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The Many Faces of Parkinson’s: Symptoms, Treatment, and How To Manage It

By Sneha Mantri, MD, MS, Chief Medical Officer at the Parkinson's Foundation HealthDay Reporter

Medically reviewed by Carmen Pope, BPharm. Last updated on July 24, 2025.

THURSDAY, July 24, 2025 — About 90,000 people are diagnosed with Parkinson’s disease (PD) each year – one person every six minutes. While most people associate PD with tremors and stiffness, the condition is far more complex than these symptoms and may affect more than just movement.

An estimated 1 million people in the United States are living with this disease, according to the Parkinson’s Foundation. As the population continues to age, prevalence of PD is expected to rise to 1.2 million by 2030 – making it the second-most common neurodegenerative disorder after Alzheimer's disease.

What is PD?

PD is a neurodegenerative disorder that mostly affects dopamine-producing neurons in the area of the brain called the substantia nigra. Dopamine is a chemical that is essential for movement and coordination. As dopamine levels drop, a variety of symptoms may gradually emerge and worsen over time.

There is currently no cure for PD, but there are many treatment options for symptoms and maintaining a high quality of life.

Symptoms of PD

PD may cause a variety of symptoms, usually falling into two categories: motor (movement-related) and non-motor symptoms.

Motor symptoms may include:

• Tremors

• Slowed movements (bradykinesia)

• Muscle stiffness (rigidity)

Non-motor symptoms may include:

• Anxiety

• Depression

• Sleep disorders

• Fatigue

• Constipation

• Double vision

• Loss of smell

• Sleep disorders

Every person’s experience with PD is unique, and no two people experience the same exact symptoms or rate of progression.

Early signs of PD may look like:

• Tremor: A slight shaking or tremor of the hand, finger or chin occurring mostly at rest, for example while sitting.

• Small handwriting: Handwriting that features more crowded words or cramped letters than before.

• Loss of smell: Inability to smell distinct odors, such as dill pickles, bananas or licorice.

• Trouble sleeping: Physically acting out dreams, thrashing around or any other sudden movements during sleep.

• Trouble moving or walking: Arms, legs or body parts that feel stiff and do not get better with active movement.

If you or someone you know is experiencing early signs, it’s important to talk to your primary care doctor about making an appointment with a neurologist to receive a proper diagnosis.

How is PD diagnosed?

A neurologist assesses an individual’s medical history and symptoms and also conducts a physical exam to make a clinical diagnosis. While research is moving at an optimistic pace and new diagnostic tools are entering trial stages, there is not yet one standardized test that can comprehensively diagnose PD.

However, some tools and exam procedures can be used to support the diagnosis of PD or to rule out other medical conditions that may present symptoms similar to those of PD. They are:

• Magnetic resonance imaging (MRI scan) of the brain

• Dopamine transporter (DaT) scan

• Blood work

• Skin biopsy

Making an accurate diagnosis of Parkinson’s, particularly in its early stages, can be a difficult and lengthy process. Whether a person is newly diagnosed or has been living with PD for a while, getting the right care at the right time can make a big difference for individuals and their families.

The Parkinson’s Foundation recommends that in addition to making an appointment with an internist or family practitioner, a person experiencing symptoms should also see a movement disorders specialist, a neurologist with experience and specific training in the assessment and treatment of PD and related disorders.

How to treat PD?

There is currently no cure for PD, but the following treatments may manage symptoms:

• Medications: The most common are drugs that replace or mimic dopamine in the brain. These help improve motor symptoms like tremors and stiffness.

• Therapy: Physical, occupational and speech therapies may support movement, communication and daily functioning.

• Exercise: Regular activity helps with flexibility, balance and mood — and may even slow symptom progression.

• Mental health support: Counseling or medication may ease depression or anxiety.

When medication and lifestyle changes don’t provide enough help managing symptoms, advanced treatment options, such as surgery, may be considered.

For people living with PD who have exhausted medication treatments and who experience severe motor fluctuations, these surgical options are sometimes recommended by a PD care specialist:

• Deep brain stimulation (DBS)

• Duopa™

• Vyalev™

• Onapgo™

DBS is a surgical procedure, in which electrodes are implanted into targeted areas of the brain to interrupt problematic electrical signals that create debilitating movement symptoms. An impulse generator battery (called an IPG), similar to a heart pacemaker, is then implanted under the collarbone or in the abdomen to deliver electrical stimulation. A controller allows the patient to turn the newly inserted device on or off as needed.

