Original Article:http://www.mayoclinic.com/health/parkinsons-disease/DS00295/DSECTION=1
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Parkinson's disease

ARTICLE SECTIONS

 Introduction
 Signs and symptoms
 Causes
 Risk factors
 When to seek medical advice
 Screening and diagnosis
 Complications
 Treatment
 Self-care
 Coping skills


Introduction
Parkinson's disease is a disorder that affects nerve cells in the part of the brain controlling muscle movement.
People with Parkinson's disease often experience trembling, muscle rigidity, difficulty walking, problems with balance and slowed movements. These symptoms usually develop after age 60, although some people affected by Parkinson's disease are younger than age 50.
Parkinson's disease is progressive, meaning the signs and symptoms become worse over time. But although Parkinson's disease may eventually be disabling, the disease often progresses gradually, and most people have many years of productive living after a diagnosis.
Furthermore, unlike other serious neurological diseases, Parkinson's disease is treatable. One treatment approach is medications. Another involves an implanted device that stimulates the brain. Other approaches involve surgery. Meanwhile, research into other treatments continues.

By Mayo Clinic Staff
Apr 12, 2007
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Signs and symptoms
The earliest symptom of Parkinson's disease can be as subtle as an arm that doesn't swing when you walk, a mild tremor in the fingers of one hand or soft, mumbling speech that's difficult to understand. You may lack energy, feel depressed or have trouble sleeping. Or you may notice that it takes you longer to shower, shave, eat or do other routine tasks.
Other signs and symptoms of Parkinson's disease may include:
 Tremor. This often starts with a slight shaking in your hand or even one finger. Sometimes hand tremor causes a back-and-forth rubbing of your thumb and forefinger known as pill-rolling. Tremor may also develop in your legs. These signs may occur on one or both sides of your body and may be more noticeable when you're under stress. Although tremor can be very distressing, it's usually not disabling and often disappears when you're sleeping. Many people with Parkinson's disease do not experience substantial tremor.
 Slowed motion (bradykinesia). Over time, Parkinson's disease may cause a slow, shuffling walk with an unsteady gait and stooped posture. And leg muscles may freeze up, making it hard to resume normal movement. This is especially distressing because it can make performing the simplest tasks difficult and time-consuming.
 Rigid muscles. Muscle stiffness (rigidity) often occurs in your limbs and neck. Sometimes the stiffness can be so severe that it limits the size of your movements and causes pain.
 Impaired balance. Your posture may become unstable as a result of Parkinson's disease. Often this problem remains minor for many years.
 Loss of automatic movements. Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson's disease, these acts tend to be diminished and even lost. Some people may develop a fixed staring expression and unblinking eyes. Others may no longer gesture or seem animated when they speak.
 Impaired speech. Many people with Parkinson's disease have some trouble speaking, and their voices often become monotonous and very soft. This may be a special problem for older adults because the soft voice of a person with Parkinson's disease may not be audible to a spouse with poor hearing.
 Difficulty swallowing. This may develop in the later stages of the disease, but except in rare cases, most people who have trouble swallowing can continue to eat on their own.
 Dementia. A small percentage of people with Parkinson's develop this mental disorder — which affects the ability to think, reason and remember — late in the course of the disease. Although it's often associated with Alzheimer's disease, dementia can also occur with other conditions. In Parkinson's, the onset of dementia is often marked by slowed thought processes and problems with concentration.


