Parkinson’s disease is a brain disorder characterized by the loss of brain cells. It is a progressive neurological disease seen in about 1-2% of people over 65 years of age. Approximately 60% of patients experience tremors in the fingers, hands, or sometimes feet during rest, while about 30% show slowness of movement and stiffness in their limbs.

The disease usually starts insidiously and progresses very slowly but steadily over the years. In the 1800s, it was also called “shaking palsy.”

What is Parkinson’s Disease?
Parkinson’s disease occurs due to damage and gradual loss of nerve cells in deep brain structures called the substantia nigra, which produce dopamine — a chemical responsible for communication between nerves.

Symptoms typically begin when about 80% of these cells are lost. Although the exact causes of this damage are not fully understood, genetic predisposition and environmental factors are believed to play important roles.

What Are the Symptoms of Parkinson’s Disease?
The most common initial symptom noticed by patients and their families is a resting tremor, often triggered temporarily by excitement or stress, appearing in a finger or hand at rest. Sometimes a masked facial expression develops. Symptoms usually start on one side of the body and later, in a milder form, may appear on the opposite side.

Parkinson’s is a progressive brain disease characterized by slow movements, resting tremors in the arms and legs, muscle stiffness and rigidity, and posture abnormalities such as forward bending. Additional symptoms affecting other systems may also appear. Sometimes, a rapid, unstoppable walking pattern called festination can develop.

The most important symptom is the slowness of movement, which also affects walking. When walking, the arm on the affected side swings less, and steps become smaller and slower.

When facial muscles are involved, facial expressions decrease, leading to a masked or expressionless face. Tremors mostly occur when the patient is at rest, predominantly in the hands, less commonly in the feet, chin, and lips. It is important to note that not all patients experience tremors.

As the disease progresses, body posture may bend forward or sideways. Other symptoms can include difficulty initiating movement (called freezing), memory problems, constipation, urinary symptoms, sleep disorders, and psychiatric issues. Sleep disturbances are common in most patients.

There is a condition called Parkinsonism or Parkinson’s syndrome, which mimics Parkinson’s disease but results from different causes. These patients usually do not respond to standard Parkinson’s treatments.

Some forms of Parkinsonism show Parkinson’s symptoms together with other system findings. Secondary Parkinsonism can be caused by vascular diseases, infections, tumors, medications, or toxins. It is important to differentiate these conditions before planning treatment.

How is Parkinson’s Disease Treated?
There is no treatment to completely stop disease progression. The primary treatment is medication, which must be used lifelong. In advanced stages, surgical and infusion therapies may be applied if necessary.

Rehabilitation is very important for Parkinson’s patients. It is crucial to encourage regular physical exercise habits and to emphasize exercises that promote an upright posture. Rehabilitation also aims to prevent complications related to the musculoskeletal and cardiopulmonary systems. Teaching patients to turn with a wide base helps prevent falls by improving postural control.

A tailored rehabilitation program should be designed according to the patient’s symptoms and needs, including:

• Relaxation exercises,
• Joint range of motion exercises,
• Aerobic exercises,
• Breathing exercises,
• Strengthening exercises,
• Balance and coordination exercises,
• Occupational therapy,
• Dance therapy,
• Walking exercises,
• Obstacle negotiation exercises,
• On-the-spot turning exercises,
• Upright posture exercises.

Reducing rigidity with relaxation exercises can lead to better progress in the rehabilitation program.

To prevent the decline in physical activity, patients should be encouraged to develop a habit of regular exercise, and special attention should be given to exercises supporting upright posture.