What Does A Parkinson’S Brain Look Like?

Does Parkinson’s show up on a brain scan?

There’s no single test for Parkinson’s disease. The diagnostic process for this chronic condition can often take months. In many cases, trials of Parkinson’s medications are used ‌to help diagnose Parkinson’s. Recent studies have found that magnetic resonance imaging (MRI) can be used to help find and diagnose Parkinson’s much earlier than other methods.

• MRIs look for specific markers in the brain that can indicate Parkinson’s.
• Often, these markers are present even before symptoms of Parkinson’s begin.
• Eep reading to learn how MRIs can be used to detect Parkinson’s, as well as other tests used to confirm a diagnosis and what your next steps are after diagnosis.

MRIs use magnets to create detailed images of the inside of the body. Brain MRIs can help doctors spot tumors, brain bleeding, and other brain health conditions. Recently, medical researchers have discovered that MRIs can also spot small changes in the brain that can indicate Parkinson’s disease.

A 2019 study on MRIs and Parkinson’s found that people with Parkinson’s often have visibly damaged brain neurons. The damage to neurons is present before any brain atrophy begins, and before symptoms are present. By using an MRI to look for damaged neurons, researchers believe Parkinson’s could be found much earlier.

Additionally, researchers think that damaged neurons can indicate the possible severity of future cognitive decline. Using this information, doctors can prescribe appropriate treatments, such as Deep Brain Stimulation (DBS) therapy, that can slow down decline and improve the quality of life for people with Parkinson’s.

Because there isn’t a specific test for Parkinson’s disease, doctors instead assess patients and look for key symptoms of Parkinson’s, such as tremors, slow movements, or stiffness. The presence of these symptoms, along with a review of a person’s medical history, can often be used to diagnose Parkinson’s,

In some cases, a doctor might order tests to rule out other conditions that can cause similar symptoms. This can include MRIs and other imaging tests, such as PET scans, It might also include bloodwork, urine samples, and other lab work. This type of testing can’t help diagnose Parkinson’s, but it can help confirm a suspected Parkinson’s diagnosis.

Parkinson’s can take several months and several visits to diagnose. Often, doctors will prescribe Parkinson’s medications before they’re certain of a diagnosis. A person’s response to Parkinson’s medications can be a strong indicator of whether their symptoms are caused by Parkison’s or by another condition.

Once you have a diagnosis of Parkinson’s, your doctor can begin developing a treatment plan. Parkinson’s treatments aim to minimize symptoms and slow down progression. Treatment plans will take into account such factors as symptoms, overall health, and response to treatment.

Physical therapy: Physical therapy can help improve strength and balance. Speech therapy: Speech therapy can help reduce communication difficulties, Lifestyle changes: People with Parkinson’s often benefit from adding exercise to their daily lives. Medication: There are several medications approved to treat the symptoms of Parkinson’s. You might need to change medications as Parkinson’s progresses. Deep brain stimulation: Deep brain stimulation is a surgical procedure. Surgeons place electrodes in your brain that are connected to a generator placed in your chest. These electrodes can help reduce the symptoms of Parkinson’s.

A chronic condition such as Parkinson’s can be overwhelming to manage. It’s important to have support. Here are some useful resources where you can find educational materials, support groups, and more.

The Michael J. Fox Foundation: The Michael J. Fox Foundation offers advocacy, educational materials, and community for people with Parkinson’s. The American Parkinson Disease Association: You can connect with The American Parkinson Disease Association to find wellness programs and other support in your community. The Parkinson’s Foundation: The Parkinson’s Foundation provides online support, a resource library, and connections to local community-based support. The Davis Phinney Foundation fro Parkison’s: You can learn more about managing Parkinson’s through The Davis Phinney Foundation for Parkinson’s events, blog, podcasts, webinars, and other resources.

You can read more about early onset Parkinson’s by checking out the answers to some common questions below.

What does Parkinson’s look like on a brain scan?

MRI or CT scans – These are brain-imaging scans and can tell your specialist what the structure of your brain looks like. Brain scans of people with Parkinson’s usually look normal, but they can be helpful in diagnosing other types of parkinsonism – the scan may not look normal in some of the rarer forms.

Does Parkinson’s show up on a brain MRI?

Helping diagnose Parkinson’s with DaTscan and other tests – Rather, use of imaging is most helpful when the diagnosis is uncertain, or when physicians are looking for changes in the brain that are more typical of one of several Parkinsonian syndromes (and not idiopathic Parkinson’s) and other conditions that can mimic Parkinson’s.

Imaging studies to evaluate Parkinson’s disease and Parkinsonian syndromes include magnetic resonance imaging (MRI), which examines the structure of the brain, and DaTscan, an imaging test approved by the Food and Drug Administration (FDA) to detect the dopamine function in the brain. A DaTscan may help differentiate idiopathic Parkinson’s disease from certain other neurologic disorders.

Most physicians’ offices will have access to MRI; however, DaTscan imaging may only be available at larger hospitals or medical centers. Other imaging studies that can be done, but that are not used routinely in the clinic, include functional MRI (fMRI), a specialized form of brain imaging that examines brain function, and positron emission tomography (PET), which can measure certain brain functions.

How does Parkinson’s show up in the brain?

Causes – In Parkinson’s disease, certain nerve cells called neurons in the brain gradually break down or die. Many of the symptoms of Parkinson’s are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes irregular brain activity, leading to problems with movement and other symptoms of Parkinson’s disease.

Genes. Researchers have identified specific genetic changes that can cause Parkinson’s disease. But these are uncommon except in rare cases with many family members affected by Parkinson’s disease. However, certain gene variations appear to increase the risk of Parkinson’s disease but with a relatively small risk of Parkinson’s disease for each of these genetic markers. Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is small.

Researchers also have noted that many changes occur in the brains of people with Parkinson’s disease, although it’s not clear why these changes occur. These changes include:

The presence of Lewy bodies. Clumps of specific substances within brain cells are microscopic markers of Parkinson’s disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson’s disease. Alpha-synuclein found within Lewy bodies. Although many substances are found within Lewy bodies, scientists believe that an important one is the natural and widespread protein called alpha-synuclein, also called a-synuclein. It’s found in all Lewy bodies in a clumped form that cells can’t break down. This is currently an important focus among Parkinson’s disease researchers. Researchers have found the clumped alpha-synuclein protein in the spinal fluid of people who later develop Parkinson’s disease.