Causes
In the nearly 200 years since Parkinson's disease was first described, researchers have come to understand some of the processes of this complex disorder.
They now know that many of the signs and symptoms of Parkinson's disease develop when certain nerve cells (neurons) in an area of the brain called the substantia nigra are damaged or destroyed. Normally, these nerve cells release dopamine — a chemical that transmits signals between the substantia nigra and another part of the brain, the corpus striatum. These signals cause your muscles to make smooth, controlled movements.
Everyone loses some dopamine-producing neurons as a normal part of aging. But people with Parkinson's disease lose half or more of neurons in the substantia nigra. Although other brain cells also degenerate, the dopamine-containing cells are critical for movement and so take center stage. Just what causes this is a subject of intense research. Scientists believe Parkinson's disease may result from a combination of genetic and environmental factors. Certain drugs, diseases and toxins also may cause symptoms similar to those of Parkinson's disease.
Genetic factors
Scientists believe that genes contribute to the development of Parkinson's, but it's not yet clear whether heredity plays a major or minor role in this disease.
It has been known for some time that people with a first-degree relative with Parkinson's disease, such as a parent, child or sibling, are more likely to develop the disease than are people without a family connection. Although the risk among first-degree relatives is small — less than 5 percent — it nevertheless suggests a genetic link. For that reason, scientists have focused on the rare families in which several people have Parkinson's — and that research has provided insights into the cause of the disease in general.
In families with Parkinson's, researchers have identified two types of genetic causes. One involves abnormalities of alpha-synuclein, a protein that accumulates in degenerating neurons in people with Parkinson's. The other involves problems with the systems in the body that dispose of unwanted proteins. It now appears that both of these factors play a key role in the development of Parkinson's in all people.
Environmental factors
People with unusual exposure to herbicides and pesticides are more likely to develop Parkinson's disease than are people who don't have this exposure. Researchers haven't yet been able to connect a specific herbicide or pesticide to the disease.
Medications
A number of drugs taken for long periods of time or in excessive dosages can cause symptoms of Parkinson's disease. These include medications such as haloperidol (Haldol) and chlorpromazine (Thorazine), which are prescribed for certain psychiatric disorders, as well as drugs used to treat nausea, such as metoclopramide (Reglan, Metoclopramide HCL). The epilepsy drug valproate (Depakene) also may cause some of the features of parkinsonism, especially severe tremor.
These medications do not cause Parkinson's disease, however, and symptoms disappear when the drugs are stopped.


Risk factors
Age is one of the main risk factors for Parkinson's disease. Although the disease can rarely affect adults in their 20s, it ordinarily starts in middle or late life. The risk continues to increase with age. Some researchers theorize that people with Parkinson's disease may have neural damage from genetic or environmental factors that becomes worse over time.
Other risk factors include:
 Heredity. Having one or more close relatives with Parkinson's increases the chances that you'll also develop the disease, although your risk is still less than 5 percent.
 Sex. Men are more likely to develop Parkinson's disease than women are.
 Exposure to pesticides and herbicides. Ongoing exposure to herbicides and pesticides puts you at slightly increased risk of Parkinson's. You also have a higher risk if you're involved in farming, live in a rural area or drink well water.
 Reduced estrogen levels. Reduced estrogen levels may increase the risk of Parkinson's disease. This means that menopausal women who receive little or no hormone therapy (HT) and those who have had hysterectomies may be at higher risk. Menopausal women using HT appear to have a decreased risk. But not all effects of HT are positive. Taking HT as a combination therapy — estrogen plus progestin — can increase your risk of serious side effects. Work with your doctor to evaluate the options and decide what's best for you.
When to seek medical advice
See your doctor if you have any of the symptoms associated with Parkinson's disease — not only to diagnose the illness but also to rule out other causes for your problem. For instance, tremor is often an early sign of Parkinson's disease yet the most common type of tremor, known as essential tremor, isn't caused by Parkinson's.
Although Parkinson's disease can sometimes be difficult to pin down, getting an accurate diagnosis is the key to starting appropriate treatment that may help delay or manage symptoms for years.
Screening and diagnosis
Because no definitive tests exist for Parkinson's, the disease can be difficult to diagnose, especially in the early stages. What's more, signs and symptoms of Parkinson's disease — including gait changes, trembling and trouble speaking or writing — may be dismissed as the effects of aging, particularly in older adults with the disease. At the same time, doctors sometimes miss Parkinson's disease in young people because they may believe it mainly affects older adults.
A diagnosis of Parkinson's disease is based on your medical history, observations of your signs and a neurological examination. As part of your medical history, your doctor will want to know about any medications you take and whether you have a family history of Parkinson's.
The neurological examination includes an evaluation of your walking, coordination and some simple tasks of dexterity. Your doctor may also notice subtle signs of parkinsonism — such as reduced facial expressions, a lack of gestures or a subtle tremor — when he or she takes your history.



