What are the causes of Parkinson Disease and what are the early sumptoms or signs to look out for?

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:

1.Tremor especially at rest

2.Stiffness in your body, arms or legs 

3.Slowing in walking or movement, e.g. handwriting has gotten much smaller than it was in the past, masked face (reduced facial expression and eyes blinking)

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 

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.

1.With regards to your mum’s moaning, this is something noticed in advanced Parkinson, a manifestation of restlessness or due to some new medication. Do discuss this with your doctor. 

2.There are medications available for restless leg syndrome and REM sleep behaviour disorder (talking, screaming and acting out the dream)

3.With regards to being unable to sleep and REM sleep behaviour, there is a medication to try (I suspect that it may be the sleeping pill that you mentioned).

4.People with PD can have delusion (false belief) and hallucination. Do inform the doctor who manages her condition. We usually do not treat mild cases, but we can adjust her medication regime and if needed, antipsychotic medication can be added. 

5.PD is a neurodegenerative disorder which progress gradually. We have an allied health team consisting of a nurse, physiotherapist, occupational therapist, dietician, medical social worker to help support your mum and caregivers, both physically and mentally. 

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.

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.

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:

1.Diet

2.Possible supplement 

3.Exercise

4.Mental health 

5.What to stop or avoid

6.Others

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:

1.Diet: a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy

2.Possible supplement: there is currently no evidence to suggest any specific supplement can slow down PD

3.Exercise: regular exercise that you like and can endure (ranging from more active sports to less strenuous activities such as walking, gardening, yoga and etc.)

4.Mental health: be positive

5.What to stop or avoid: make your home safe to prevent falls such as getting rid of loose rug and clutter, and make sure all electrical cords are neatly tucked away

6.Others: people with Parkinson’s can get support from support groups by talking with others who are going through similar experiences ; learning more about PD and its treatment. 

Hi Dr Lim Ee Wei,

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. 

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).

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.

Dear Doc Lim

1. Is shaking hand while carrying something a sign of PD as well? The persom is >70 years old. 

2. If the same happened to a young lady aged 29. What does that mean?

Thanks

There are other causes of tremor apart from Parkinson’s disease. Shaking hands in PD tends to occur at rest and is associated with other symptoms such as slowing down or stiffness. Different causes of tremor include essential tremor, enhanced physiological tremor, tremor induced by medication, tremor due to hyperthyroidism and etc. If you are concerned, do seek an evaluation at a polyclinic or GP.

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.

Thank you

Gabapentin does not delay Parkinson’s.

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. 

Dear Dr Lim

My dad is diagnosed with PD. Below are some questions on PD that we hope you could enlighten us.

1.Does PD runs in the family?

2.Are there ways to slow down the deterioration?

3.What exercises should PD patient to help their condition?

4.There are reports showing cycling is helpful, is this true? Does a stationary bike help?

5.Can PD patient continue to drive a car?

6.What are some daily activities that you will recommend to keep PD patient active?

7.Any particular food PD patient should or shouldn’t eat?

8.What are the side effects of PD medicines? My dad is subscribed to Madopar and Trihexyphenidyl) 

9.Are there any lifestyle changes we should take note or be prepared to deal with his condition in the long term?

Thank you

1.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. 

2.Currently, there is no licensed treatment to slow or stop the progression of PD. However, many trials are ongoing in the world to address this issue. Recent research suggests that physical therapy-including gait and balance training, resistance training and regular exercise-may help improve or hold the symptoms of PD at bay. 

3.Exercise is a vital component to maintaining balance, mobility and activities of daily living. There is no "exercise prescription" that is right for every person with PD. The most important thing is to do the exercise regularly. All types of exercises are beneficial. Find an exercise that you enjoy and stick with it. It will be good to see a physiotherapist for full functional evaluation and recommendation. 

4.As in 3.

5.Be aware of driving safety if you still drive. You can get yourself tested to make sure it is safe for you to keep driving. Do talk to your doctor to be referred for driving assessment. Each case has to be assessed on its own. 

6.Regular exercise or physical therapy. 

7.Eat a healthy balanced diet which improves general well-being. Stay hydrated as well. 

8.The most common short-term side effects of madopar are nausea, headache, feeling dizzy and feeling sleepy. These problems are not usually serious. Serious side effects (e.g., confusion, hallucination) can happen, especially in older people, but they are less common. 

Side effects of trihexyphenidyl include dizziness, confusion, dry mouth, blurry vision, nauseas and trouble urinating or having bowel movements. 

Not everyone will develop side effects. Different people react differently to medications. Usually the doctor will start medication in low dose and gradually increase. Therefore, most of the patients can tolerate.

9.As you already are aware, Parkinson’s is a progressive disease, meaning that it changes over time. Your involvement will change along the way. Each individual with PD is unique and different. A strong support network is essential for the wellbeing of the caregivers and people with PD. There are support groups at NNI @ Tan Tock Seng Hospital campus and NNI @ Singapore General Hospital campus. Parkinson Society Singapore (PSS) also provides a platform for people with PD and caregivers to support each other. 

My Father has been diagnosed with PD. He is frequently awakened from his night- time sleep by leg cramps/ "pulls". This causes much distress and frustration. Would you have any solution or suggestions to manage this so that he can get a restful night's rest? Look forward to your kind response.

I suggest you tell the neurologist who treats your father’s PD. The neurologist will evaluate the causes of the cramp and manage accordingly.

I had my thyroid gland removed and on thyroxine daily. I took my madopar

(125mg) 2 hours later.

I took madopar 5 times daily on 3 hours interval

Why do I have more energy prior to taking 1st madopar of the day?

I tend to get easily tired if I do more work/house core? Is the 125mg madopar insufficient for the 3 hour period?

What created the saliva to be sticky & thick?

I am not sure why you have more energy prior to taking the 1st dose of madopar for the day. It could probably be because you had a restful night. Whether 125mg madopar is sufficient enough, I suggest you ask your neurologist who will examine you. As you may already know, apart from motor symptoms of PD, there are non-motor symptoms. Fatigue is one of the non-motor symptom that can occur. If the tiredness continues to disturb you, do inform your doctor. There are tips to cope with fatigue. You can find more information from the Parkinson’s foundation (www.parkinson.org) website. 

Sticky or thick saliva can occur when there is not enough moisture in the saliva or due to mixture of mucus with saliva. 

Hello Dr,

Here are my questions. I am caregiver of Parkinson patient.

1.Does a stationary bike help the patient? Recently read some articles on this.

2.Typically, how long before the patient needs to start taking medication? Currently he has trembling hand symptoms. First diagnosed in last quarter of 2019. Have tried not to take medication as doctor has listed side effects of various PD medicine.

1.A stationary bike is helpful. All types of exercises are beneficial. The most important thing is to do the exercise regularly. 

2.There is no clear answer about how long an individual can wait before starting medications. Each individual is different. It is a balance between the quality of life, control of symptoms and the side effects of medications. Do discuss with the managing doctor.

Hello Dr,

What are the pros and cons of taking medicine to treat Parkinson's disease?

The decision to start medication is determined by the degree to which symptoms interfere with functioning or impair quality of life. The decision should be a shared decision between the patient and treating doctor. There are different types of medications available. Do discuss with your doctor about your concerns and your preferences regarding the use of medications. Each medication has its own side effects. We usually start medication at the lowest possible dose and gradually increase based on the response and side effects experienced.