How long can you live with parkinsons?

What Is Life Expectancy with Parkinson’s Disease? – It should be noted that the life expectancy of Parkinson’s disease can be normal or near normal. However, a number of factors can shorten life expectancy. According to the Michael J. Fox Foundation for Parkinson’s Research, patients usually live between 10 and 20 years after diagnosis.

• There also appears to be a correlation between mortality rate and gender.
• According to multiple studies, Parkinson’s disease has a higher mortality rate among those assigned females at birth.
• Finally, let’s review how to improve life expectancy for Parkinson’s disease as well as ways to improve the overall quality of life.

Download Our Warning Signs of Parkinson’s Disease Guide

What is the finger test for Parkinson’s?

Learning More from Finger Tapping in Parkinson’s Disease: Up and Down from Dyskinesia to Bradykinesia Mov Disord Clin Pract.2016 Mar-Apr; 3(2): 184–187. Published online 2015 Oct 27. doi: PMCID: PMC6353362

• 1 Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
• 2 Division of Neurology, University of Toronto, Toronto, Ontario, Canada
• 3 Center for Neurodegenerative diseases (CEMAND), University of Salerno, Salerno, Italy

Find articles by 4 Movement Disorders Unit, Department of Neurology, Hospital Occidente de Kennedy, Universidad la Sabana, Bogota, Colombia Find articles by 1 Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada 5 Department of Neurology, University of Colorado, Denver, Colorado, USA Find articles by 1 Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J.

Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada 2 Division of Neurology, University of Toronto, Toronto, Ontario, Canada Find articles by 1 Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada 2 Division of Neurology, University of Toronto, Toronto, Ontario, Canada Find articles by 1 Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J.

Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada 2 Division of Neurology, University of Toronto, Toronto, Ontario, Canada Find articles by

1. 1 Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
2. 2 Division of Neurology, University of Toronto, Toronto, Ontario, Canada
3. 3 Center for Neurodegenerative diseases (CEMAND), University of Salerno, Salerno, Italy
4. 4 Movement Disorders Unit, Department of Neurology, Hospital Occidente de Kennedy, Universidad la Sabana, Bogota, Colombia
5. 5 Department of Neurology, University of Colorado, Denver, Colorado, USA
6. Corresponding author.

Received 2015 Jun 30; Revised 2015 Jul 24; Accepted 2015 Jul 27. © 2015 International Parkinson and Movement Disorder Society The finger tapping test evaluates bradykinesia, focusing on decrement in rate, amplitude, or both with repetitive action. Vertical positioning of the hands during this task may also be clinically relevant. We developed a ” TAP score,” measuring the vertical level above the lap where the patient performs the finger tapping ranging from 1 (task performed with the hand close to the lap) to 4 (above the head). In this pilot study, we retrospectively applied the TAP score in addition to usual motor scales during acute levodopa challenge in 123 PD patients (of whom 88 presented l ‐dopa‐induced dyskinesia ). TAP ON was higher than TAP OFF, Patients with LID presented higher TAP ON, TAP ON was related to LID severity, whereas TAP OFF was inversely related to the OFF motor symptoms. The TAP score may be a measure of proximal movement amplitude representing an easy method to evaluate defective or excessive motor output in patients with advanced disease. Keywords: dyskinesia, bradykinesia, finger tapping, levodopa response, Parkinson’s disease Bradykinesia is defined as the progressive reduction in speed, amplitude, or both of repetitive actions and is an important diagnostic feature of Parkinson’s disease (PD). It is assessed by the patient performing repetitive movements including the finger tapping task of the UPDRS‐III. Advanced PD is also characterized by motor fluctuations and levodopa‐induced dyskinesias (LIDs). LIDs are difficult to objectively rate and only a few rating scales have been validated. These scales are time‐consuming and require extensive training and expertise in movement disorders to administer. The aim of the present pilot study was to explore the clinical meaning of a specific aspect of performance of the finger tapping item of the UPDRS‐III. We have observed that patients with PD tend to perform the finger tapping in the off condition with their arm and hand lower and closer in approximation to their lap, whereas they raise their arm at least to head level in the on condition with dyskinesia. We sought to use this phenomenon in developing a simple and easily administrated scale to score off / on / on with dyskinesia state in patients with PD. To this aim, we developed a “TAP score” evaluating the vertical level where the patient performs the finger tapping. By retrospectively applying the TAP score to videos of PD patients undergoing a l ‐dopa challenge, we tested the following hypotheses: (1) TAP score during the on phases (TAP ON) is higher than the score during the off phases (TAP OFF); (2) TAP ON is positively correlated with the severity of LID in the whole body and specifically in the upper limbs; and (3) TAP OFF is negatively correlated with the severity of bradykinesia in the whole body and specifically in the upper limbs. At the Toronto Western Hospital (TWH), all patients with PD being evaluated for DBS undergo a videotaped l ‐dopa challenge taking a l ‐dopa dose corresponding to their morning dose of dopaminergic medications according to the Core Assessment Program for Surgical Interventional Therapies in Parkinson’s Disease (CAPSIT‐PD). The videotaped l ‐dopa challenge is performed by experienced and trained nurses, who consistently demonstrate the finger tapping task at the level of the trunk for two to three times, then the patient is asked to perform the task on his or her own. One hundred twenty‐three l ‐dopa challenge videos recorded from 1 August 2012 to 30 June 2014 and stored in the archive of the DBS center of the TWH were assessed. Eighty‐eight presented LID whereas 35 did not. Patients with a history of orthopedic issues affecting the mobility of upper limbs (e.g., frozen shoulder or contractures) were excluded. The TAP score was preliminary tested in a smaller number of patients in which different heights were measured; finally, a version ranging from 1 (finger tapping performed with the hand close to the lap) to 4 (finger tapping performed above the head) was developed, with higher scores representing a higher position of the hand (Fig. A). (A) TAP scoring system. Line C corresponds to the top of the head, line B corresponds to the ears, and line A corresponds to the top of the shoulders. For the finger tapping performed above the line C, a score of 4 was applied; for the finger tapping performed above the line B, but under the line C, a score of 3 was applied; for the finger tapping performed above the line A, but under the line B, a score of 2 was applied; for the finger tapping performed under the line A, a score of 1 was applied. (B) Change in TAP scores between off (triangles) and on (circles) medication conditions in patients with or without l ‐dopa‐induced dyskinesias. (C) A paradigmatic patient performing the finger tap during the off (left panel, TAP OFF : 2/4) and on medication condition (right panel, TAP ON : 4/4). The TAP score was applied for both hands in both off and on conditions (TAP OFF and TAP ON, respectively) and rated by a reviewer blinded to the patient’s medications and condition. Twenty‐three randomly selected videos (i.e., the first video recorded each month of the time frame) were reevaluated by the same rater after 4 weeks and by another author as well in order to assess intra‐ and inter‐rater reliability, respectively. The patients’ demographic and clinical data previously scored during the l ‐dopa challenge were retrieved, including UPDRS‐III in both off and on conditions (at the time of the l ‐dopa challenges the new MDS‐UPDRS was used yet at the center) and the Clinical Dyskinesia Rating Scale (CDRS), a validated scale to assess LID in PD. Both the total scores and the score related to the upper limbs were considered. Written informed consent for the videotape and permission to publish were obtained by all the patients at the time of the l ‐dopa challenge. The study was approved by the local ethical committee. Because the Mann–Whitney test did not detect any significant differences of motor scores (including TAP ON and OFF, UPDRS‐III OFF bradykinesia score, and CDRS upper limbs score), data from right and left hands were pooled to reduce the number of multiple comparisons (thus, the database consisted of a total of 246 observations). Inter‐ and intrarater reliability were evaluated by the intraclass correlation coefficient (ICC) and 95% confidence intervals (CIs). ICC values above 0.90 were considered as excellent and between 0.75 and 0.90 as good. Because data distribution was found to be non‐normal, medians (25th–75th percentiles, interquartile range) were reported. Wilcoxon’s sign‐rank and Mann–Whitney’s tests were used to perform within‐ and between‐group comparisons, respectively. Spearman’s rank‐correlation coefficient was used to correlate TAP ON with CDRS total and upper limb scores, TAP OFF with UPDRS‐III OFF, and UPDRS‐III OFF bradykinesia score. The predetermined significance level for all analyses was 0.05. Multiple comparisons were corrected for with Bonferroni’s test, and the significance level was set at P < 0.007. All analyses were performed using SPSS software (v.17; SPSS, Inc., Chicago, IL). Table shows the demographic and clinical features of the 123 patients included. All fulfilled the diagnostic criteria for PD, had response to l ‐dopa greater than 50%, and had motor fluctuations. Demographic and clinical characteristics of the 123 PD patients included, divided in two groups according to the presence of l ‐dopa‐induced dyskinesia