Complications
As many as half the people with Parkinson's disease develop depression. In some cases, depression may occur months or even years before Parkinson's disease is diagnosed. Although physical limitations resulting from Parkinson's disease can be frustrating and stressful, depression in someone with Parkinson's isn't usually a reaction to physical disability. Instead, it more likely arises from underlying brain changes associated with the disease itself.
In addition, some people with Parkinson's disease eventually develop dementia, a condition that can include memory loss, impaired judgment and personality changes.
Medications for Parkinson's disease also may cause a number of complications, including involuntary twitching or jerking movements of the arms or legs (dyskinesia), hallucinations, sleepiness, and a drop in blood pressure when standing up (orthostatic hypotension).
Other complications of Parkinson's disease may include:
 Difficulty chewing and swallowing. In the later stages of the disease, the muscles you use to swallow may be affected, making eating more difficult.
 Urinary problems. Parkinson's disease may cause either urinary incontinence or urine retention. Certain medications used to treat the disease, especially anticholinergic drugs, also can make it difficult to urinate.
 Constipation. Many people with Parkinson's disease develop constipation because the digestive tract works more slowly. Constipation may also be a side effect of medications used to treat the disease.
 Sleep problems. People with Parkinson's disease often have trouble falling asleep and may wake up frequently throughout the night. They may also experience restless sleep and even act out their dreams (rapid eye movement sleep behavior disorder).
 Sexual dysfunction. Some people with Parkinson's disease may notice a decrease in sexual desire (libido). This may stem from a combination of psychological and physical factors, or it may be the result of physical factors alone.


