have commenced and if so do you need any more participants, I am willing to participate. I look forward to hearing from you.
The research is being led by Associate Professor Joachim Loo at NTU's School of Materials Science and Engineering, and the clinical trial preparation is currently ongoing. However, when the clinical trial goes ahead, it will be unlikely to be conducted in Singapore due to the smaller number of suitable PD patients as compared to other larger countries. You may ask your doctor if there are other clinical trials you can be a part of that may be suitable for you.