	Total Cohort (=123)	PD With LID (=88)	PD Without LID (=35)	P Value
Age at l ‐dopa challenge, years	65 (58.25–69.75)	65 (60–70)	64 (56–68)	0.2
Disease duration, years	16 (11–22)	18 (13–23)	12 (9–20)	<0.001
Gender, women/men (N)	80/43	60/28	20/15	0.2
Side of onset, R/L (N)	66/57	47/41	19/16	0.5
UPDRS‐III off	39 (30–49)	38.5 (30.0–49.7)	40 (26–49)	0.9
Bradykinesia score off	6 (4–8)	6 (4–7)	5 (4–7)	0.2
UPDRS‐III on	21 (13–31)	21.5 (14–30)	20 (12–32)	0.9
ΔUPDRS‐III	15 (9–23)	17 (11–22)	13 (6–26)	0.1
CDRS total score on	3 (0–6)	4.5 (2.0–6.7)	NA	NA
CDRS upper limbs score	0 (0–1)	1 (0–2)	NA	NA
TAP OFF	2 (2–3)	2 (2–3)	2 (1.75–3.00)	0.3
TAP ON	3 (3–4)	3 (3–4)	3 (2–3)	<0.001

Intra‐rater reliability was good for the TAP OFF (ICC = 0.87; 95% CI: 0.78–0.93) and excellent for the TAP ON (ICC = 0.93; 95% CI: 0.89–0.96). Inter‐rater reliability was good for both TAP OFF and TAP ON (ICC = 0.75; 95% CI: 0.49–0.86 and ICC = 0.85; 95% CI: 0.73–0.91, respectively). TAP ON was significantly higher than TAP OFF ( P < 0.001). Spearman's rank test showed a positive correlation between TAP ON and both CDRS total score (ρ = 0.486; P < 0.001) and CDRS upper limbs score (ρ = 0.533; P < 0.001) and an inverse correlation between TAP OFF and UPDRS‐III off (ρ = −0.263; P = 0.001) and UPDRS‐III off bradykinesia score (ρ = −0.249; P < 0.001). Patients with LID presented higher TAP ON, but similar TAP OFF, as compared to patients without ( P < 0.001 and P = 0.3, respectively). Figure B shows the change in TAP scores between on and off medication conditions in patients with and without LID. Figure C shows a paradigmatic patient with LID with different TAP scores during the off and on condition. Video 1 displays 2 other example patients. By categorizing the height at which the finger tapping is performed by 123 PD patients, we introduced a simple score able to detect the effects of l ‐dopa. Specifically, we demonstrated that the TAP ON is higher than TAP OFF regardless of the occurrence of LID; in addition, TAP ON was found to be higher in patients with LID, as compared to those without, and, accordingly, it also correlated to the severity of dyskinesia. Indeed, these results support a relationship between the height of the finger tapping performance and the on condition as well as the presence and severity of LID. The inverse relationship between the TAP OFF and both the total UPDRS‐III and the UPDRS‐III off bradykinesia score suggests that patients tend to perform the finger tapping lower and closer to the lap while in off, In keeping with our initial hypothesis, these findings confirm that the height at which the patient performs the finger tapping may represent a measure of the proximal amplitude of voluntary movements. Several studies have focused their attention on the assessment of the amplitude of distal movements, and occasionally of proximal movements, in patients with PD with sophisticated devices.,,, However, no previous studies focused on the amplitude of the proximal movements in PD and their response to l ‐dopa by means of an easy and straightforward scoring of a task already implemented in clinical practice. In keeping with previous data, and supporting previous observations, the association between the TAP OFF and the UPDRS‐III OFF bradykinesia score suggests that the amplitude of the proximal and distal movements are related and the TAP OFF may represent a measure of the upper‐limb bradykinesia. Indeed, we found that TAP ON is significantly higher as compared to the TAP OFF in all patients, suggesting that the amplitude of proximal movements is significantly increased by l ‐dopa irrespective of LID. Alternatively or complementary, the hand elevation in patients on medication may reflect an improvement of the postural motor adjustments during voluntary movements of the upper limbs. A lack of awareness of arm position may also play a part in this phenomenon, which is more pronounced in those with dyskinesia who have reduced awareness of involuntary movements. We acknowledge that our study has limitations. First, when LID were present, a true blind assessment was not feasible; however, given that the TAP score is based on the objective position of the hand during the finger tapping task in relation to specific body site of reference, we believe that an unblinded assessment would have not influenced the scoring. Second, selection of the videos was not randomized. Third, the physical distance between the heights of the scoring system varies and patients can seldom perform the task at different levels (especially when they repeatedly cross the ears' plane) or—more rarely—exactly at the level of one reference plane; in order to partly overcome this limitation, we instructed raters to score the patient on the basis of the level most frequently occupied during the task. Finally, our study included only patients under evaluation for DBS, thus representing a fairly homogeneous group in terms of severity of disease, irrespective of the presence of dyskinesia. We acknowledge that our results are not easily generalized to all PD patients and further studies are needed to confirm the relationship between TAP OFF and bradykinesia in other subjects with a wider range of motor impairment and without motor fluctuations. On the other hand, though a pilot study, the relatively large sample size (n = 123) and the use of standardized videotaped l ‐dopa challenges performed by experienced and trained personnel ensures reliability in the administration of the finger tap task. Finally, we have demonstrated that the TAP score is sensitive to change, that is, in detecting on / off differences and has adequate intra‐ and inter‐rater reliability. In order to confirm the