Treatment

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Parkinson's surgery


For many people with Parkinson's, the initial response to treatment can be dramatic. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms can usually still be fairly well controlled. In addition to medications, your doctor may also recommend that you try lifestyle changes, such as physical therapy, a healthy diet and exercise.
Physical therapy, especially, can be extremely helpful for people with Parkinson's disease — both in the early stages and later, as the disease progresses. It can help improve mobility, range of motion and muscle tone. Although specific exercises can't stop the progress of the disease, improving muscle strength can help you feel more confident and capable. A physical therapist can also work with you to improve your gait and balance. For many people, working with a speech pathologist can help improve problems with speaking and swallowing.
When lifestyle changes are no longer enough, your doctor will likely recommend certain medications, either alone or in combination.
Medications
Medications can help manage problems with walking, movement and tremor by increasing the brain's supply of dopamine. Your medication needs may change over time, and the drug dosage and timing may require adjustment. For these reasons, you and your doctor will work together to design a program that best suits your needs, especially as the disease progresses. The medications used to treat Parkinson's disease include:
 Levodopa and carbidopa. Since its introduction in the 1960s, levodopa has been considered the gold standard drug therapy for Parkinson's disease. Levodopa is a natural substance found in plants and animals. It's a precursor to dopamine that, when given to people with Parkinson's, is converted into dopamine by nerve cells in the brain. The increase in dopamine may reverse many of the disabling symptoms of Parkinson's disease.
Treatment with dopamine itself isn't possible, because dopamine doesn't cross the body's blood-brain barrier. This is a meshwork of tightly packed cells in the walls of the brain's capillaries that screen out certain substances. Levodopa, on the other hand, does cross this barrier, but only a small amount actually reaches the brain. Today levodopa is combined with another drug, carbidopa (Sinemet), that causes more levodopa to get to the brain and helps reduce some of the side effects of this therapy.
During early treatment, side effects from carbidopa-levodopa therapy are usually not a major problem. However, the drug works less evenly and predictably as the disease progresses. As a result, some people may experience involuntary movements (dyskinesia), primarily when the medication is having its peak effects. The length of time for which each dose is effective may begin to shorten (wearing-off effect), leading to more frequent doses.
Another problem that may develop with long-term carbidopa-levodopa usage, the on-off effect, may cause Parkinson's-related movement problems to appear and disappear suddenly and unpredictably. Other side effects may include hallucinations and a drop in blood pressure when standing (orthostatic hypotension). Some people may experience nausea with carbidopa-levodopa therapy. Still, carbidopa-levodopa typically allows people with Parkinson's disease to extend the time they're able to lead relatively normal lives and in many cases is effective for a number of years.
 Dopamine agonists. Unlike levodopa, these drugs aren't changed into dopamine. Instead, they mimic the effects of dopamine in the brain and cause neurons to react as though sufficient amounts of dopamine were present. Dopamine agonists are used both as adjuncts to carbidopa-levodopa therapy and also initially in early Parkinson's disease, especially in younger adults.
This class of drugs includes bromocriptine (Parlodel), apomorphine (Apokyn), pramipexole (Mirapex) and ropinirole (Requip). Bromocriptine is now prescribed less frequently than in years past because it may cause inflammatory reactions in your lungs or heart valves. Also, in light of studies showing that another dopamine agonist, pergolide (Permax), increases the risk of heart valve disease, the FDA withdrew that drug from the U.S. market. There is no evidence of similar problems with other dopamine agonists approved for treating Parkinson's disease.
The side effects of dopamine agonists are similar to those of carbidopa-levodopa, although they're less likely to cause involuntary movements and more likely to cause hallucinations or sleepiness. These medications may also increase your risk of compulsive behaviors such as hypersexuality, compulsive gambling and compulsive overeating. If you are taking these medications and start behaving in a way that's out of character for you, talk to your doctor.
Avoid dopamine agonists if you already have experienced hallucinations or confusion associated with Parkinson's disease.
 Selegiline (Eldepryl). This drug, used with or without carbidopa-levodopa therapy, helps prevent the breakdown of both naturally occurring dopamine and dopamine formed from levodopa. It does this by inhibiting the activity of the enzyme monoamine oxidase B (MAO-B) — the enzyme that metabolizes dopamine in the brain. Research has shown that selegiline may delay the need for carbidopa-levodopa for about a year, and when taken with carbidopa-levodopa, may enhance the drug's effectiveness. At one time it was thought that this drug might slow the progression of Parkinson's disease, but this now appears not to be the case. Toxic reactions have occurred in some people who took selegiline with the narcotic drug Demerol.
 Catechol-O-methyltransferase (COMT) inhibitors. These drugs prolong the effect of carbidopa-levodopa therapy by blocking an enzyme that breaks down dopamine. Tolcapone (Tasmar) is a potent COMT inhibitor that easily crosses the blood-brain barrier. But because Tasmar has been linked to liver damage and liver failure, the drug is normally used only in people who aren't responding to other therapies. Entacapone is a COMT inhibitor that shares some of the properties of tolcapone but doesn't cross into the brain. It may help manage fluctuations in the response to carbidopa-levodopa in people with Parkinson's disease. Entacapone doesn't cause liver problems and is now combined with carbidopa and levodopa in a medication called Stalevo.
 Anticholinergics. These drugs were the main treatment for Parkinson's disease before the introduction of levodopa. In general, they help control tremor in the early stages of the disease. Even so, they're only mildly beneficial and sometimes the benefits are offset by side effects such as dry mouth, nausea, urine retention — especially in men with an enlarged prostate — and severe constipation.
Anticholinergics can also cause mental problems, including memory loss, confusion and hallucinations. A number of anticholinergic drugs, such as trihexyphenidyl and benztropine (Cogentin), are available. The antihistamine diphenhydramine (Benadryl) and antidepressants such as amitriptyline work much like anticholinergics, and doctors may use them in older adults who can't tolerate anticholinergics themselves.
 Amantadine. Doctors may prescribe this antiviral drug alone to provide short-term relief of mild, early-stage Parkinson's disease. Amantadine may also be added to carbidopa-levodopa therapy for people in the latter stages of Parkinson's disease, especially if they have problems with involuntary movements induced by carbidopa-levodopa (dyskinesia). Side effects include swollen ankles and a purple mottling of the skin.
 Coenzyme Q10. Small structures within your cells called mitochondria manufacture substances that are essential for the cells to work normally. One of these substances is coenzyme Q10, which transports electrons during cellular respiration — the process by which cells get their energy from oxygen. People with Parkinson's disease tend to have low levels of coenzyme Q10, and research has suggested that coenzyme Q10 supplements may slow the progression of early-stage Parkinson's disease. You can buy coenzyme Q10 without a prescription in drug and natural food stores, but not all products may be equally effective. Talk with your doctor before taking this supplement.