Duopa™ is a therapy that inserts a gel form of a carbidopa-levodopa prescription into the small intestine, rather than by oral medication. By directly delivering the drug through a surgical procedure, Duopa™ may improve absorption and reduce “off” times (changes in movement abilities as a levodopa dose wanes).

Vyalev™ is an infusion therapy that delivers foslevodopa-foscarbidopa under the skin. Once absorbed, these are converted to levodopa and carbidopa, respectively. Like Duopa™, Vyalev™ is a continuous-release medication and therefore, can help with “off” times

Onapgo™, delivers apomorphine under the skin. Apomorphine is a dopamine agonist, rather than levodopa-based. Like Vyalev™ and Duopa™, the continuous delivery can help with “off” times.

Everyone’s treatment plan should be tailored to their symptoms and lifestyle, and it’s important to consider options based on your PD specialist’s recommendations.

What causes PD? Are there any risk factors?

The cause of PD is still unknown, but scientists suspect that a combination of both genetic and environmental factors is at play.

The Parkinson’s Foundation estimates that 13% of people living with PD have a genetic link. Meanwhile, some environmental exposures have been determined to possibly increase the risk of PD, while others may lower it.

Environmental risk factors associated with an increased risk for PD include:

• Head injury

• Area of residence

• Occupation

• Exposure to metals

• Solvents and Polychlorinated Biphenyls (PCBs)

• Pesticide and herbicide exposure

• Paraquat Exposure

Other risk factors associated with PD include age (about 1% of people over age 60 have PD) and gender (PD is 1.5 times more likely to affect men than women).

Things that may lower risk of PD include regular physical activity, a Mediterranean diet (one based on whole grains, legumes and nuts; fruits and vegetables; healthy fats such as olive oil; and limited ultraprocessed food); and caffeine.

Living with PD

People living with PD may face a range of complications that evolve over time. The symptoms and rate of progression vary from person to person, but complications often fall into short-term and long-term categories.

Short-term complications may emerge in everyday settings or during hospitalization. For example:

• Missed or delayed Parkinson’s medications during a hospital stay may lead to increased fall risk, difficulty participating in rehabilitation or delayed discharge.

• Swallowing problems (dysphagia), common in PD, may worsen during illness or hospitalization, raising the risk of aspiration pneumonia and weight loss.

• Mental health symptoms such as anxiety, depression and apathy may appear early in the disease and interfere with daily life.

Long-term complications typically reflect the progressive nature of the disease:

• Movement issues like rigidity, tremors and balance difficulties tend to worsen over time, increasing the risk of falls and limiting independence.

• Cognitive and psychiatric complications, including confusion, hallucinations and sleep disturbances may emerge or intensify in later stages.

• Hospital risks increase as the disease advances, especially if care teams are unfamiliar with Parkinson’s-specific needs, such as avoiding dopamine-blocking medications.

Despite these challenges, early intervention, consistent care and staying physically active can help reduce complications and support a higher quality of life.

Learn more. If you or your loved one has recently been diagnosed with PD, it can feel overwhelming. It’s important to know that you are not alone and many people with PD can live active and fulfilling lives. With the right tools and support, you can manage your PD symptoms. For more information about available local resources in your area, visit Parkinson.org.

Meet the expert

As the Parkinson’s Foundation first-ever Chief Medical Officer, Dr. Sneha Mantri leads medical and clinical care efforts, guiding the Foundation’s care portfolio and strategy to ensure impactful, sustainable initiatives. Dr. Mantri is a practicing movement disorders specialist with extensive training and experience, completing her medical education at Columbia University, residency at the University of Virginia and a movement disorders fellowship at the University of Pennsylvania and Philadelphia VA Medical Center. As a seasoned principal investigator of health equity studies and clinical trials, Dr. Mantri has successfully communicated complex findings to diverse members of the PD community. She has developed educational courses for future medical health professionals and currently leads narrative medicine workshops for patients.

Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

Posted July 2025

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