present results, the next step is a prospective application of our score in a large, heterogeneous cohort of PD patients, possibly also measuring the repeatability of TAP scores in individual patients. In conclusion, our pilot study suggests that the height at which the finger tapping is performed closely mirrors the severity of both bradykinesia and hyperkinesia in patients with advanced disease and is an easy, feasible, and reliable method to obtain further information from the finger tapping. Interestingly, the TAP score can be retrospectively applied to existing patient video recordings; therefore, we believe that it could be easily implemented in virtually every research protocol involving PD patients. (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique.M.P.: 1A, 1B, 2A, 2B, 2C, 3A G.B.V: 1B, 1C, 3B D.S.K.: 1C, 3B S.H.F.: 3B A.E.L.: 3B A.F.: 1A,1B, 3B Funding Sources and Conflicts of Interest: The authors report no sources of funding and no conflicts of interest. Financial Disclosures for previous 12 months: M.P. received honoraria from University of Salerno (Salerno, Italy), "New initiative grants" from the Division of Neurology, University of Toronto, and grants from the Michael J. Fox Foundation (MJFF).S.H.F. holds consultancies with AstraZeneca, Avanir, Merz, Novartis, and Teva; received honoraria from AAN, IPMDS, Ipsen, Teva, and Zambon; received grants from Canadian Institutes of Health Research (CIHR, MJFF, Parkinson Society Canada, and the National Institutes of Health; receives salary support from the UHN Department of Medicine Practice Plan; has contracts with Eisai and Kyowa; and receives royalties from Cambridge University Press and Springer.A.E.L. serves on the advisory boards of AbbVie, Allon Therapeutics, Avanir Pharmaceuticals, Biogen Idec, Boerhinger Ingelheim, Ceregene, Lilly, Medtronic, Merck, Novartis, NeuroPhage Pharmaceuticals, Teva, and UCB; receives honoraria from Teva, UCB, and AbbVie; receives grants from Brain Canada, CIHR, Edmond J Safra Philanthropic Foundation, MJFF, National Parkinson Foundation, Ontario Brain Institute, Parkinson Society Canada, Tourette Syndrome Association, and the W. Garfield Weston Foundation; provided expert testimony for cases related to the welding industry; and receives royalties from Saunders, Wiley‐Blackwell, Johns Hopkins Press, and Cambridge University Press.A.F. holds consultancies with and receives honoraria from UCB pharma, Medtronic, Boston Scientific, and AbbVie; serves on the advisory board for AbbVie; and received grants from the MJFF. A video accompanying this article is available in the supporting information here. Video 1. Segment 1: A patient with LID performing the finger tap during off and on medication conditions. TAP OFF score was 2/4 on the right and 3/4 on the left, whereas TAP ON was 4/4 on both the right and left sides. Segment 2: A patient without LID performing the finger tap during off and on medication conditions. TAP OFF score was 1/4 on both the right and left sides, whereas TAP ON was 3/4 on both the right and left sides. We are grateful to Melanie Fallis, Yu‐Yan Poon and Alejandro Valencia who performed the videotaped levodopa challenges at the DBS centre of the Toronto Western Hospital. We are also grateful to Dr. Leigh Anne Bakel for her inputs for the statistical analysis. Relevant disclosures and conflicts of interest are listed at the end of this article.1. Hughes AJ, Daniel SE, Kilford L, et al. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico‐pathological study of 100 cases, J Neurol Neurosurg Psychiatry 1992; 55 :181–184.2. Fahn S, Elton RL. Members of the UPDRS development committee. Unified Parkinson's Disease Rating Scale In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Development in Parkinson's Disease, Vol.2. Florham Park, NJ: MacMillan Healthcare Information; 1987:153–163.3. Schrag A, Quinn N. Dyskinesias and motor fluctuations in Parkinson's disease. A community‐based study, Brain 2000; 123 :2297–2305.4. Colosimo C, Martinez‐Martin P, Fabbrini G, et al. Task force report on scales to assess dyskinesia in Parkinson's disease: critique and recommendations, Mov Disord 2010; 25 :1131–1142.5. Defer GL, Widner H, Marie RM, et al. Core assessment program for surgical interventional therapies in Parkinson's disease (CAPSIT‐PD), Mov Disord 1999; 14 :572–584.6. Hagell P, Widner H. Clinical rating of dyskinesias in Parkinson's disease: utility and reliability of a new rating scale, Mov Disord 1999; 14 :448–455.7. Portney LG, Watkins MP, eds. Foundation of Clinical Research: Applications to Practice, Appleton and Lange: Norwalk, CT; 1993.8. Espay AJ, Beaton DE, Morgante F, et al. Impairments of speed and amplitude of movement in Parkinson's disease: a pilot study, Mov Disord 2009; 24 :1001–1008.9. Timmermann L, Braun M, Groiss S, et al. Differential effects of levodopa and subthalamic nucleus deep brain stimulation on bradykinesia in Parkinson's disease, Mov Disord 2007; 23 :218–227.10. Vaillancourt DE, Prodoehl J, Sturman MM, et al. Effects of deep brain stimulation and medication on strength, bradykinesia, and electromyographic patterns of the ankle joint in Parkinson's disease, Mov Disord 2006; 21 :50–58.11. Potter‐Nerger M, Wenzelburger R, Deuschl G, Volkmann J. Impact of subthalamic stimulation and medication on proximal and distal bradykinesia in Parkinson's disease, Eur Neurol 2009; 62 :114–119.12. Pietracupa S, Fasano A, Fabbrini G, et al. Poor self‐awareness of levodopa‐induced dyskinesias in Parkinson's disease: clinical features and mechanisms, Parkinsonism Relat Disord 2013; 19 :1004–1008. : Learning More from Finger Tapping in Parkinson's Disease: Up and Down from Dyskinesia to Bradykinesia