Surgery
Doctors once commonly used surgical procedures to treat Parkinson's disease. But with the advent of levodopa and other drug therapies, surgical approaches have been re-evaluated. The following procedures may be an option when symptoms can't be controlled with medications:
 Thalamotomy. This procedure has been used for years to reduce tremor in people with Parkinson's disease, although it's not generally helpful for other aspects of parkinsonism. Thalamotomy involves the destruction of small amounts of tissue in the thalamus — a major brain center for relaying messages and transmitting sensations. The surgery can cause slurred speech and sometimes lack of coordination when performed on both sides of the brain. For that reason, it's usually done on only one side of the brain, with the benefits confined to one side of the body.
 Pallidotomy. There has been renewed interest in pallidotomy since improved imaging techniques have allowed surgeons to pinpoint the areas to be treated with greater precision. In this procedure, an electric current is used to destroy a small amount of tissue in the pallidum (globus pallidus), a part of the brain responsible for many symptoms of Parkinson's disease. Pallidotomy may improve tremor, rigidity and slowed movement by interrupting the neural pathway between the globus pallidus and the thalamus. It's especially helpful in countering the involuntary movements caused by drug therapy.
Although pallidotomy has been helpful for some aspects of Parkinson's disease in certain people, it's not a cure and in many cases, benefits may not last. In addition, the surgery carries a number of risks, including slurred speech, disabling weakness and vision problems, especially when performed on both sides of the brain.
 Deep brain stimulation. A brain implant device is now widely used to help control many of the symptoms of Parkinson's disease. The deep brain stimulator consists of a pacemaker-like unit implanted in the chest wall that transmits electric impulses through a wire to tiny electrodes inserted deep within the brain. The specific brain center that is targeted, the subthalamic nucleus, controls many aspects of motor function.
Rarely, this procedure may cause brain hemorrhage and stroke-like problems. Infection is also a risk of deep brain stimulation, and may in some cases require parts of the device to be replaced. In addition, the unit's battery beneath the skin of the chest wall must be surgically replaced every few years. Deep brain stimulation isn't beneficial for people who don't respond to carbidopa-levodopa. And the device isn't for people who already have serious difficulty with thinking and memory because it may make those symptoms worse.



Self-care
If you've received a diagnosis of Parkinson's disease, you'll need to work closely with your doctor to find a treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain lifestyle changes also may help make living with Parkinson's disease easier.
Healthy eating
Eat a nutritionally balanced diet that contains plenty of fruits, vegetables and whole grains. These foods are high in fiber, which is important for helping prevent constipation.
If you take a fiber supplement, such as psyllium powder, Metamucil or Citrucel, be sure to introduce it gradually and drink plenty of fluids daily. Otherwise, your constipation may become worse. If you find that fiber helps your symptoms, use it on a regular basis for the best results.
Exercise
Regular exercise is extremely important if you have Parkinson's disease. It helps improve mobility, balance, range of motion and even emotional well-being. Your doctor or physical therapist may recommend a formal exercise program, but any physical activity, including walking, swimming or gardening, is beneficial. Weight-bearing exercises, such as walking, jogging and dancing, may be helpful.
Keep in mind that your energy level may go up and down, and you'll sometimes need to pace yourself. If you're tired, try doing one part of your routine at one time of day and adding another segment later. Choose a time to exercise when your medicines are working well and you feel strong.
Be sure to stretch before and after you exercise. Stretching warms up your muscles, helps prevent stiffness, and improves your flexibility and balance.
Walking with care
Parkinson's disease can disturb your sense of balance, making it difficult to walk with a normal gait. These suggestions may help:
 If you notice yourself shuffling, slow down and check your posture. It's best to stand up straight with your head over your hips and your feet eight to 10 inches apart.
 Buy a good pair of walking shoes. Avoid running shoes.
 Practice taking long steps and exaggerate lifting your legs and swinging your arms.
 If you become stuck in place — known as freezing ¾ rock gently from side to side or pretend you're stepping over an object on the floor.
Avoiding falls
In the later stages of the disease, you may fall more easily. That's because Parkinson's disease affects the balance and coordination centers in the brain. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:
 Ask your doctor or physical therapist about exercises that improve balance, especially tai chi. Originally developed in China more than 1,000 years ago, tai chi uses slow, graceful movements to relax and strengthen muscles and joints.
 Wear rubber-soled shoes. They're less likely to slip than are shoes with leather soles.
 Remove all area rugs from your home and make sure carpeting is secured firmly to the floor.
 Install handrails, especially along stairways.
 Keep electrical and telephone cords out of the way.
 Install grab bars around your tub and beside the toilet.
 Make sure you can reach the telephone from your bed and carry a cordless phone with you during the day.
Dressing
Dressing can be the most frustrating of all activities for someone with Parkinson's disease. The loss of fine motor control makes it hard to button and zip clothes, and even to step into a pair of pants. A physical therapist can point out techniques that make daily activities easier. These suggestions also may help:
 Allow plenty of time so you don't feel rushed.
 Lay clothes nearby.
 Choose clothes that you can slip on easily, such as sweat pants, simple dresses or pants with elastic waistbands.
 Look for clothes and shoes with fabric fasteners, such as Velcro, or replace buttons on clothes you have with fabric fasteners.
Speaking
Even in the early stages of Parkinson's disease, your voice may become very soft or hoarse. To communicate more easily:
 Face the person you're talking to, and deliberately speak louder than you think is necessary.
 Practice reading or reciting out loud, focusing on your breathing and on having a strong voice.
 Speak for yourself — don't let others speak for you.
 Consult a speech-language pathologist who is trained to treat people with Parkinson's disease.