Does Parkinson’s dementia show on CT scan?

CT, or computed tomography, uses X-rays and computers to produce images of the inside of the body, including the brain. This test is used to look for signs of disease like Parkinson’s.

Can Parkinson’s stay mild?

Can Parkinson’s disease disappear? – In most cases, people with Parkinson’s disease will need long-term treatment to manage their symptoms. However, some studies have identified cases where Parkinson’s disease symptoms disappear. In one study, a 78-year-old man experienced a remission of all symptoms 16 years after his diagnosis.

• Although full remission is very rare, it can happen in some cases.
• Future studies may reveal more about why this happens.
• Parkinson’s disease causes both motor and nonmotor symptoms, and their severity can fluctuate over time.
• Certain medications for Parkinson’s disease can cause symptoms to fluctuate.

Symptoms may also worsen gradually as the disease progresses. Although there is no cure for Parkinson’s disease, treatments can help manage symptoms. Timely diagnosis and effective treatment can both maximize the quality of life for people living with this disease.

How quickly can Parkinson’s progress?

Stages of Parkinson’s Parkinson’s disease (PD) impacts people in different ways. Not everyone will experience all the symptoms of PD; even if people do, they won’t necessarily experience the symptoms in quite the same order or at the same intensity. While symptoms and disease progression are unique to each person, knowing the typical stages of Parkinson’s can help you cope with changes as they occur.

• Some people experience the changes over 20 years or more.
• Others find the disease progresses more quickly.
• It is difficult to accurately predict the progression of Parkinson’s.
• Following a diagnosis, many people experience a good response to medications, such as,
• This optimal timeframe can last many years and varies for everyone.

However, as the disease progresses, people with Parkinson’s often need to work alongside their doctor to adjust levodopa dosages. In this timeframe, they may experience new or worsening movement symptoms and fluctuations, levodopa-induced,,, falls and imbalance.

People with young-onset PD are more prone to levodopa-induced dyskinesia and changes in movement (called motor fluctuations), while those diagnosed later in age may experience more and non-movement symptoms. Motor fluctuations can become an issue five to 10 years after diagnosis. (trouble with balance and falls) typically occurs after about 10 years.

In 1967, Hoehn & Yahr defined five stages of PD based on the level of clinical disability. Clinicians use it to describe how motor symptoms progress in PD. On this scale, stages 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage PD.

• During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. and other occur on one side of the body only. Changes in, and occur.
• Symptoms start getting worse. Tremor, and other movement symptoms affect both sides of the body or the midline (such as the neck and the trunk). Walking problems and poor posture may be apparent. The person is able to live alone, but daily tasks are more difficult and lengthier.
• Considered mid-stage, loss of balance (such as unsteadiness as the person turns or when he/she is pushed from standing) is the hallmark. Falls are more common. Motor symptoms continue to worsen. Functionally the person is somewhat restricted in his/her daily activities now, but is still physically capable of leading an independent life. Disability is mild to moderate at this stage.
• At this point, symptoms are fully developed and severely disabling. The person is still able to walk and stand without assistance, but may need to ambulate with a cane/walker for safety. The person needs significant and is unable to live alone.
• This is the most advanced and debilitating stage. in the legs may make it impossible to stand or walk. The person is bedridden or confined to a wheelchair unless aided. Around-the-clock care is required for all activities.

Doctors use clinical rating scales to characterize the movement and non-movement symptoms of PD, how severe they are, and their impact on a person’s daily activities. Clinical scales also help doctors track the progression of PD and are used in clinical trials. In addition to the Hoehn and Yahr Scale described above, examples of widely used clinical scales for PD include:

• A commonly used and validated tool originally developed in the 1980s by a Parkinson’s Foundation researcher. It contains four parts:
  1. Mentation, behavior and mood
  2. Activities of daily living
  3. Motor examination
  4. Complications of therapy
• A revision and expansion of the UPDRS, published in 2008. It is a more comprehensive scale developed to evaluate the various aspects of PD. The four components included in this scale are:
  1. Non-movement aspects of experiences of daily living
  2. Movement aspects of experiences of daily living
  3. Movement examination
  4. Movement complications
• Used to evaluate abnormal involuntary movements (dyskinesia) that occur with advancing PD.
• Uses percentages to assess a person’s level of functional independence to complete daily chores.
• A 39-item self-reported questionnaire assessing PD-specific health related functioning and well-being across eight quality of life dimensions. There is also a short-form version derived from the PDQ-39, the PDQ-8.
• A patient-based screening tool designed to draw attention to the presence of non-movement symptoms in people with PD.
• A 30-item rater-based scale to measure the severity and frequency of a wide range of non-movement symptoms across nine dimensions in people with PD.
• They may provide invaluable insights on motor fluctuations in relation to medication intake. Increasingly, clinicians and researchers are exploring new kinematic sensor technologies to help detect and measure motor symptoms and fluctuations.

Researchers believe a combination of genetic and environmental factors cause Parkinson’s. In 2003, Heiko Braak, MD, hypothesized that an unknown pathogen (a bacteria, virus or other microorganism that causes disease) in the gut could be the cause of PD.

This was followed by a more extensive hypothesis, stating that PD starts in two places: the neurons of the nasal cavity and the neurons in the gut. This is now known as Braak’s hypothesis. In this theory, the pathogen enters the body via the nose and/or gets swallowed and reaches the gut. The pathogenic products thus come into contact with the olfactory (smell) and/or enteric (gut) neurons, triggering the aggregation of an abnormal protein called α-Synuclein.

The aggregated α-Synuclein (called Lewy body) then spreads toward the central nervous system (namely the brain), and eventually arriving in and causing the degeneration of the dopaminergic neurons in the area of the brain called the substantia nigra.

This theory is supported by evidence that non-movement symptoms, such as a loss of sense of smell, sleep disorders and constipation, may appear several years ahead of movement symptoms. For this reason, researchers focus on these non-motor symptoms to detect PD as early as possible and to look for ways to stop its progression.

Page reviewed by Dr. Jun Yu, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence. : Stages of Parkinson’s

How long can you have Parkinson’s without knowing?

Early symptoms of Parkinson’s can be overlooked – Symptoms of Parkinson’s disease are divided into 2 groups: motor symptoms and non-motor symptoms. Early non-motor symptoms can be subtle and it’s possible to overlook them as signs of Parkinson’s: for example, anxiety and depression, fatigue, loss of smell, speech problems, difficulty sleeping, erectile dysfunction, incontinence and constipation,

Another sign of Parkinson’s is handwriting that becomes smaller. Motor symptoms of Parkinson’s can include tremor (shakiness), slowness of movement (called ‘Bradykinesia’), muscle rigidity and instability ( falls ). It’s possible for non-motor symptoms to start occurring up to a decade before any motor symptoms emerge.

Years can pass before symptoms are obvious enough to make a person to go to the doctor. There’s no ‘one size fits all’ when it comes to Parkinson’s disease — different people will experience different symptoms, and of varying severity. One in 3 people, for example, won’t experience tremor.

Can Parkinson’s deteriorate suddenly?

Can Parkinson’s deteriorate suddenly? – In most cases, Parkinson’s disease symptoms develop gradually. However, recent studies have noted that some individuals in the advanced stages of this disease can deteriorate suddenly. Typically, an abrupt worsening may occur due to a stroke, as this can also affect movement and balance.

Can you think normally with Parkinson’s?

Thinking and memory changes This information aims to answer the most common questions you might have about thinking and memory changes, and looks at what you can do to manage these symptoms. It’s for people living with Parkinson’s, their family, friends and carers.

• You do not need to read all of the information at once.
• You can skip to the sections that are most relevant to you, or read parts only when you feel ready to.
• Thinking and memory changes include things like becoming more forgetful, or taking a bit longer to remember things.
• For example, you might not remember why you’ve entered a room, or forget people’s names.

These changes can be a normal part of getting older because as we age, our brains become slower at processing information. But if you have Parkinson’s, these symptoms can be more noticeable. As well as forgetfulness, you may experience confusion, problems concentrating or difficulty making decisions.

• problems planning or doing a few things at the same time (multitasking). Or moving quickly from one task to another
• problems with attention and concentration. You might find it difficult to do everyday activities such as reading a newspaper article from start to finish
• difficulty using a computer or reading maps
• slowness of thoughts. You might find it harder to make decisions or respond to questions

Generally, these symptoms may not affect your daily life too much, but they might make you feel less organised than you used to be. Or you may get confused, particularly if you’re feeling stressed. It’s important to remember that Parkinson’s affects everyone differently.

1. Not everyone will experience these symptoms or have the same combination of symptoms.
2. If you’re experiencing these symptoms, your Parkinson’s specialist may diagnose you with Parkinson’s with mild cognitive impairment.
3. If you are worried about or are experiencing these symptoms, speak to your specialist doctor or Parkinson’s nurse, as there may be positive steps you can take to improve them.

What happens if thinking and memory changes get worse? For some people, their symptoms may get worse over time. But this doesn’t happen to everyone.

• If you have thinking and memory problems that get worse and start to affect everyday life, including things like cooking, cleaning and dressing, then it’s important to speak to your specialist.
• They will be able to talk to you about useful things that you can do which could improve your symptoms.
• See the section ‘What happens when I speak to a specialist’.

If your thinking and memory problems are serious enough to affect your ability to carry out everyday tasks, your Parkinson’s specialist may diagnose you with Parkinson’s dementia. Not everyone who experiences thinking and memory changes goes on to develop Parkinson’s dementia.

• Parkinson’s dementia is very similar to another type of dementia, called dementia with Lewy bodies, and they share the same symptoms.
• These are the two main types of dementia that can affect people with Parkinson’s.
• People with Parkinson’s dementia and dementia with Lewy bodies may experience: • difficulty with visual and practical tasks.

For example, reading clocks or putting on trousers correctly • slowness in thinking, difficulty finding words, or trouble concentrating, which can affect how you talk or communicate with others • changes in thinking during the day – sometimes being alert but other times being confused • changes in sleeping patterns.

• For example, taking more naps during the day despite getting a normal amount of sleep, or nodding off during meal times • visual hallucinations (seeing something that is not there), and mistaking objects for other things.
• For example, a pile of clothes might look like a dog • being less engaged, or finding you do not have as much interest in the activities you used to enjoy (apathy) • anxiety, depression or feeling agitated You may find that symptoms fluctuate from hour to hour, and day to day.

What is the difference between Parkinson’s dementia and dementia with Lewy bodies? There are many different types of dementia. Parkinson’s dementia and dementia with Lewy bodies are the two types of dementia that are most likely to affect people living with Parkinson’s.