Coping skills
Living with any chronic illness can be difficult, and it's normal to feel angry, depressed or discouraged at times. Parkinson's disease presents special problems because it can cause chemical changes in your brain that make you feel anxious or depressed. Furthermore, Parkinson's disease can be profoundly frustrating, especially in the advanced stages when ordinary tasks take longer to accomplish and walking, talking and even eating become more difficult.
Some of the following suggestions may help you deal with the stress of living with Parkinson's disease:
 Learn all you can about your illness. Find out how the disease progresses, your prognosis, and your treatment options and their side effects. The more you know, the more active you can be in your own care. In addition to talking to your health care team, look for books and information on the Internet, including the Web sites of various Parkinson's disease organizations.
 Be proactive. Although you may often feel anxious or discouraged, don't let others — including your family and your doctors — make important decisions for you. Take an active role in your treatment.
 Maintain a strong support system. Strong relationships are crucial in dealing with chronic illnesses. Although friends and family can be your best allies, the understanding of people who know what you're going through can be especially helpful. Support groups aren't for everyone, but for many people, they can be a good resource for practical information about Parkinson's disease. You may also find that you develop lasting bonds with people who are going through the same experiences as you. Support groups also exist for the families of people with Parkinson's disease. To learn about support groups in your community, talk to your doctor, a Parkinson's disease social worker or a local public health nurse. Or contact the National Parkinson Foundation or the American Parkinson's Disease Association.
 Minimize work-related stress. A diagnosis of Parkinson's disease doesn't mean you have to stop working. Many people with the disease continue to hold either full- or part-time jobs. But you may need to approach work differently. Start by breaking your job into individual tasks. Then consider whether your symptoms will affect your ability to perform each task.
Next, try to create a schedule that allows you to do the most challenging assignments when you're at your peak. In some cases, you may consider telecommuting, working part-time or even changing jobs. Keep in mind that the Americans with Disabilities Act (ADA) requires your employer to make reasonable accommodations to help you function more easily on the job. These accommodations include modified work schedules, reassignment to vacant positions, job restructuring, and the use of special equipment or devices. For more information about the ADA, call the toll-free ADA information line at (800) 514-0301.
Although you may not feel comfortable talking about your illness, in many cases it's best to be candid with your supervisor. That way, he or she can work with you to make the adjustments necessary to meet your needs. On the other hand, you're under no legal obligation to disclose your condition to your employer as long as you can do your job.
 Maintain good communication with your partner. It's extremely important for couples to be open about their feelings, especially when it comes to living with Parkinson's disease. The disease may change your life and the lives of your loved ones in a number of ways. It's best if you can talk honestly about these changes. For instance, if you're no longer able to work full time, there may be financial issues that need to be resolved. The amount of care a person with Parkinson's disease needs is also often an issue. Because it may take you longer to do ordinary tasks, your partner might want to help. But most people with Parkinson's disease like to remain as independent as possible. You'll need to let your partner know when you need help and when you don't.
Sometimes couples also experience sexual problems. Parkinson's disease makes it more difficult to move easily, which can affect intimacy. In addition, some men with Parkinson's disease may have problems with impotence, and women may experience decreased desire (libido). This may be the result of anti-Parkinson medications or of the disease itself. But these problems can often be helped.
In addition, try to schedule time together when your medications are at their peak and you're less likely to be troubled by symptoms. And keep in mind that intercourse is only one way to be intimate. Just cuddling or holding each other often can deepen a relationship and make it more emotionally satisfying.
Most important, try to talk frankly about your feelings and concerns. Repressed feelings can be harmful to your immediate well-being and long-term health. If necessary, discuss your problems with your doctor or counselor.
 Be honest with children. If you have children, don't try to hide the diagnosis from them. Children can usually sense when something is wrong in the family, and the anxiety and fear of not knowing is often harder on them than knowing the truth. In addition, children need to be reassured that their mother or father will be all right and will still be there for them. Answering your children's questions honestly can help them cope.