1. The main difference is the timing of when you start experiencing symptoms.
2. If you’ve had movement symptoms (such as tremor or stiffness) for at least one year before symptoms of dementia, specialists will often give a diagnosis of Parkinson’s dementia.
3. If you get dementia symptoms before or at the same time as movement symptoms, specialists will usually give a diagnosis of dementia with Lewy bodies.

These two conditions are sometimes grouped under an umbrella term: Lewy body dementia, which can be useful as the two conditions have similar symptoms. The term Lewy body dementia may also be used where it is not clear exactly when the thinking and memory problems started.

The causes and ways of managing symptoms in Parkinson’s dementia and dementia with Lewy bodies are the same. How is Parkinson’s dementia different from other dementias, such as Alzheimer’s? Parkinson’s dementia is different from Alzheimer’s disease, although some of the symptoms overlap. People with Alzheimer’s experience memory problems, which means they may repeat questions and conversations.

This is less common in Parkinson’s dementia. People with Alzheimer’s may also have trouble recognising their family and loved ones, which does not usually happen in Parkinson’s dementia. Thinking and memory changes are common in Parkinson’s. Around half of all people with Parkinson’s will experience some form of thinking and memory changes within 10 years of their diagnosis.

But this doesn’t mean you will go on to develop more serious problems. Everyone’s Parkinson’s is different. If you’re worried, you should speak to your Parkinson’s specialist. There are different ways to improve symptoms or even slow the progression of these changes. So it’s helpful to recognise them early.

See the section ‘Practical things to know about’ to learn about the support available for you and your family members. What causes memory and thinking changes? Parkinson’s leads to physical changes in the brain. As Parkinson’s progresses, more brain areas are affected.

1. One of the reasons for this is that there are lower levels of a brain chemical called acetylcholine, as well as dopamine.
2. Another cause is that proteins can build-up in the brain and affect different brain areas.
3. There is still a lot of research happening to understand the brain changes that cause thinking and memory symptoms in Parkinson’s.

Why do some people get these symptoms, and others don’t?

1. It is not clear why some people are affected by these changes and others aren’t.
2. Research shows that different things might increase the risk of developing thinking and memory changes if you have Parkinson’s.
3. These are called risk factors, and can include:

• Age, People who are older when they are diagnosed with Parkinson’s are more likely to develop these changes.
• Genetics, Researchers have found that some genes are linked with a higher risk of developing thinking and memory problems. One example is a gene called GBA.
• Sleep changes, Some types of sleep changes are linked with higher risk of developing thinking and memory symptoms. These include moving or shouting out during sleep.
• Depression, Whilst depression is common in Parkinson’s, research has shown that it is also linked with a higher risk of developing thinking and memory problems.
• Heart disease and stroke, These conditions can have an effect on the structure of the brain, which can affect thinking and memory. For this reason, lowering the risk of heart disease and stroke is also important in Parkinson’s.

These risk factors are highly variable between people. This means that if you have one or more of these risk factors, it doesn’t mean that you will definitely develop thinking and memory problems. A significant proportion of people living with Parkinson’s will never develop serious thinking and memory symptoms.

• Anxiety and depression, These symptoms can have a big impact on your ability to think, remember and process information properly. They can also affect your attention span and concentration. It’s important to talk to your specialist if you’re experiencing these symptoms so that you can get treatment.
• Poor quality sleep, If you’re feeling tired or run down, or you’re not sleeping well, this can affect your thinking, concentration and memory. Talk to your specialist if you are having trouble with your sleep, as they may be able to recommend things that may help.
• Hearing or visual loss, This will make it harder to respond to people and surroundings. Improving these through hearing aids, or treating visual loss, can improve thinking and memory symptoms.
• Being unwell for other reasons, Other issues like being constipated or having an infection can affect your thinking and memory and ability to concentrate. If you experience a sudden change in your thinking or memory, speak to your GP or Parkinson’s nurse to see if they can rule these things out.

See the section ‘Can I get involved in research?’ to find out about research into thinking and memory changes. If you’ve noticed changes in your thinking and memory, or are worried about developing symptoms, you should talk to your Parkinson’s specialist at your next appointment.

• It’s important to act early as there may be treatments that you can benefit from and things that you can do to improve your symptoms.
• In your appointment, your specialist will ask questions to understand more about the changes you are experiencing.
• You may find it helpful to keep a diary or record your symptoms to help you to explain what has been happening.

You may be asked to do some assessments, such as drawing or copying simple pictures, writing a sentence, or performing a short thinking and memory test. Your specialist may also carry out a physical examination, or arrange blood or urine tests. Sometimes, symptoms like confusion can be caused by other conditions.

1. So they will need to rule out any other potential causes.
2. They may also arrange a brain scan.
3. If possible, it is very helpful to bring someone who knows you well to your appointment.
4. This can be your partner, family member or friend.
5. This will be helpful for your specialist, as they can also give information about the changes they’ve noticed.

If your specialist diagnoses you with Parkinson’s mild cognitive impairment or Parkinson’s dementia, they may suggest a change to your current medication, or suggest starting a new medication for your thinking and memory. They may also suggest extra support for you or your family if that is needed, and you may be referred to a memory clinic for more support.

• What changes can I expect?
• What can I do to slow the progression of thinking and memory changes?
• What help can I get?
• What help is available for my partner or family?
• What things do I need to think about to plan ahead?

What to take to your appointment

• Notes of the changes you’ve noticed
• A list of your current medications
• Your questions
• Someone who knows you well, if possible

Even if you’ve already started experiencing thinking and memory changes, there are things you can do to help manage symptoms. It’s especially important for managing thinking and memory symptoms. Regular, moderate to vigorous physical activity may help improve your cognitive ability and help your brain to work more efficiently.

Do people with Parkinson’s think the same?

Thinking Changes & Dementia A broad spectrum of potential thinking and memory changes can occur in people with Parkinson’s disease (PD), including slowed thought processes, forgetfulness, confusion when doing routine tasks, lack of judgment, compulsive behaviors, paranoia, anxiety, hallucinations, delusions and personality changes.

1. When thinking changes are mild (known as mild cognitive impairment), symptoms often do not interfere with daily activities.
2. As PD advances, people can develop more profound changes in thinking.
3. Sudden changes in cognition are not typical of PD and should be evaluated for another cause, such as a urinary tract infection (or other infections) or medication side effects.

Promptly report any new or sudden changes in thinking or behavior to the healthcare team. Some changes to cognition can be reversible if the underlying cause is addressed. Thinking changes, also known and cognitive change, are common in Parkinson’s. There are different types, from mild to advanced types of cognitive change. Learn more about these changes, their signs and symptoms. At this time, there is no reliable tool to predict who will or won’t develop thinking changes (also known and cognitive changes) in PD.

As with motor symptoms, your loved one can have good days and bad days When evaluating your loved one for cognitive change, their PD doctor may interview them and their primary caregiver Your loved ones PD doctor may ask you to help apply specific strategies that can help address cognitive changes Consider making adjustments to your home to help minimize memory, vision and perception or orientation difficulties. Strategies include decluttering and simplifying living areas to reduce confusion and using low-level nighttime lighting to reduce visual misperceptions and confusion. Helping your loved one follow a structured, regular day-to-day routine can also help people with Parkinson’s-related dementia feel more comfortable

What looks like Parkinson’s but isn’t?

Several conditions fall into the category of Parkinson-like diseases. They can mimic Parkinson’s symptoms, such as tremors, slow movements, and stiffness. Examples of conditions similar to Parkinson’s include dementia with Lewy bodies, multiple system atrophy, and progressive supranuclear palsy.

While these conditions mimic Parkinson’s disease, each one has distinguishing features that can lead doctors to a correct diagnosis. The conditions may differ in the order in which symptoms appear or in the additional symptoms they cause that do not link to Parkinson’s disease. Some of the conditions have no specific treatment, but doctors may prescribe a combination of medications, such as carbidopa and levodopa (Sinemet), the main treatment for Parkinson’s disease.

This article will explain which conditions can mimic Parkinson’s disease, as well as the symptoms, diagnosis, and treatment of Parkinson’s disease. Several conditions can manifest one or more of the main symptoms of Parkinson’s disease. Those listed below are the most common :

Can you live to 90 with Parkinson’s?

Parkinson’s Disease Is a Progressive Disorder – Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that primarily affects movement and, in some cases, cognition. Individuals with PD may have a slightly shorter life span compared to healthy individuals of the same age group.

According to the Michael J. Fox Foundation for Parkinson’s Research, patients usually begin developing Parkinson’s symptoms around age 60 and many live between 10 and 20 years after being diagnosed. However, a patient’s age and general health status at onset factor into the accuracy of this estimate. Age is the greatest risk factor for this condition, but young-onset Parkinson’s disease, which affects people before age 50, accounts for between 10 and 20 percent of PD cases.

While there is no cure for Parkinson’s disease, many patients are only mildly affected and need no treatment for several years after their initial diagnosis. However, PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.

What is the cause of death for most Parkinson’s patients?

Abstract – Classified as the second most common neurodegenerative disorder associated with aging after Alzheimer’s disease, Parkinson’s disease (PD) is the most common movement disorder. In the last decade, despite advances in treatment, mortality rates linked with PD continued to reach significant figures.

1. Available studies have shown that compared with healthy controls, patients with PD are accompanied by high rates of premature death.
2. This is usually caused by factors such as pneumonia and cerebrovascular and cardiovascular diseases.
3. Recently, it has been demonstrated that a significant proportion of patients with PD die suddenly.

This is referred to as a sudden and unexpected death in PD (SUDPAR). Here, we focus on the magnitude of SUDPAR. Finally, it is important to learn more about SUDPAR for the implementation of effective prevention strategies. Keywords: Parkinson’s disease, Sudden death, Heart, Prevention

What is the hardest part about having Parkinson’s?

Anxiety and depression For many people, Parkinson’s affects brain chemistry—hindering the body’s ability to produce dopamine, norepinephrine, and serotonin. These chemicals determine mood, energy, and motivation, leaving many in a state of depression, which can be treated, but is certainly a struggle to live with.

What part of the brain is first affected in Parkinson’s disease?

The spread of Parkinson’s – Researchers have found that areas of the brain stem below the substantia nigra show cell loss in Parkinson’s. And cells in these areas have been found to contain clumps of alpha-synuclein protein, which may form before those in the substantia nigra. Adapted from work by Patrick J. Lynch’s, based on ‘The prion hypothesis in Parkinson’s disease: Braak to the future’, CC BY 2.5 These findings have led some researchers to suggest that Parkinson’s spreads up the spinal cord to the substantia nigra, Indeed, there is evidence that, for some, Parkinson’s may start in the gut and travel up the vagus nerve, which connects the gut and the brain, to the substantia nigra.

Stage 1. Parkinson’s begins in the lower brainstem and the olfactory system, Changes in the areas of the brainstem could be responsible for some of the earliest symptoms of Parkinson’s, such as constipation. While changes in the olfactory system are believed to be responsible for the loss of sense of smell. Stage 2. Progression of Parkinson’s sees it move further up the brainstem, travelling to the areas below the substantia nigra that are involved in pain, sleep and mood. Stage 3. At the beginning of Stage 3, Parkinson’s has entered the substantia nigra and Lewy bodies begin to form. Stage 4. By this stage, a large proportion of the dopamine-producing cells have been affected. Additionally, Parkinson’s has continued to spread to the limbic system, which is involved in emotion, motivation and long term memory. At stage 4, significant damage has been done to the olfactory system. Stage 5. Parkinson’s has spread to the mesocortex — the area of the brain between the limbic system and outermost part of the brain known as the cerebral cortex. By this stage, Parkinson’s has begun to invade the neocortex, which is involved in higher-order brain functions such as perception, cognition and language. It spreads in all directions into the structures of the temporal, parietal, and frontal lobes, Stage 6. At this late stage of the condition, changes in the neocortex start to affect the memory and sensory areas in the brain.

While there is still some debate over the origin of Parkinson’s, and even competing and more complex theories about the spread of Parkinson’s, attempts to understand how and why different areas of the brain are involved in the motor and non-motor symptoms are helping in the development of better treatments.

What part of the brain is most affected in Parkinson’s disease?

The area of the brain most affected in the development of Parkinson’s is the substantia nigra pars compacta, a tiny area in the midbrain.